Nepal’s fight against malaria is complicated by the ongoing presence of the disease in India, experts say, as the latest report by the World Health Organisation (WHO) shows a sharp increase in locally transmitted cases and two deaths in Nepal in 2024.

Besides the two deaths, 37 people were infected with locally transmitted malaria in Nepal last year, according to the WHO report.

The “World malaria report 2025” by the UN’s apex health body published on Thursday shows that cases of indigenous malaria or locally transmitted malaria rose by 146.7 percent in 2024 compared to 2023, when only 15 cases of indigenous malaria were detected and no one had died.

What has alarmed doctors as well as entomologists is that a more than two-fold rise in locally transmitted cases and deaths could hinder the country’s efforts to achieve elimination status for the disease, which is potentially fatal.

“If there are deaths despite the availability of testing and effective treatment throughout the country, it is a serious issue,” said Dr Yasho Vardhan Pradhan, former director general at the department of Health Services. “How is it possible to achieve the elimination goal, if deaths and new cases of locally transmitted malaria keep rising ?”

Malaria is caused by Plasmodium parasites carried by female Anopheles mosquitoes, according to the WHO.

In indigenous cases, infected persons do not have a history of travel to malaria-affected countries or areas. Imported cases refer to infections in people who have travelled to disease-hit areas or countries.

Nepal missed its malaria elimination target multiple times in the past—2026, 2023, and 2020.

The new deadline to achieve elimination status has now been postponed to 2030.

To achieve the elimination status, a country must bring indigenous cases or local transmission of the disease to zero, achieve zero deaths, and sustain zero cases for three consecutive years, according to the UN health body.

Entomologists say they are sceptical about Nepal’s ability to eliminate the disease even in the next five years, as the country faces old and new challenges. Open borders, global movements and mosquitoes moving to higher altitudes due to global warming pose challenges to the elimination goal, they said.

They added that due to proximity, and an open and porous border between Nepal and India, and unregulated movement of people between the two countries, it will be impossible to eliminate malaria in Nepal until the disease is eliminated in India.

“Additional efforts from all agencies concerned, and financial resources, are needed if we are to achieve the targets,” said Sishir Panta, an entomologist. “Along with this, cross-border collaboration is crucial in the fight against malaria.”

Although Bhutan borders India, its controlled crossings have helped it stay malaria-free for the past three years. Bhutan reported no malaria cases in 2022, 2023, and 2024, and is now eligible for malaria-free status.

The WHO report also highlighted cross-border challenges, as population movement across the porous Nepal-India border continues to sustain residual transmission and complicate control measures.

“Malaria transmission remains localised across India and Nepal, where outbreaks and cross-border population movement have continued to challenge elimination efforts,” reads the report.

“These patterns highlight the importance of enhanced cross-border collaboration, targeted subnational responses and strengthened surveillance systems to address remaining transmission and sustain progress towards elimination.”

Of the total locally transmitted cases reported last year, 92.5 percent were male and only 7.5 percent were female, which indicates that migrant labourers travelling to India are at high risk of infection. Officials say that of the total imported cases, over 80 percent originated in India.

Despite multiple challenges in eliminating the disease, the WHO report shows that India and Nepal are on track to achieve the global technical strategy target of at least a 75 percent reduction in incidence by 2025, as these countries have already achieved reductions exceeding 70 percent by 2024.