After years of success in the fight against malaria, resulting in a major decline in cases and deaths, drug resistance has emerged as a new challenge. This calls for a change in strategy in dealing with a disease that still kills over 400,000 people yearly.
Children are particularly vulnerable -- in 2015, almost 70% of all malaria deaths were children under five. The theme of World Malaria Day 2017 is "End Malaria for Good".
We have witnessed huge advances in malaria prevention, including new methods of testing, the widespread distribution of insecticide-treated nets and the introduction of artemisinin-based combination therapies (ACTs) which have contributed significantly to major reductions in malaria cases and deaths in the Greater Mekong Sub-region (GMS) that encompasses Cambodia, Laos, Myanmar, Thailand, Vietnam and China's Yunnan province.
The World Health Organisation reports that the six GMS countries cut their malaria case incidence by an estimated 54% between 2012 and 2015. Malaria death rates fell by 84% over the same period. Yet, the emergence of drug resistance has clouded that success and it will now require a change in strategy to completely eliminate the disease in the Asia-Pacific region.
Migrant and mobile populations (MMPs) are considered as highly vulnerable to malaria for a variety of reasons. The GMS region, which is home to some 300 million people, hosts an estimated 4 million cross-border migrants, mainly in Thailand. Many others migrate internally in search of work.
Migrants' vulnerability to the disease is linked to the fact they often live and work in forest-related industries, agriculture or construction in remote rural areas, where the anopheles mosquito that carries the malaria parasite still exists.
In addition, due to their lack of official status and their frequent exclusion from public health systems, they may be less aware of malaria and have less access to health services than host communities. Their biological immunity may also be lower if they come from non-forest areas where there is no malaria. And they often live in poor housing with few mosquito screens or bed nets.
While malaria elimination efforts need to target all at-risk populations, the International Organisation for Migration (IOM) believes the vulnerability of MMPs in the region could be dramatically reduced through better outreach, education, protection, service provision and surveillance by national health systems and their implementing partners.
IOM is working across the GMS with migrants, host communities, work sites, employers and governments to improve access for MMPs to malaria diagnosis and prevention services. But more needs to be done.
Governments and society as a whole need to rethink a commonly held view that MMPs are "a problem that needs to be addressed". They are sometimes excluded because we often fail to fully understand their situation and don't always know where, when or how they can best be reached.
The problem which needs to be addressed is therefore the failure of our health systems to adequately reach migrants.
The WHO recognised this challenge in 2008, when it called on its member states and partners to advance migrant-friendly practices and policies to achieve universal health coverage -- on the grounds that healthy migrants are necessary for healthy societies.
IOM is working with WHO, The Global Fund (for Aids, TB and malaria), the Roll Back Malaria Partnership and other partners to combat malaria on World Malaria Day 2017 under the slogan "End Malaria for Good".
We believe that in order to move forward we now need to rapidly improve the tools, methodologies and practices for assessing and understanding local mobility dynamics and how they affect transmission of malaria.
We also need to link malaria prevention, treatment and surveillance data and initiatives across migration routes and borders. Cross-border cooperation will show us where MMPs are currently being missed.
In addition, we need to strengthen multi-sectoral engagement to combat malaria beyond health to include relevant public sector bodies like immigration, labour ministries and private sector players, notably forest product companies.
Finally we must promote and encourage migrant inclusion in national/state/provincial health service planning and all malaria services in all six GMS countries.
These initiatives reflect the four-pillar approach that IOM recommends for combating malaria worldwide. They are: the introduction of migrant-inclusive policies and legal frameworks; the creation of migrant-sensitive health systems and programmes; the establishment of partnerships, networks and multi-country frameworks; and better monitoring of migrants' health.