Newsweek丨From 30 million cases to 0 confirmed, how can China be free from malaria?

  Bai Yansong: There are 20 days to say goodbye to us in 2021. It also reminds us that the tug of war between humans and the new crown virus has been two years, and the new crown virus is not only annoying itself, but also It brings all aspects of the impact.

On Monday, the World Health Organization released a report that affected by the new crown epidemic, the global malaria diagnosis rate fell by 4.3% last year, and the number of malaria deaths in sub-Saharan Africa increased by 13%.

WHO Director-General Tan Desai said that if action is not accelerated, the disease will soon reappear in many parts of the world.

In contrast, on June 30 this year, WHO has just certified that China has officially eliminated malaria. From the peak of 30 million people with the disease, there are now zero reports in the local area. How do we eliminate malaria? Malaria?

At this moment in the fight against the new coronavirus, what experience does China offer to eliminate malaria?

"Newsweek" this week focuses on: infectious diseases that have been eliminated in China.

  Mosquitoes in Yunnan, aiming to avoid "malaria"

  Dong Xueshu, a mosquito expert from the Yunnan Provincial Institute of Parasite Control: Painting mosquitoes is not painting pictures, nor is it sketching or art, but painting like mosquitoes.

What are the structures, what parts are there, and where are the important features?

After the painting is drawn, people will know whether it is this kind of mosquito or not. The difference between each mosquito is very small, and it is generally impossible to take pictures with photography.

  When it comes to painting mosquitoes, 86-year-old Dong Xueshu always has a lot to say.

He is a retired expert of the Yunnan Institute of Parasitic Disease Control.

Since the age of 23, he has been "cooperating" with mosquitoes, the main vector of malaria.

  Dong Xueshu, a mosquito expert from the Yunnan Institute of Parasite Control: I graduated from Guiyang Medical College in 1953 with a major in infectious diseases and insects. After graduation, I was assigned to the Yunnan Epidemic Prevention Station.

At that time, because of the serious malaria epidemic in the border areas, many houses were deserted in Menghai County of Xishuangbanna.

The so-called young people and middle-aged people rarely exceed 1.6 meters, and they are all 1.5 meters and 1.4 meters.

After malaria has a fever, especially what we call a blood disease, the spleen becomes enlarged, and the children's stomachs are very big.

  In the 1940s and 1950s, more than 350 million of our country’s 450 million people were threatened by malaria, and more than 300,000 people died of malaria every year.

With the exception of the Qinghai-Tibet Plateau, almost all malaria has been prevalent throughout the country.

This disease is also called "swinging a pendulum" because the patient will have a high fever, chills, and fight all over the body when it comes on.

Malaria is caused by the parasite of "Plasmodium". When a mosquito sucks the blood of a person with malaria, it will infect the parasite. When it sucks blood again, it will inject the parasite into another person.

At that time, the domestic medical community only knew that malaria was transmitted by Anopheles mosquitoes, while more than 300 kinds of mosquitoes were breeding in the hot and humid Yunnan.

Finding out which one is the culprit is the most urgent task for Dong Xueshu and his friends.

  Dong Xueshu, a mosquito expert at the Yunnan Provincial Institute of Parasite Control: The equipment at that time was very simple, catching mosquitoes.

There is a kind of mosquito tube, just suck it in. After anesthesia, start dissecting it.

Take the salivary glands out of the mosquito’s neck and check under the microscope for the presence of malaria parasites.

If there is, it proves that this mosquito is spreading malaria. There are dozens of species of Anopheles and Guang Menghai, all of which were used for anatomy.

In about a month and a half, the Anopheles minus we are talking about was discovered.

  At that time, there were only five or six colleagues working with Dong Xueshu.

After confirming that Anopheles minus was a vector, they began to search for and investigate the pool where Anopheles minus grew, and mobilized villagers to sprinkle medicine to kill its larvae.

The bamboo buildings where the villagers live and the livestock sheds are also sprayed with special pesticides.

They also persuade villagers who are not sick to take targeted preventive drugs.

More than two years later, malaria in Menghai was gradually brought under control.

  Dong Xueshu, a mosquito expert from the Yunnan Institute of Parasite Control: Everyone must take medicine in places where malaria is endemic.

During the day, the common people have to go up the mountain to pick tea. They will not be at home, so our work has to be carried out at night. You can't get a job if you don't live in that village.

When we go to the countryside, we just pick up some simple luggage and wash clothes at one end of the pole, and pick a microscope at the other end. There was no transportation at that time.

  After ten years of work in Menghai County, in 1967, the state launched the "523 Project", and artemisinin was discovered in the 1970s, becoming the most effective core compound of antimalarial drugs today.

At the same time, drug-impregnated mosquito nets are being promoted in many places across the country. As the main measure to control malaria, the incidence rate has begun to drop significantly.

Since 2010, the "137" strategy has been gradually established: that is, cases are reported within 1 day when a case is detected; investigations are completed within 3 days; measures such as mosquito elimination are taken within 7 days to ensure that the epidemic does not spread.

After four consecutive years of no local cases, on June 30 this year, the World Health Organization surveyed that China has established a timely and effective malaria surveillance system that can control the re-spread of malaria and issued a malaria-free certification.

  Dong Xueshu, a mosquito expert from the Yunnan Provincial Institute of Parasite Control: After hearing this, several of us were very excited and shed tears.

I came here when I was 23 years old, now that malaria is eliminated, I am 86 years old.

One part of my current job is teaching, and the other part is sorting out some materials.

There are more than 3,000 pictures in the upper and lower volumes of "Yunnan Mosquitoes". It took me more than 5 years to finish painting. Mastering some basic knowledge of mosquitoes is more important for future disease control.

  Bai Yansong: When it comes to foreign defense imports, everyone will immediately think of the epidemic prevention challenges of reaching Manzhouli in the north and Ruili in the south.

In fact, even if China has certified the elimination of malaria, it still needs to be imported. After all, between 2011 and 2019, Myanmar imported nearly 5,000 malaria cases into China every year, which was once the largest source country of imported malaria cases outside of China.

This is the case with infectious diseases. It is impossible for us to eliminate it ourselves, but we must also help others eliminate malaria in order to really cure the root cause.

In fact, around this point, someone started to act 30 years ago.

  To prevent border input, he chooses experience output

  There were 2 cases on Monday, 1 case on Wednesday, and 5 cases on Thursday. This week, local cases of new crowns in border areas such as Ruili, Yunnan still appeared from time to time.

Since Ruili first initiated nucleic acid testing for all employees due to the epidemic in September last year, this city with a border of more than 160 kilometers has been facing the risk of overseas import of the epidemic for more than a year.

It is connected by mountains and rivers in Myanmar on three sides and faces the villages. In places with frequent cross-border people, any infectious disease may inadvertently break through the borders of defense. Malaria prevention and control was once a major challenge for border prevention and control.

  Zhang Jun, chief representative of the Yunnan Representative Office of the Healthy Poverty Alleviation Action: We have a saying in the malaria prevention and control industry, saying that China's malaria sees Yunnan, Yunnan malaria sees the border, and border malaria sees northern Myanmar.

When it comes to the elimination stage of malaria, it is actually very difficult. It is the pressure of imported malaria. Mosquitoes know no borders, and bring such germs and parasites with them.

From the perspective of global health, diseases really know no borders.

  He graduated from China Medical University and joined the former Ministry of Health in 1985. Zhang Jun witnessed the improvement of China's parasitic disease prevention and control level after the reform and opening up. He also learned from the work opportunity that the situation of malaria prevention and control in neighboring Myanmar was severe at that time.

Thirty years ago, Zhang Jun resigned from the "iron rice bowl" and officially entered the northern region of Myanmar, where the medical and health standards are underdeveloped, as a public welfare person, and formed a team to help locals fight malaria.

  Zhang Jun, Chief Representative of the Yunnan Representative Office of the Health Poverty Alleviation Action: When I arrived in northern Myanmar, I walked for several months to interview the health conditions and death factors of the local people. Malaria was the number one factor and the culprit. Five or six out of ten One died of malaria, and most of them died before the age of five.

Like the local Kachin language, there is no word for malaria. The common people think that after taking a shower, they catch cold and start to sway. They don’t know that the disease is transmitted by mosquitoes.

You have to tell him from the root that it has nothing to do with water and bathing. We need to prevent mosquitoes.

  In the face of malaria, a disease that has plagued locals for a long time, the disease control capacity in northern Myanmar is insufficient.

In order to change the local status quo, Zhang Jun’s team can only start from scratch, starting with killing mosquitoes, distributing mosquito nets, and establishing the most basic public health system.

  Zhang Jun, chief representative of the Yunnan Representative Office of the Health Poverty Alleviation Initiative: The mosquito nets we make are medicine-impregnated mosquito nets, and the textile fibers contain medicine.

So once the mosquito sticks to the mosquito net, it will automatically faint.

In fact, there are many lessons in the process. Traditional mosquito nets have five sides and one mouth. Later, we found that its size was not good and needed to be enlarged.

Many mothers have to take their children to sleep. If it is a single mosquito net, the mosquitoes will get in when the mosquito net has an opening under the foot of the child.

If you don't do these subtle things in the community, you don't understand.

  Through materials and technical support from China, Zhang Jun was able to impart his experience in malaria prevention and control to the local area, and used malaria to cut his way into it, contributing to the improvement of the local public health system.

After the outbreak of the new crown epidemic, although Zhang Jun and his team members were separated on the front line of Kunming, Yunnan and Myanmar, the hard-won local public health system also helped to fight the new crown epidemic.

  Zhang Jun, chief representative of the Yunnan Representative Office of the Health Poverty Alleviation Action: In the process of infectious disease control, there is actually a joint relationship.

In Myanmar, the annual incidence of malaria was nearly 400,000 in 2011, but by 2019, it was 40,000.

In fact, the span of the past decade is quite large, and the control is very good. The background lies in the international assistance provided by it. It has funds to deal with individual diseases.

  In June last year, Yunnan, once known as the "Plaas Area", achieved its goal of eliminating malaria because there were no local cases of malaria infection for four consecutive years.

As China’s late malaria elimination province, Yunnan borders Myanmar, Laos, and Vietnam, three malaria endemic countries. The long borderline has frequent personnel exchanges, which has made it more difficult for the local area to prevent and control malaria from overseas. At this time, help northern Myanmar It is more practical to carry out anti-malarial work in the region.

  Zhang Jun, chief representative of the Yunnan Representative Office of the Health Poverty Alleviation Action: After the elimination of malaria in Yunnan in 2020, the pressure of imported malaria is very high.

The World Health Organization has made recommendations for China to eliminate malaria this time. One of the recommendations is for the Chinese government to provide continuous assistance to Southeast Asian countries, especially Myanmar.

Only in this way can we preserve our achievements in eliminating malaria.

  Bai Yansong: Although China has been certified by the WHO to eliminate malaria, the world still faces the dangers of malaria.

One sentence in this year's WHO World Malaria Report makes people sad: every minute a child dies of malaria, and the new crown pneumonia makes it worse.

The representative of the World Health Organization in China also issued an article reminding: countries like China that have obtained malaria-free status should also be vigilant to prevent malaria from returning. This means that you must not only help your neighbors, but also focus on distance.

  Bring anti-malarial experience to Africa

  Zhou Xiaonong, director of the Chinese Center for Disease Control and Prevention's Parasitic Disease Prevention and Control Institute: When I was in Africa for research, I once asked a young man on the plane, what's the situation with malaria?

He said that the people in the countryside are still in meetings in the morning, but this person will not come in the afternoon.

One question is malaria cases. At that time, we thought that the incidence rate was only 20%. In fact, we found that the incidence rate was 30% or even 40%, which is quite high.

  The domestic malaria has been eliminated, and Zhou Xiaonong still dare not slack off.

Since 2009, imported malaria cases have gradually become the main pressure for domestic malaria prevention. Ten years later, Africa accounted for 91.1% of imported cases.

Zhou Xiaonong asked half of the young researchers in the institute to go to Africa to participate in the fight against malaria. The malaria that bullies the poor and fears the rich will infect people there, just like a cold and a fever.

  Zhou Xiaonong, director of the Chinese Center for Disease Control and Prevention of Parasitic Diseases: China has passed the malaria elimination certification, and many of our colleagues may move to other places, which will affect our ability to truly prevent import and re-transmission. .

The World Health Organization hopes that China will transfer these existing experts to Africa in time.

  To ensure that malaria prevention and control funds are large, the team will not be withdrawn, and the intensity will not be reduced, to avoid the resurgence of local malaria, and to transfer the prevention and control experience to Africa.

In 2015, under the advice of the WHO, Zhou Xiaonong's team prepared for the establishment of a global health center. China's aid to Africa transformed from hardware output to comprehensive aid including software for prevention and control concepts and capacity building.

However, China has experienced Africa and encountered inadequacy.

  Zhou Xiaonong, director of the Chinese Centers for Disease Control and Prevention of Parasitic Diseases: The difficulty is much greater than in China. The "137" work norms are used in China to report cases to the prevention and control system and information system within one day. They do not have such information. System, and if you want to report, it may take three months or even six months.

  Doctors are extremely scarce and transportation is inconvenient. The operating system of modern society is almost completely out of order here. It is unrealistic to follow up and investigate each case one by one. Therefore, this is written into the WHO technical document and is promoted to the world. In the "137" strategy, the step of "complete case investigation and verification within 3 days" can only be omitted.

To implement the Chinese experience based on community comprehensive prevention and control into households, it is necessary to find a version tailored to local conditions, but 1 and 7 should not be lost, and we must focus on developing the strength of the locals themselves.

  Zhou Xiaonong, director of the Chinese Center for Disease Control and Prevention of Parasitic Diseases: We have hired local health volunteers, which are equivalent to our original barefoot doctors. They patrol the village and the community every day. Once a fever patient is found, we will promptly Diagnosis, treatment, and this information can be summarized in a timely manner within one day.

At the same time, if we find areas with a high incidence of malaria within 7 days, we will give these villages intensive treatment.

  The WHO developed "137" into a three-step method of "detection, treatment, and tracking", which combined the two and added drug treatment, which reduced the incidence of malaria in Tanzania by 80%.

In fact, Zhou Xiaonong’s team’s first phase of the Africa Exploration Project was funded by the British Agency for International Development, and the Gates Foundation began to support the second phase to further verify the applicability of China’s experience.

China leverages its technological advantages and cooperates with international funds to develop bilateral cooperation from aid to Africa and towards multilateral cooperation.

  Zhou Xiaonong, director of the Chinese Center for Disease Control and Prevention of Parasitic Diseases: Not only did we get financial support, we also learned project management.

Non-profit organizations can find out in time where money is really needed. In addition to carrying out prevention and control work, non-profit organizations also actively evaluate and sum up experience. Therefore, non-profit organizations are more flexible, which is conducive to China's future cooperation in Africa. Good to extend the experience to other countries.

  The WHO is taking the lead in extending the model to four countries including Zambia. This is also in the plan of Zhou Xiaonong’s team to allow African counterparts to recognize China’s experience through a pilot, and gradually expand to several countries, and finally form an epidemic in Africa. If it happens, it can produce effective networks, and this requires more sparks of assistance to Africa.

  Zhou Xiaonong, director of the Chinese Center for Disease Control and Prevention of Parasitic Diseases: We also hope that in the process of malaria assistance to Africa in the future, a province can also be used to support the model of a country. This is conducive to resource allocation, personnel arrangements and policies. implement.

  Facing the future, Zhou Xiaonong preached with concern that the decline in financial aid, malaria resistance in Southeast Asia, and the growth and flow of African populations are all affecting the global anti-malarial effectiveness.

Experts urge that when a major public health incident occurs in one country, no other country can stand alone. Strengthening cooperation and response is the only way to stop malaria in the world.

  Bai Yansong: Building a community with a shared future for mankind is easier for people to understand and support in the face of the epidemic. However, there are always many reverse forces in reality, making unity and cooperation a luxury, so the virus has it Greater living space.

Not long ago, the China-Africa Cooperation Forum issued an action plan. China will continue to support the global malaria control and elimination goals and shoulder the responsibility of a major country!

I hope that mankind can really think about and understand the meaning of the words "community of destiny", so that the story of China's elimination of malaria can be replicated in this world.

  Director | Zhang Dapeng Yao Daolei Guo Jialing