Eliminating Malaria in ASEAN: Lessons From Egypt

The Association of Southeast Asian Nations (ASEAN) has made remarkable progress in reducing malaria. Over the past two decades, the region’s cases have dropped by nearly 80%, and many countries are now transitioning from disease control to elimination.

New challenges threaten to stall this momentum. Funding for malaria programs—many of which rely heavily on international donors—has become uncertain in the wake of massive cuts to the U.S. Agency for International Development (USAID). Meanwhile, the rising temperatures and erratic rainfall of climate change are expanding mosquito breeding grounds. Deforestation and ongoing conflict further complicate control efforts. As the region aims for its goal of eliminating indigenous malaria cases by 2030, countries need to determine how to sustain progress and close the remaining gaps.

ASEAN countries can learn from both regional and global success stories to strengthen malaria control efforts, including from Egypt, which faces many similar challenges. Egypt’s journey from widespread malaria in the 1940s to zero indigenous cases in the twenty-first century shows that elimination is possible through long-term commitment.

Strengthening Surveillance and Response

Egypt’s approach to malaria elimination offers important lessons for ASEAN nations, given that the World Health Organization officially certified Egypt malaria free in 2024 after decades of investment in public health infrastructure, disease surveillance, and rapid response systems. Efforts to reduce human-mosquito contact in Egypt began in the 1920s, when the country prohibited the cultivation of rice and agricultural crops near homes. Egypt designated malaria a “notifiable disease” in 1930 and, soon after, opened its first malaria control and research station. In 1936, the first comprehensive malaria survey in Lower Egypt indicated that prevalence of the disease varied from less than 1% in Giza to around 40% in the provinces of Qaliubiya, Beheira, and Dakahlia.

During a 2014 outbreak in Aswan, authorities quickly launched [PDF] public information campaigns, accelerated case detection, delivered timely treatment, and deployed targeted mosquito control within days. This approach reflects the value of integrating surveillance systems with fast, community-level responses.

Persistent vigilance is especially relevant for Southeast Asia, where diverse landscapes require tailored approaches to mosquito control

ASEAN countries are already applying similar strategies with promising results. Cambodia, Laos, and Thailand have adopted the 1-3-7 approach, and, with some variations, Vietnam and Myanmar have as well. The strategy aims to report malaria cases within one day, launch investigations within three, and initiate responses within seven.

Malaysia has extended active case detection to private plantations, ensuring outreach even in remote communities. To achieve this, the Malaysian National Malaria Control Program collaborated with private-sector plantations in Sabah State on surveillance and vector control. Cambodia‘s use of real-time digital reporting allows health workers to respond to new cases immediately.

The Cambodian National Malaria Control Program benefited from the USAID Regional Development Mission for Asia, which provided technical assistance and support to in collaboration with Partners for Development and other nongovernmental organizations. The program expanded access to insecticide-treated bed nets and malaria case management services across sectors, strengthening provincial and district-level managerial capacity, improving quality standards for diagnostics, and collaborating on policy and strategic interventions.

Adapting Vector Control to Local Environments

In Egypt, proactive environmental management is being applied to reduce mosquito breeding grounds. In addition to implementing widespread use of insecticide-treated nets and indoor spraying, the country restricted rice cultivation near homes to reduce mosquito breeding grounds. Even after elimination, Egypt continued surveillance of these areas to prevent possible malaria reintroduction.

Persistent vigilance is especially relevant for Southeast Asia, where diverse landscapes—from dense jungles to rice paddies—require tailored approaches to mosquito control. Continued investment in adaptive, locally informed strategies will be essential as countries move toward elimination.

Approaches could include larval source management in peri-urban areas, targeted fogging in high-risk zones, and biological control. Methods such as introducing larvivorous fish in rice paddies and water reservoirs could be tried. Additionally, spatial mapping technologies, including drones, for larval habitat detection have emerged as transformative tools in vector surveillance—particularly in hard-to-reach forested regions. Integrating these tools with community-based interventions could significantly enhance the effectiveness of vector control efforts. As malaria transmission becomes more focal and harder to trace, innovative approaches will be essential in accelerating elimination across the region.

Farmers collect paddy during harvest day at a rice field, in Candipuro district, Lumajang, East Java province, Indonesia, on December 9, 2021. REUTERS/Willy Kurniawan

Learning from Cross-Border and Multisector Collaboration

Another factor in Egypt’s success was its investment in health-care access and inclusive policy. By ensuring that 95% of the population lives within roughly three miles of a health-care center, and by providing free diagnosis and treatment—including for undocumented migrants from neighboring Sudan—Egypt created a safety net that left few people behind.

Egypt’s partnerships with neighboring countries were equally important. By implementing joint treatment programs and training thousands of health workers, Egypt and Sudan reduced cross-border transmission. Egypt also established a national committee that brought together the Ministries of Health, Agriculture, Environment, and Water Resources to coordinate across sectors and ensure sustainable funding for disease prevention.

This cross-border and interministerial coordination models holds strong potential for countries such as Indonesia and Myanmar that face similar challenges related to migrant populations, border dynamics, and limited access in rural regions in ASEAN.

Country Highlights and Regional Insights from ASEAN

Despite Malaysia’s ongoing challenges with a forest-dwelling malaria, such as Plasmodium knowlesi, the country eliminated indigenous malaria in 2018. Malaysia’s robust surveillance systems, strong public-private partnerships, and early detection efforts has kept malaria at bay. Similarly, despite its tropical climate, Singapore has maintained malaria-free status through strict urban planning, effective vector control and public health policies, and strong community engagement.

Other countries in the region are making notable progress, even Indonesia and Myanmar, two countries with the highest burden of malaria. Indonesia has made major strides, declaring more than 70% of its districts now free of malaria. However, as an archipelagic country, Indonesia faces unique challenges for its vector control. The fragmented geography and inequal infrastructure maturity complicates surveillance, logistics, and equitable access to health services, especially in remote islands and border regions. The eastern provinces—Papua, West Papua, and East Nusa Tenggara—continue to report high rates of malaria, accounting for more than 90% of national cases. Cross-border mobility with Papua New Guinea and Timor-Leste further complicates control.

Strengthening Indonesia’s surveillance platform, SISMAL, and forming more coordinated partnerships with neighboring countries could significantly reduce imported and locally transmitted cases. SISMAL improves data accuracy and timeliness, which enables health authorities to identify outbreaks earlier, target interventions more effectively, and allocate resources where they are most needed. At the same time, collaborative efforts such as synchronized surveillance, shared case data, joint vector control activities, and harmonized treatment protocols could reduce the risk of imported cases slipping through national borders undetected.

Myanmar faces a different but equally complex set of challenges. Prolonged conflict in regions such as Kachin, Rakhine, and Shan has created insecurity, displaced communities, and limited the reach of government health services in areas where damaged infrastructure prevents health workers from delivering care or conducting disease surveillance. Despite these obstacles, some regions, such as Kayin State, have shown resilience. Malaria posts continue to operate, providing early access to diagnosis and treatment and maintaining malaria testing rates. Although the coup disrupted standard data transmission in 2021, continued contact with malaria post workers enabled the ongoing collection of surveillance data, including P. falciparum case information and assessments of service functionality. These experiences underscore the importance of maintaining flexible, community-based malaria services, particularly when access is reduced.

Drug-resistant malaria strains along the Myanmar-Thailand border pose a serious threat. Myanmar could benefit from transnational partnerships with Thailand and China to improve drug-resistance tracking and treatment access. Targeted strategies for high-risk populations such as mobile workers, forest goers, and informal sector laborers could improve both prevention and treatment coverage in underserved and high-transmission areas. Amid the tension, mobile clinics and community health volunteers could play a vital role in closing the access gap while reducing transmission.

Moving Toward 2030: Key Actions

Egypt’s success is a reminder that ending malaria is as much a political and social achievement as it is a technical one. In the Asia Pacific, including ASEAN, malaria control has relied heavily on external sources such as the Global Fund.

As ASEAN member states move closer to their 2030 malaria elimination goal, countries need to adapt strategies to their local contexts while increasing domestic funding levels, including public-private partnerships, and promoting regional cooperation.  