Tracking progress towards malaria elimination in China: estimates of reproduction numbers and their spatiotemporal variation

Isobel Routledge; Shengjie Lai; Katherine E Battle; Azra C Ghani; Manuel Gomez-Rodriguez; Kyle B Gustafson; Swapnil Mishra; Joshua L Proctor; Andrew J Tatem; Zhongjie Li; Samir Bhatt

In 2016 the World Health Organisation listed 21 countries for whom it would be realistic to achieve 22 elimination of malaria by 2020, defined as zero indigenous cases over three consecutive years 1 . The 23 largest of these is the People's Republic of China (thereafter called China). In 2017 China reported no 24 indigenous malaria cases for the first time since malaria became a notifiable disease in 1956 2, 3 . The 25 country has experienced a major decline in the burden of malaria, from an annual incidence of 24 26 million cases (2961 cases per 100,000) in 1970 4 . This reduction has been attributed to a combination 27 of socioeconomic improvements and the scale-up of interventions to control malaria 5 . In 2010, China 28 set out an ambitious plan for the national elimination of malaria by 2020 (the National Malaria 29 Elimination Programme, NMEP). Elements of the plan included improved surveillance, timely 30 response, more effective and sensitive risk assessment tools and improved diagnostics 6 . A key policy 31 change implemented in 2010 as part of the NMEP was the introduction of the 1-3-7 system: aiming 32 for case reporting in one day, which is then investigated within three days, with a focused 33 investigation and action taken in under seven days 7 . 34