MERA India initiative to eliminate malaria by 2030

The MERA India Initiative (Malaria Elimination Research Alliance – India) is a national collaborative platform launched by the Indian Council of Medical Research (ICMR) in April 2019 with the aim of strengthening research and innovation to support India’s goal of eliminating malaria by 2030. The initiative aligns with the objectives of the National Framework for Malaria Elimination (NFME) 2016–2030 and the National Strategic Plan (NSP) for Malaria Elimination (2017–2022), which collectively outline the roadmap for a malaria-free India.

Background and Context

Malaria has been one of the major public health challenges in India for decades. Despite significant progress in reducing the disease burden, India remains one of the countries contributing the highest number of malaria cases in the World Health Organization (WHO) South-East Asia Region. Recognising the need for a concerted research-based approach, the ICMR established the MERA India platform to bridge research gaps, facilitate data-driven policy formulation, and promote innovations in surveillance, diagnostics, treatment, and vector control.
The initiative reflects India’s commitment to achieving the WHO Global Technical Strategy for Malaria 2016–2030, which seeks to reduce global malaria incidence and mortality by at least 90% and eliminate the disease in at least 35 countries by 2030.

Objectives of the MERA India Initiative

The core objective of MERA India is to consolidate national research efforts towards malaria elimination by promoting evidence-based decision-making. Specific goals include:

• Coordinating multi-institutional research efforts to address malaria-related challenges in different epidemiological settings.
• Identifying research priorities that are region-specific and support policy and operational decision-making.
• Facilitating translation of research outcomes into actionable strategies for malaria control and elimination.
• Promoting innovation in diagnostics, vector surveillance, and treatment methods.
• Strengthening capacity building through collaboration among research institutions, universities, and state health departments.

Structure and Implementation

The Indian Council of Medical Research (ICMR) serves as the nodal agency for the MERA India initiative. It functions through its network of institutes, including the National Institute of Malaria Research (NIMR), New Delhi, which acts as the coordinating centre.
MERA India brings together a wide range of stakeholders, including:

• ICMR research institutes and laboratories.
• National and state health departments.
• Academic and research institutions.
• Non-governmental organisations (NGOs) and field implementation partners.
• International collaborators, including the World Health Organization (WHO) and other technical agencies.

The initiative operates under thematic working groups focusing on key domains such as epidemiology, vector biology, diagnostics, treatment strategies, and social and behavioural studies.

Focus Areas of Research

MERA India identifies and prioritises research areas essential to achieving malaria elimination. These include:

• Vector Control Innovations: Evaluating new tools and strategies for controlling mosquito vectors resistant to traditional insecticides.
• Surveillance and Mapping: Enhancing malaria surveillance systems and developing geo-spatial mapping for identifying transmission hotspots.
• Diagnostics and Treatment: Improving access to rapid diagnostic tests (RDTs) and studying drug resistance patterns in malaria parasites.
• Operational and Implementation Research: Identifying barriers in programme delivery and evaluating field-level interventions.
• Social and Behavioural Studies: Understanding community perceptions, healthcare-seeking behaviour, and compliance with prevention measures.

Integration with National Malaria Elimination Framework

The National Framework for Malaria Elimination (NFME), launched in 2016 by the Ministry of Health and Family Welfare, sets the goal of eliminating malaria in a phased manner by 2030. The framework divides Indian states into four categories based on Annual Parasite Incidence (API):

1. Category 0 – Prevention of Re-establishment Phase: States/UTs with zero indigenous cases.
2. Category 1 – Elimination Phase: States with API less than 1 and limited local transmission.
3. Category 2 – Pre-elimination Phase: States with API between 1 and 2.
4. Category 3 – Intensified Control Phase: States with API greater than 2.

MERA India complements this framework by ensuring that scientific research and operational interventions are synchronised with state-level malaria control strategies. It also supports the National Vector Borne Disease Control Programme (NVBDCP) in generating evidence-based insights for policy development.

Achievements and Progress

Since its inception, MERA India has made several contributions towards strengthening malaria research and elimination efforts:

• Establishment of a Research Network: The initiative has created a collaborative network of institutions across malaria-endemic states, promoting data sharing and standardised methodologies.
• Identification of Research Priorities: Based on regional consultations, MERA India has defined key research themes, including drug resistance, vector ecology, and community-level interventions.
• Integration of Technology: Use of digital tools such as mobile-based surveillance applications and GIS mapping has enhanced real-time data collection.
• Policy Support: Research findings under MERA India have informed the revision of guidelines for malaria diagnosis and treatment.

India has also recorded a significant reduction in malaria cases and deaths over the past decade. According to national surveillance data, malaria cases declined by more than 80% between 2015 and 2022, and mortality reduced by over 90%, marking steady progress towards elimination.

Challenges in Achieving Elimination

Despite remarkable progress, several challenges persist that could hinder the 2030 elimination target:

• Heterogeneous Transmission Patterns: Malaria persists in certain tribal, forested, and border regions of northeastern, central, and eastern India.
• Insecticide and Drug Resistance: Growing resistance among vectors and parasites threatens the efficacy of existing interventions.
• Surveillance Gaps: Incomplete or delayed case reporting, especially from remote areas, affects accurate assessment of disease burden.
• Sociocultural and Behavioural Barriers: Low awareness, poor healthcare-seeking behaviour, and community non-compliance in high-risk zones remain major obstacles.
• Climate Change: Changes in temperature, rainfall, and humidity may alter vector distribution and prolong transmission seasons.

Future Roadmap and Vision

The MERA India initiative envisions achieving a malaria-free India by 2030 through strengthened research–policy linkages and sustained multi-sectoral collaboration. The roadmap includes:

• Expanding the MERA India network to all states and Union Territories.
• Developing new tools for surveillance, diagnosis, and treatment, including next-generation insecticides and antimalarial drugs.
• Enhancing capacity building at district and community levels.
• Integrating malaria elimination with other vector-borne disease control initiatives.
• Promoting international partnerships for knowledge exchange and innovation.

Significance

The MERA India initiative signifies a paradigm shift from malaria control to evidence-based elimination. By consolidating scientific expertise, fostering innovation, and promoting inter-sectoral coordination, the programme ensures that research outcomes directly influence national policies and operational strategies.