An article in Malaria World this week, ‘Lessons from failure to success on malaria elimination in the Huai River Basin in China’ by Liu et al has interesting data of the rates of malaria from Yongcheng City and Guoyang County, Huai River Basin, China (1955-2023). What is very notable is how dramatically incidence declined from very high peaks around 1960 during the Great Chinese Famine (1959-1961) and 1970 during the cultural revolution (1966-1976) to practically no malaria 1983-2023, apart from a small increase from 2003-2008 (see figure).
The Cultural Revolution was characterized by violence and chaos across Chinese society. Estimates of the death toll vary widely, typically ranging from 1–2 million, including a massacre in Guangxi that included acts of cannibalism, as well as massacres in Beijing, Inner Mongolia, Guangdong, Yunnan, and Hunan.
The Great Chinese Famine was a famine that occurred between 1959 and 1961 as a result of policies of the Mao’s Great Leap Forward. It is widely regarded as the deadliest famine and one of the greatest man-made disasters in human history, with an estimated death toll due to starvation that ranges in the tens of millions (15 to 55 million). The Tibetan government in exile claimed that many Tibetans died from famines in 1961–1964 and 1968–1973 as a result of forced collectivization.
This particular ‘elephant in the room’ linking malaria incidence to famine is ignored by the authors who concentrate their discussion on the slight increase from practically zero to ~600 cases per 100,000 (0.6%) in Guoyang County in 2006. In 1970 there were 18,000/100,000 cases (18%) in Guoyang County in and 33,000/100,000 (33%) in Yongcheng City. This slight increase 2003-2008 was blamed on merger or closure of malaria control facilities, loss of medical professionals, low capacity for detection, diagnosis, prevention, and management of malaria cases, and underestimating the transmission potential of Anopheles sinensis. The Chinese authorities reacted to these deficiencies following typical Health Authority malaria control methods and consider that these reversed the decline. Increases of malaria budgets are considered particularly important.
As usual the linkage of malaria to malnutrition was ignored.