Defeating malaria in the North-East region: the forerunner for malaria elimination in India

•The manuscript presents the malaria control interventions implemented since 1988 reporting significant declining trend of malaria in North-East India along the years. However, malaria transmission in the bordering districts with Bangladesh is still intense, which are prone to disease outbreaks evidenced by high rise in cases and attributable deaths. The manuscript discusses the actions to be taken to galvanize malaria control in the North-East region of India, such as intensified disease surveillance and universal coverage with long-lasting insecticidal nets coupled with improved access to healthcare services mitigating the risk of disease outbreaks and spread of drug-resistant malaria helping realize the goal of malaria elimination in India by 2027. India is a malaria endemic country which is targeting malaria elimination by 2027. Transmission intensities are low-to-moderate depending on the region supported by multiple disease vectors. Among these, comparatively North-East India contributes to high proportions of malaria cases annually, the majority of which are due to Plasmodium falciparum (90%). Anopheles minimus and An. baimaii (sibling species in the An. dirus complex) are widely prevalent and incriminated as vectors of malaria. Number of intervention tools were field-evaluated beginning 1988 to date against disease vectors and causative parasites to contain the spread of malaria. These included (i) insecticide-treated netting materials (ITNs) for vector control, (ii) rapid diagnostic tests (RDTs) for in situ diagnosis, and (iii) therapeutic efficacy of artemisinin-based combination therapies (ACTs) for improved drug-policy; all of which were incorporated in healthcare services resulting in substantial disease transmission reduction. Populations of both An. minimus and An. baimaii were observed depleting, instead An. culicifacies s.l. recorded to be fast invading degraded forests and assessed to be resistant to multiple insecticides. Of the two prevalent Plasmodium species, while P. vivax continued to be susceptible to chloroquine therapy, P. falciparum had emerged resistant to most available antimalarial drugs except ACTs over space and time and spreading to peninsular India threatening elimination efforts. Disease transmission trends were observed to be declining for which the state of Assam has made huge strides reporting steady fall in cases each passing year vis-à-vis Meghalaya, Mizoram and Tripura (all sharing international border with Banglad