An ambitious goal - to eliminate malaria from the Asia-Pacific region by 2030 - faces formidable hurdles but is achievable if enough political will and funding are available to fight the mosquito-borne disease, health experts say.
Malaria experts have been meeting in the Thai capital Bangkok this week to thrash out a plan to meet the target agreed late last year by the leaders of 18 countries in the region, where some two billion people are at risk of infection.
There is concern the plan could unravel because resistance to artemisinin, a powerful component in malaria drugs, looms in the Greater Mekong region and could spread westward, even reaching Africa at a cost of millions of lives.
"Shifting towards an elimination goal is the best strategy, in particular if you have drug resistance," Maxine Whittaker, co-coordinator of the Asia Pacific Malaria Elimination Network (APMEN), a group of 16 countries formed to speed up the fight against the disease, told the Thomson Reuters Foundation.
"Even if malaria doesn't seem to be a major problem in your country, you've got to finish off the job, and even if you have eliminated it from your own country, it can easily spread across borders," said Whittaker.
APMEN works in partnership with the Asia Pacific Leaders Malaria Alliance (APLMA), a group of heads of government chaired by the prime ministers of Australia and Vietnam, to increase regional cooperation.
A new approach
Moving from containing malaria to an elimination strategy has been a major shift in approach to the disease, said Patricia Moser, lead health specialist at the Asian Development Bank.
"We support the bold push towards elimination as it has become clear that containment of artemisinin resistance is a risky strategy - the region must push for elimination while these key drugs (artemisinin combination therapies) remain effective," she told the Thomson Reuters Foundation in an email interview.
As part of a three-year initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria has allocated $100 million to Myanmar, Cambodia, Laos, Thailand and Vietnam through its Regional Artemisinin Initiative (RAI). The biggest slice of the grant - $40 million - has been allocated to Myanmar, which has the highest malaria burden among the five countries.
The RAI is piloting a new approach in the region by giving malaria drugs to everyone who lives in hotspots along the Myanmar-Thai border, including those who are not ill.
"Artemisinin resistance is a time bomb ticking away in Southeast Asia", Izaskun Gaviria, a senior fund portfolio manager at the Global Fund, told the Thomson Reuters Foundation.
"Given the urgency of the issue, we don't have years to decide what needs to be done, so through targeted malaria elimination along the border, we're hoping to make a big step forward in fighting drug resistance."
The RAI is also trying to improve mapping and real-time reporting of malaria cases, especially among migrants, she said.
The Asia-Pacific region is on target to achieve a World Health Assembly Goal of a 75 percent reduction in the number of cases and deaths between 2000 and 2015, and Bangladesh, Sri Lanka and Thailand are among nations that have already achieved the goal.
But complacency and any decline in funding could lead to a deadly resurgence of the disease, experts warned.
Funding for the World Health Organization's Southeast Asia region, where 1.2 billion people are estimated to be at risk of contracting malaria, increased from $104 million in 2005 to $236 million in 2010, but fell to $203 million in 2013.
Experts are also concerned that malaria may slip down the list of priorities as world leaders work towards signing a new global framework for future development policy later this year, given that other health emergencies, such as Ebola in West Africa, command much of their attention.
Sri Lanka, for example, experienced a resurgence of malaria in the 1960s, and had major epidemics in the late 1980s and early 1990s. Thanks to sustained funding, no new cases have been detected for the past two years even though the country is recovering from 30 years of civil war.
"It's harder to go the last mile but if you can continue it right to the end, with enough funding and mobilised domestic resources, then we have a real chance of winning this battle for our generation and keeping it that way," Stephen O'Brien, a British lawmaker and global advocate for the Roll Back Malaria Partnership (RMB), told the Thomson Reuters Foundation.
O'Brien said the private sector also had a key role to play. Oil and gas companies, in particular, had been supporting anti-malaria initiatives as their staff and the communities in which they work are particularly threatened by the disease.