**4. Gaps and challenges**

Although the malaria elimination program has made significant progress in China, there are still challenges. The main challenge is to accomplish malaria elimination along border areas. China is sharing 4060 km long international borders with GMS countries. These borders are devoid of natural barriers and porous, permitting population movement and facilitating cross border malaria transmission. The China-Myanmar border is particularly difficult to access for healthcare services due to ongoing armed conflict on the Myanmar side of the border resulting in proliferation of disease vectors and uninterrupted disease transmission [13, 15, 32, 45–48]. A related challenge is the prevention of re-introduction and re-establishment of malaria considered as a real threat to malaria elimination [2, 33, 34, 37]. Surveillance is highly recommended as a key intervention in the post-malaria elimination stage. However, decisive and rapid response to imported malaria is vital to prevent re-introduction and sustain malaria elimination [11, 27, 29, 49–53]. A shift from community to hospitals at the county and higher level for primary diagnosis was also recorded [8, 27], indicative of a more active role of the main city airports as ports of entry. In addition, owing to the sharp decrease of indigenous cases, it becomes difficult to maintain the capacity of intervention and proper training at the local level. Novel and innovative capacity building and training modules must thus be developed for both clinicians and CDC staffs.
