**6. Conclusions**

students are being trained in Europe on molecular approaches applied on *Anopheles* mosquitoes [13–15]. These international collaborations on malaria and vector control toward elimination provided strong support to reduce malaria incidence in China and will be the basis for sustaining

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

The main objective in China with respect to malaria will be focused on how to sustain malaria elimination and prevent transmission re-establishment in accordance with the WHO's newly updated guidelines [33]. This requires a specific and sustainable investment even at post-elimination stage. Malaria is on the list of the "Health China 2030" blueprint issued by the State Council of China in 2016. This will ensure the required sustainable investment. Following this blueprint, a series of technical guidelines for malaria surveillance and response at post-elimination stage, as well as protocols for preventing malaria transmission re-establishment, are under development for short release. Meanwhile, mechanisms for maintaining anti-malaria capacity in health system are implemented. A National Technical Competition for Parasitic Disease Diagnosis and Test is organized annually for health workers from clinical agencies and CDCs [54]. This competition is an efficient way to maintain awareness and efficiency in malaria detection within the health system and prevent erosion of capacity along with malaria elimination. However, malaria elimination is primarily an international endeavor. Broad engagement and sustained investments are needed with support from multiple international partners [55– 57]. In 2013, Chinese President Xi Jinping proposed the "One Belt and One Road Initiatives" to the world for international cooperation and development. Cooperation in health is one of the key components as it relates to the mutual benefits. China has already been actively involved

modules must thus be developed for both clinicians and CDC staffs.

malaria elimination efforts.

248 Towards Malaria Elimination - A Leap Forward

**4. Gaps and challenges**

**5. Perspectives**

China has made substantial progress on malaria elimination and is on the way to achieve the elimination goal on time by 2020. The lessons drawn based on experiences in China will make a good reference for the countries aiming at malaria elimination. Challenges identified in the malaria elimination process in China might help other countries formulating appropriate strategies in time and place. International collaboration is strongly advocated to achieve the global issue to eliminate the most important infectious disease of the current times.
