Three Main Reasons Why Malaria Elimination Is Difficult to Achieve

MALARIA PERDHAKI–JAKARTA. Malaria is not a new disease in the world. Various historical records document that malaria parasites were responsible for many deaths across different parts of the world, ranging from China, Mesopotamia, and Egypt to Greece thousands of years ago.

The same thing also happened in Indonesia. In the 18th and 19th centuries, Jakarta was once known as one of the deadliest places in the world for Europeans due to outbreaks of tropical diseases, especially malaria. Until today, Indonesia continues to “fight” against malaria, particularly in Eastern Indonesia, such as Papua, East Nusa Tenggara (NTT), and parts of Sulawesi.

According to health epidemiologist Dicky Budiman, as quoted by Liputan 6, there are three main reasons why malaria is considered one of the most difficult diseases to eliminate, even though it has existed since ancient times.

First, the malaria vector, the Anopheles mosquito, has characteristics that allow it to adapt and breed easily in various environments, including forests, swamps, rice fields, mining areas, and stagnant water.

Second, in those regions there are still people who can relapse after previously suffering from malaria. Certain malaria parasites, such as Plasmodium vivax and P. ovale, can “sleep” in the form of hypnozoites in the liver, which are undetectable by regular blood tests and are not killed by standard malaria medication. After months or even years, these parasites can reactivate and enter the bloodstream, causing malaria to recur without any new mosquito bites.

“So, it can relapse again,” said Dicky.

Third, malaria control depends heavily on external interventions, such as the use of insecticide-treated mosquito nets, insecticide spraying, and environmental cleanliness. Dirty environments are the most comfortable breeding grounds for Anopheles mosquitoes. When these preventive activities stop, malaria that had previously disappeared or been controlled can re-emerge due to environmental factors or human behavior.

“If people are not disciplined, the risk of malaria being reborn will increase, and malaria cases will happen again,” he said.

The interaction between strong vector adaptation, the relapse phenomenon of parasites, and dependence on disciplined interventions creates a fragile cycle. As a result of these three factors, it is not uncommon for regions in Indonesia that had previously achieved malaria-free status to experience drastic surges in cases and eventually be declared Extraordinary Events (KLB/outbreaks). This “rebound” phenomenon has been recorded in several areas such as Kulon Progo (Yogyakarta), Pangandaran (West Java), and several regions in Lampung and West Nusa Tenggara.

Therefore, the struggle toward a Malaria-Free Indonesia by 2030 is not merely a race to reach zero cases, but also a continuous effort to sustain it. Collective vigilance, strengthened grassroots surveillance, and the commitment of both the government and society to maintaining environmental cleanliness are the key factors. Only through discipline and uninterrupted collaboration can Indonesia’s dream of achieving complete malaria elimination truly become a reality.