Jakarta. Indonesia continues to face significant challenges in its national malaria elimination efforts, with most of the country’s cases still concentrated in Papua, according to the Health Ministry. More than 90 percent of Indonesia’s malaria cases were recorded in the easternmost region, where weak detection systems and mobile populations are hampering progress.

Ina Agustina Isturinin, Director of Infectious Disease at the Health Ministry, outlined four critical obstacles to achieving malaria-free status during a virtual media briefing for the 2025 Asia Pacific Malaria Summit on Thursday.

“The burden of malaria in Papua remains very high, but the detection rate is still low,” Ina said. “In 2024, only 54 percent of estimated cases were detected, an improvement from previous years, but still far from ideal.”

The second major hurdle, she said, comes from mobile migrant populations (MMPs), including forest workers, plantation laborers, indigenous nomadic groups, and refugees. These populations often reside in and move across high-transmission areas, making it difficult to implement consistent monitoring and treatment programs.

Of the 500,000 malaria cases reported in 2024, nearly 100,000 were found in these mobile groups. Ina warned that their mobility poses a continued threat even in low-endemic areas, where their presence can delay malaria-free certification.

“They are often in receptive areas, places prone to high transmission, and their movements make elimination efforts more complicated,” she said.

Another concern is the reemergence of malaria outbreaks in regions previously declared malaria-free. One such outbreak occurred in Rokan Hilir, Riau, in 2024.

“Even after an area is certified malaria-free, an outbreak can still happen. If not managed swiftly, it could trigger a public health emergency,” she cautioned.

The fourth issue adding complexity is the rise of zoonotic malaria cases, especially those caused by Plasmodium knowlesi, a parasite that normally infects macaques but can be transmitted to humans via Anopheles mosquitoes.

“This zoonotic transmission has become a growing challenge in Indonesia, Malaysia, the Philippines, and Thailand,” Ina said, noting the added difficulty of managing diseases that involve animal-to-human transmission.

To effectively combat malaria, Ina stressed the importance of adopting a One Health approach, an integrated strategy that considers human health, animal health, and environmental factors. She acknowledged that while 407 districts and cities in Indonesia have achieved malaria-free status, the broader strategy is still lacking in key areas.

“The One Health approach is not yet fully optimized, especially in environmental health management and vector control,” she concluded.