Mapping of the Global Importation Risk of Malaria to China - Global, 2024

China achieved World Health Organization certification for malaria elimination in 2021; however, the risk of local retransmission from imported malaria remains a primary challenge in the post-elimination era. While international trade is a critical driver of importation risk, current risk assessments are constrained by the lack of granular cross-border population mobility data.

This study introduces service trade volume as a proxy for population mobility. By integrating global malaria epidemiology, socioeconomic factors, and geographic resistance, an enhanced gravity model was developed to stratify global malaria importation risks. The findings revealed that Plasmodium falciparum importation risk exhibited pronounced geographic clustering, predominantly in sub-Saharan Africa. Conversely, Plasmodium vivax importation showed a distinct "connectivity-driven" pattern. Notably, low-endemicity countries geographically adjacent to China or sharing intensive trade relations (such as Republic of Korea, Thailand, and Vietnam) present substantial cryptic importation pressures, identifying them as pivotal surveillance targets in the post-elimination era.

The risk stratification matrix provides a scientific framework for tailoring surveillance strategies. For "high-endemicity, high-mobility" regions (such as specific African nations), priorities should focus on strengthening port-of-entry screening and post-arrival follow-up. For "low-endemicity, high-mobility" regions, heightened vigilance is required against cryptic importations driven by frequent commercial and economic exchanges. Public health strategies must move beyond analyses based solely on geographic proximity and incorporate economic connectivity metrics into active surveillance frameworks.