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As countries across Asia Pacific make historic progress towards malaria elimination, the frontier has shifted. Cases are increasingly concentrated not in population centres, but in border areas where population movement, porous boundaries, and uneven health system capacities converge to sustain transmission and drive reintroduction risks. Addressing border malaria is no longer peripheral to elimination. It is central to it.
Border malaria is defined by the World Health Organization (WHO) as malaria transmission or the potential for transmission, that occurs across or along international land borders. It cannot be solved by any single country acting alone, and instead requires regional solutioning. When people and vectors move freely across borders, surveillance gaps on one side undermine progress on the other. The logic is straightforward: a country can reduce its malaria burden to near-zero, but without coordinated action with its neighbours, the risk of re-establishment remains.
To understand how countries can meet this challenge, Asia Pacific Leaders Malaria Alliance (APLMA) and the Mahidol Oxford Tropical Medicine Research Unit (MORU), in consultation with the WHO Malaria and Neglected Tropical Disease Department, conducted a study that draws on stakeholder perspectives from four Asia Pacific subregions to examine what makes cross-border collaboration work, and what stands in the way.
Based on interviews with 29 national, subnational, regional, and international stakeholders across four diverse subregions: six cross-cutting recommendations emerge.
Institutionalize, Not Just Improvise
One of the most consistent findings across subregions is that cross-border collaboration depends heavily on informal networks, individual relationships, and short-term project funding. When key personnel leave, funding cycles end, or political priorities shift, coordination can collapse. Institutionalizing cross-border collaboration as a routine programmatic function is therefore crucial. Countries can do so by embedding cross-border collaboration within formal mandates, standing coordination mechanisms, and designated focal points at both national and subnational levels.
Prioritize Timely Data Sharing Over Perfect Harmonization
Effective surveillance depends on swift data-sharing across borders, but the pursuit of fully harmonized data systems has too often delayed progress. Countries may wish to adopt a pragmatic shift: agree on a minimum dataset for cross-border sharing, prioritize timeliness and usability over comprehensiveness, and build in tiered arrangements that can expand as trust and capacity grow. Experience from the Greater Mekong Subregion, including real-time case reporting between Cambodia and Lao PDR and cross-border malaria teams linking Lao PDR and Viet Nam, shows what becomes possible when fit-for-purpose mechanisms take precedence over theoretical ideals.
Empower Those Closest to the Border
Frontline health workers and subnational authorities are the most effective in responding to border malaria cases. Village malaria workers, community health teams, and district officials are best positioned to detect imported cases, engage mobile populations, and coordinate informally across borders. By formally authorizing province-to-province and district-to-district engagement, designating subnational border focal points, and investing in community trust, countries can shape subnational personnel to become its operational backbone for cross-border collaboration on malaria.
Finance Collaborations Beyond Individual Countries
Border malaria sits at the intersection of national and cross-border responsibilities, yet financing remains trapped within administrative boundaries. District health teams often cannot fund routine joint meetings or imported case follow-up because such activities fall outside existing budget lines. Where malaria burden is spread across borders, border districts can also receive lower funding priority despite disproportionate transmission risk. To sustainably finance cross-border collaborations, it will be crucial for countries to integrate cross-border malaria activities into domestic planning and budget frameworks, to enable resources to flow flexibly across programme and administrative boundaries, as well as to advocate to donors for donor financing mechanisms to support the cross-jurisdictional nature of border malaria.
Embed Malaria in Broader Health Systems
As malaria declines in much of the region, dedicated malaria programmes face shrinking political and financial attention. Integrating malaria functions into broader communicable disease surveillance, health security, and primary health care platforms can help sustain capacity and responsiveness, but only if the structural weaknesses in border health systems are simultaneously addressed. Population mobility, climate risk, socioeconomic vulnerability, and security constraints continue to undermine health system performance in many border settings, limiting the effectiveness of even well-designed integrated approaches.
Invest in Neutral Convening Platforms
In politically sensitive or security-constrained border environments, direct bilateral engagement is often difficult or impossible. Regional and neutral platforms, such as WHO's Mekong Malaria Elimination programme, PIAM-Net in the Eastern Mediterranean, and APLMA across the wider Asia Pacific – fill a critical gap. They provide trusted spaces for dialogue, build institutional memory that persists through political transitions, and help elevate border malaria from a localized operational issue to a shared regional priority. Yet these platforms are only as strong as commitments sustain them. Their sustainability depends on the active engagement, political backing, and financial contributions of national governments.
The Road Ahead
The diversity of border contexts across Asia Pacific means that there is no single, one-size-fits-all model for cross-border malaria collaboration, and that adaptive, context-sensitive approaches are needed. However, the six recommendations from this study provide a practical framework for national programmes, development partners, and regional bodies to strengthen collaboration in ways that are durable and effective.
As the region approaches its 2030 malaria elimination goal, borders will remain a critical frontier. Meeting that goal will require not just national commitment, but coordinated regional action.
Read the full policy brief from the study below.
This policy brief was also disseminated at the Regional Policy Dialogue on Cross-Border Collaboration for Malaria Elimination in Asia Pacific, as part of the APMEN Joint Working Groups Meeting 2026.
