Now We Can, Now We Must: Viet Nam's last mile in the fight to eliminate malaria

The roads into the far reaches of Lai Chau province in northern Viet Nam wind through some of the country’s most challenging terrain. At every curve, the landscape grows wilder and the villages more remote. Pa U commune health station, when it finally appears, is a modest building – but in the last mile effort to eliminate malaria in Viet Nam, it is leading the fight on the front line.

^{Pa U commune health station in Lai Chau province.}

The mountains that malaria forgot to leave

Viet Nam has made remarkable progress against malaria over the past three decades. Numbers have plummeted from millions of cases in the 1990s, down to only a few hundred in recent years. The country has set an ambitious target - stop transmission from 2027 and achieve national elimination by 2030. But the closer the finish line gets, the harder the final stretch becomes.

In Lai Chau, number of cases has declined but not disappeared. Here, Plasmodium vivax, the species capable of lying dormant in the liver and relapsing months later, continues to circulate. Classified as a severe endemic malaria zone, decades of transmission have seeded a reservoir of infection that conventional methods such as routine case detection, vector control and insecticide-treated bed nets alone cannot clear.

The answer, health authorities and international partners have concluded, lies in an older tool: going house to house, village to village, and giving everyone — infected or not — the medicine to clear the parasite from their blood.

This method of mass drug administration has become the centerpiece of Vietnam's last mile effort.

Mass drug administration’s role in the fight

Mass drug administration is not a new approach. It was used against malaria in other parts of Asia and Africa decades ago to reduce the human reservoir of infection and prevent future infections.

The strategy targets high-burden communities where transmission persists despite years of conventional control. Health workers offer free courses of antimalarial medicines to every eligible person in the area regardless of their malaria infection status. The aim is to reduce any dormant presence of the parasite by treating any existing infections and preventing new infections for the duration of the drug’s prophylactic period.

In 2024 and 2025, the Lai Chau Provincial Center for Disease Control deployed mass drug administration of chloroquine across six high-risk communes within the Muong Te area.

The results have been impressive. After two years of implementation, malaria cases in Lai Chau province fell from 93 in 2023 to just three in 2025.

One commune, one fight: the story of Pa U

One of these high-risk communes is Pa U, home to the La Hu ethnic minority group – a community whose way of life is shaped by the mountains around them. It is common practice here for people to work on distant hillside farms and sleep overnight in makeshift shelters in the forest; some not using insecticide-treated nets or other protection methods. In some cases, these workers stay there for a month or two, making it difficult for health workers to reach them.

“Some people come to us within two days of their symptoms starting – but others wait four or five days. When the fever breaks, they think they are cured. Then the next day, it comes back,” said commune health worker Ms Ly Thi Nhieu. 

^{Ms Ly Thi Nhieu, midwife and dedicated malaria officer at Pa U commune health station.}

By title, Ms Nhieu holds two distinct responsibilities at Pa U commune health station: a midwife and a dedicated malaria officer. Her two roles are inseparable as a community needs healthy children to thrive, as well as the threat of malaria to be eliminated.

At the health station, one of Ms Nhieu’s most critical tasks is microscopic examination of blood smears for malaria parasites – a procedure that requires both precision and patience. When rapid diagnostic tests can sometimes miss infections, the blood smear remains the gold standard for confirming malaria cases and identifying malaria species.

^{Malaria officer Ms Nhieu examining a blood smear slide under the microscope.}

Giving people antimalarial drugs or distributing insecticide-treated bed nets is only half the battle. “I have seen many cases where people having malaria were given the medicine,” she says, “and they stop taking it the moment they feel better.”

So community outreach is also critical, with Ms Nhieu regularly going to communities – armed with posters, a laptop, and the village loudspeaker – patiently explaining malaria symptoms, how villagers can protect themselves, how the disease can be treated, and the importance of completing the full course of treatment.

In Pa U commune, some households still call on a shaman to perform rituals or turn to traditional herbal remedies at the first sign of fever. This means precious time is lost before the parasite takes a deeper hold in the system. In a commune where a broken fever is still mistaken for being cured, Ms Nhieu knows that no drug campaign can succeed without changing people’s mindset.

And she is not alone. Malaria elimination for a community, undoubtedly, is not a one-person job. Together with her in the front line is a team of dedicated village health workers. One of them is Mr Thang Ha Do.

 

^{Mr Thang Ha Do and WHO Technical Officer Dr Nguyen Thi Thuy Van.} 

Mr Do is both a village chief and a village health worker – a combination that makes him uniquely powerful in the fight against malaria.

In nearly a decade of service to his community, he has become the bridge between the health system and the households it is trying to reach. Mr Do helps carry out community communications, explaining to the villagers in La Hu language why malaria prevention matters; distributing antimalarial medicine during mass drug administration rounds; working to convince everyone in his community to take the full drug course; and when a case is reported, he is there conducting household investigations.

Thanks to his dedication, the most recent malaria case in his village was reported in 2023.

Aiming for zero

The story of Pa U is part of a larger transformation across Lai Chau province. Of the province’s 38 communes, 30 have now met the criteria for malaria elimination.

“In the first three months of 2026, we have not recorded any malaria cases,” said Dr Tran Do Kien, Director of Lai Chau Provincial Center for Disease Control. “Moving forward, the province determines malaria prevention and control and moving toward malaria elimination is a key priority that must be maintained consistently and without interruption.”

Dr Hoang Dinh Canh, Director of the National Institute for Malariology-Parasitology-Entomology (NIMPE) said, “Viet Nam has come a long way in the fight against malaria. What was once a disease infecting over a million people and claiming thousands of lives every year, has been gradually brought under control.

“Today, we see just about less than 300 cases annually, very few deaths, and 26 out of 34 provinces and cities with no local transmission. Viet Nam is reaching close to the goal of malaria elimination by 2030. "

“This World Malaria Day, our message is clear: driven to end malaria – now we can, and now we must,” said WHO Representative in Viet Nam Dr Angela Pratt.

“Lai Chau province has demonstrated that elimination is not a distant dream. What is happening in Lai Chau is proof that the tools we have work when they are delivered with determination and care. For provinces where malaria cases are still being recorded, Lai Chau’s story is an inspiration. The finish line is within reach.”

WHO is proud to work with NIMPE and regional institutes, and partners including the Global Fund, the United Nations Office for Project Services (UNOPS), the Clinton Health Access Initiative (CHAI), Health Poverty Action (HPA) and the Vietnam Public Health Association (VPHA) to support the country’s malaria elimination efforts.