Introduction

Malaria is thought to have exerted more influence on the history of humankind than any other infectious or metabolic disease due to its notably high morbidity and mortality rates extending over millennia of coevolution (Garcia, 2010). Despite multiple control measures and treatments, malaria remains an alarming global health issue, affecting millions of people worldwide. The World Health Organization (WHO, 2023) reported for 2022 an estimated 249 million malaria clinical cases and 608,000 fatalities in 85 malaria-endemic countries. The greatest burden was in sub-Saharan Africa, which contributed 82% of global incidence and 94% of deaths, followed by Southeast Asia with 10% of cases and 3% of fatalities. Consistently, the most susceptible groups are children under 5 years of age, pregnant women, and immunocompromised individuals, such as patients with HIV/AIDS. The causative agents of malaria are protozoan parasites of the genus Plasmodium that are transmitted via the bite of infectious female Anopheles spp. mosquitoes. These insect vectors require freshwater bodies, commonly in many tropical and subtropical countries, as primary sites for reproduction (Hamza & El Rayah, 2016). Among six plasmodial species that are known to naturally infect humans, P. vivax and P. falciparum are responsible for the vast majority of clinical cases worldwide, with the latter accounting for more than 80% of all recorded incidence in Vietnam (Thanh et al., 2015).

The Mekong Delta is the world’s youngest but third largest river basin. Spanning an area of over 40,000 km2 of southwestern Vietnam between Ho Chi Minh City and Cambodia, it is connected by a network of tributaries to the last 250 km of the Mekong River before emptying into the East Sea (also known as the South China Sea). Home to 18 million people, the Delta yields half of Vietnam’s rice output and 65% of its aquaculture produce, contributing 17% of the country’s gross domestic product (General Statistics Office of Vietnam, 2023). During the past decade, this “rice basket of Vietnam” has seen major socioeconomic development, resulting in rapid changes in malaria vector ecology. As recently as 1992 it was considered a malaria-endemic region, with over 360,000 confirmed diagnoses and 516 deaths (Erhart et al., 2004a). However, following concerted prevention, detection and treatment efforts both incidence and mortality rates reduced considerably, with the implementation of the National Malaria Control and Elimination Program (NMCEP) in the 1990s serving as a significant milestone. More recently, underpinned by strong political commitment and driven by advances in malaria control, the Greater Mekong Subregion (GMS), consisting of nations intersected by the 4,909 km-long Mekong River, ratified a malaria elimination plan to eradicate the disease by 2030 (Cui et al., 2018). The six countries involved are China (Yunnan Province), Myanmar, Laos, Thailand, Cambodia and Vietnam. However, this demanding but admirable objective has confronted a slew of obstacles that necessitates a multifaceted and collaborative approach.

Since the Mekong Delta is a regionally important economic and diplomatic crossroads (Vietnam Chamber of Commerce and Industry, 2023), it is of the utmost importance to understand existing issues in order to develop or refine social, economic or public health initiatives. This article evaluates the rationale, implementation, and current effectiveness of Vietnam’s ongoing malaria-eradication program in the Delta by drawing cross-regional and national comparisons – with a view towards future implementation.