Quantifying the Investment Gap, Cost of Malaria Elimination, and Returns on Investment in India: A Macroeconomic Analysis

Background Malaria continues to impose a significant health and economic burden in India, accounting for over half of cases and deaths in the WHO South-East Asia Region despite substantial progress in recent decades. Although India has committed to achieving zero indigenous malaria cases by 2027 and complete elimination by 2030 under the National Strategic Plan (NSP) 2023–2027, current investments may be inadequate to meet these targets. This study quantifies the economic burden of malaria, estimates the investment required for elimination, and assesses the potential returns on investment using a macroeconomic modelling approach. Methods A district-level SEIR model stratified by endemicity (high, low, and malaria-free districts) was applied to estimate intervention costs under three scenarios: (1) present investment; (2) NSP 2023–2027–aligned investment; and (3) intensified interventions modelled on the Mandla Malaria Elimination Demonstration Project (MEDP) plus Sri Lanka and Bhutan–based approaches. The cost-of-illness method was used to estimate the national economic burden, including treatment costs, productivity losses, premature mortality, and personal protection expenditures. Forecasting models were applied to project malaria incidence through 2035, while Disability-Adjusted Life Years (DALYs) and return on investment (ROI) were calculated to assess health and economic outcomes. Results The findings indicate that the current investment of approximately INR 6 per capita annually is insufficient. The required annual investment is estimated at INR 16,414 million, compared with INR 4,451 million allocated in 2024. Under current trends, malaria transmission would persist beyond 2035. Scaling up to NSP targets could reduce cases to two digits by 2032, eliminate deaths by 2029, and yield an ROI of 3.18. The intensified MEDP-plus scenario projected near elimination by 2030, zero deaths by 2028, and a higher ROI of 3.76. Conclusion These findings demonstrate that closing India’s malaria investment gap is both a public health and macroeconomic priority.