Is the world on track to eradicate malaria?

As the international development community marked World Malaria Day on April 25, global malaria burden remained alarmingly high, despite new tools and breakthroughs that have sparked cautious optimism among global health experts. In 2015, the World Health Organization and its partners set a bold vision: a 90% reduction in global malaria incidence and mortality by 2030, with elimination in at least 35 countries. But progress has stalled. The COVID-19 pandemic disrupted supply chains, diverted health financing, and constrained outreach efforts, eroding hard-won gains in prevention and treatment. In 2023 alone, malaria caused an estimated 260 million infections and 600,000 deaths across 83 countries. Sub-Saharan Africa accounted for a large share of these cases, with children under five constituting the most vulnerable group. Still, with the introduction of new tools — including two Malaria vaccines — some experts believe the 2030 target remains viable, albeit contingent on major scale-ups in investment, community engagement, and political will. New vaccines In October 2021, WHO recommended the expanded use of the RTS,S/AS01 malaria vaccine — also known as Mosquirix — for children in high-transmission settings. Seventeen African countries have since rolled out the vaccine.. Early outcomes are promising: data presented at a recent Johns Hopkins Bloomberg School of Public Health briefing suggest a 13% reduction in malaria mortality and a 22% drop in hospitalizations in areas where the vaccine has been administered. “Two malaria vaccines are now available. Between 2019 and 2023, 2 million children in Ghana, Kenya and Malawi had been vaccinated, and by early December 2024, 17 countries in the sub-Saharan Africa region had introduced the vaccine through routine vaccine interventions and many are expected to sign,” said Jane Carlton, director of the Johns Hopkins Malaria Research Institute, at the briefing. “We are hopeful of a significant slowdown in malaria, especially if the vaccine is used with other interventions.” For a disease that has historically resisted vaccine development, RTS,S represents a milestone. However, its modest efficacy — ranging from 30% to 40% in severe malaria prevention — has generated debate among key players, especially when weighed against the complexity and cost of deployment in resource-limited settings. “RTS,S isn’t perfect, but its value lies in complementing existing interventions — long-lasting insecticidal nets [LLINs], seasonal chemoprevention [CMC], and timely diagnostics,” said Adamson Muula, a professor of epidemiology and public health at Malawi College of Medicine. “In areas of high transmission, even partial protection can translate into thousands of lives saved.” While the logistics of vaccine delivery, particularly in rural and remote areas, remains a significant challenge, Muula said administering the full four-dose schedule demands robust health systems, trained personnel, and cold-chain infrastructure — requirements that he sadly said are not consistently met across the endemic regions. Muula, however, said to overcome these challenges, there is a need to use multiple preventive measures to ensure that the vaccine can have reasonable efficacy. The higher-efficacy R21/Matrix-M vaccine, which has a malaria-specific antigen, developed by the Jenner Institute at Oxford University and Serum Institute of India, was approved in 2023 — after demonstrating up to 77% protection against malaria in clinical trials. The R21 vaccine became available in mid-2024 and has since been rolled out in several African countries, including Côte d'Ivoire, Mozambique, Ghana, Nigeria, and Burkina Faso. The Central African Republic has also authorized its use. Meanwhile, Mali has adopted a hybrid approach to vaccine delivery, deploying both the R21 and RTS,S vaccines. Climate dynamics Despite the optimism, experts warn that malaria’s future trajectory is increasingly influenced by climate dynamics. According to WHO, climate change is increasing the risks of malaria transmission globally, and in Africa alone, it is projected that climate change will lead to 550,000 additional malaria deaths between 2030 and 2049. While countries such as Kenya have made significant strides in their malaria response, experts say climate change could lead to a resurgence of malaria in new areas and intensify the disease in regions where it is already endemic. They warn that warmer temperatures and increased rainfall could expand mosquito breeding grounds, while higher temperatures could also accelerate the parasite's development within mosquitoes, leading to increased malaria transmission. “The malaria situation in Kenya has declined since 2015. A study has shown a reduction in mortality and hospitalization, which is good news, but there is a worrisome finding, however indicates that the invasive Anopheles mosquito appears to have migrated in urban Kenya, and this would lead to a rise in urban malaria,” said Carlton. Researchers note that at 18 degrees Celsius, the malaria parasite matures in about 15 days. Since the average lifespan of a female Anopheles mosquito is roughly three weeks, rising temperatures could give the parasite more time to become infectious. “A rise in temperature, rainfall, and humidity is likely to cause a proliferation of the malaria-carrying mosquitoes at higher altitudes, resulting in an increase in malaria transmission in areas in which it was not reported earlier,” Dorothy Memusi, a researcher and former deputy director of the malaria division at Kenya's Ministry of Health told China Daily. To anticipate and mitigate this shift, experts say there is an urgent need for investment in climate-informed surveillance systems that can integrate epidemiological data with environmental indicators to map outbreak risks in near real time. WHO and its regional partners are also leveraging climate modeling to guide vector control strategies and resource allocation. “Climate change is not a distant threat — it’s already reshaping malaria transmission patterns,” Chikwe Ihekweazu, WHO’s acting regional director for Africa, said during a high-level briefing on Malaria. “Surveillance systems must adapt accordingly, and they must do so fast.” Funding constraints According to WHO, global malaria response received $4 billion in funding in 2023, less than half the $ 8.3 billion needed annually to meet global targets. The consequences are especially severe in high-burden countries such as the Democratic Republic of the Congo and Mozambique, where under-resourced health systems are stretched thin. While international mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria continue to play a critical role, experts warn that domestic resource mobilization must be strengthened if long-term sustainability is to be achieved. Cuts in development aid, including those to malaria programs, could also undermine global efforts to control and eliminate the disease, potentially leading to a resurgence of malaria cases and deaths, especially among vulnerable populations. “It is important to know that malaria is a poverty disease, and it is disproportionately poor and marginalized populations which often have poor housing infrastructure and access to prevention technologies that are bearing the brunt of malaria,” said George Dimopoulos, deputy director at Johns Hopkins Malaria Research Institute. In March 2024, ministers of health of the 11 African countries that suffer from about two-thirds of the world’s global malaria burden pledged to increase their commitment and funding to malaria control programs, improve their data systems, bolster health sector infrastructure, and expand multisectoral collaboration. Alongside funding, innovation will be central to accelerating progress. Beyond vaccine development, this includes next-generation insecticides, improved diagnostics, and digital surveillance tools that enable more agile response strategies. While aid gaps could significantly undermine the malaria control efforts, hindering implementation of essential interventions, reducing access to treatment and slowing down research and innovation, countries need to adapt strategic use of data to have a better understanding of where malaria efforts are working, and where more focus is needed, according to Arnaud Le Menach, lead author of the 2024 World Malaria report. “Beyond any one specific intervention, countries should adopt data-driven, cross-cutting strategies that will lower the malaria burden. That might also mean working to improve primary healthcare or building regional partnerships,” he said. Community engagement and ensuring that interventions are context-specific, culturally appropriate, and delivered equitably are also essential, Dimopoulos said. The Zero Malaria Starts with Me campaign, now active in more than 25 African countries, has helped amplify grassroots action and political commitment. Meanwhile, some countries, notably China, El Salvador, and Algeria, have achieved malaria-free certification in recent years, proving that with sustained investment and coordination, elimination is possible — even in formerly high-transmission settings. “There’s reason for hope,” said Carlton. “We have better tools, more data, and more engaged stakeholders than ever before. But to get to zero, we must act with urgency — and we must act together.”