Vector control, vaccines, and preventive medicines each bring unique strengths to malaria prevention efforts.
New insecticides are critical for combating resistance in mosquito populations and ensuring the continued effectiveness of widely used interventions such as insecticide-treated bed nets and indoor residual spraying. Vaccines RTS,S and R21 represent a breakthrough in reducing malaria morbidity and mortality, offering protection for children in areas with high and moderate transmission of Plasmodium falciparum, the deadliest form of the malaria parasite. Preventive interventions, such as seasonal malaria chemoprevention and intermittent preventive treatment in pregnancy, among others, protect the two populations most at risk: children and pregnant women.
While each of these tools has significant benefits on its own, their combined use creates a multilayered defense against malaria that is far more powerful than any single intervention. All three are needed to prevent malaria and reduce deaths in different populations and contexts.
Protecting and treating children and pregnant women is and should remain the priority for the global malaria community, as they are the hardest hit by the disease.
For young children, vaccines offer new hope, especially when combined with preventive measures such as vector control and seasonal malaria chemoprevention. For example, evidence shows that using seasonal malaria chemoprevention and the RTS,S vaccine together provides greater protection than either intervention alone, highlighting the importance of integrated strategies.
Vector control and preventive medicines are the only options for children under 5 months of age, school-aged children, and pregnant women. However, coverage of these tools remains alarmingly low, reaching only a fraction of those who need them. In 2023, 40% of people in sub-Saharan Africa had no access to an insecticide-treated net in their household, and only 44% of pregnant women received the recommended three doses of preventive malaria medicine, according to the WHO World Malaria Report.
By addressing the needs of children and pregnant women through a combination of tools, the global malaria community can make strides — not only in reducing malaria deaths but also in alleviating the long-term social and economic burdens associated with the disease.
However, even the best tools will fall short without delivery systems that reach patients. To maximize the impact of these tools, deployment must be guided by integrated and tailored strategies. This means considering how each tool’s strengths can complement others within the national or subnational context.
Achieving this calls for a commitment to evidence-based decision-making, informed by clinical trials and real-world data on the combined use of the tools. These insights are critical to understanding how best to distribute resources and interventions effectively.
In a world of constrained public health budgets, evaluating cost trade-offs is equally important. Rigorous pharmaco-economic and health-technology assessments should guide decisions to ensure the greatest possible impact and value for investment within each local context.
Finally, deployment must be led by relevant community leaders and health workers to ensure it is practical, sustainable, and culturally appropriate. Implementation research is key to achieving this.
While the current set of malaria prevention tools has brought us closer to zero deaths, gaps still remain. Closing these and eliminating malaria will require sustained investment in research and development efforts.
Several promising technologies on the horizon are poised to address current challenges, including drug and insecticide resistance and moving beyond the prevention of individual cases to reaching disease elimination. Innovative vector control solutions, long-acting injectable medicines, and next-generation vaccines are among the advancements with the potential to address these challenges.
Insecticide resistance is projected to intensify in the coming years. To stay ahead of this threat, the development of new active ingredients for insecticide-treated nets will be vital. These novel solutions will play a key role in preserving the effectiveness of vector control tools.
Long-acting injectable medicines represent another innovative approach, bridging the gap between prevention and elimination. By targeting high-risk groups such as children and pregnant women, these preventive treatments can deliver focused protection where it’s needed most. Over time, their scalability and cost-effectiveness will enable broader community coverage, significantly advancing malaria elimination efforts.
Next-generation vaccines, now undergoing clinical testing, are also showing great promise. Utilizing multi-antigen and multi-stage approaches, these vaccines aim to provide higher efficacy, longer-lasting protection, and simpler dosing regimens.
Together, these advancements could redefine how we prevent malaria and bring us closer to reaching elimination.
It will take a strong commitment from public health leaders, governments, and global organizations to ensure these tools are accessible and widely adopted, and that their implementation is tailored to the needs of each community. Each tool addresses a different facet of the malaria burden, and together, they have the potential to make a significant impact against malaria.
This effort requires a level of investment, coordination, and political commitment that transcends typical public health campaigns. But the costs of inaction are even greater. Malaria’s toll is not just a public health crisis; it is a long-standing obstacle to social and economic progress in many countries. Achieving zero malaria deaths is not just an ambitious goal — it is a moral imperative.
Let’s not miss this moment. Working together, we can make zero deaths from malaria a reality.
This opinion piece has been co-authored by Ashley Birkett, global head of bacterial and parasitic diseases at PATH's Center for Vaccine Innovation and Access; Cristina Donini, executive vice president, head of research, early development and modelling at Medicines for Malaria Venture; Justin McBeath, CEO of Innovative Vector Control Consortium; and Keziah Malm, program manager at the National Malaria Elimination Program of Ghana.
Learn more about medicines for malaria prevention: https://www.mmv.org/research-development/rethinking-chemoprevention