World Malaria Report 2022: Progress against malaria is stalling – what needs to change?

Today, the World Health Organization (WHO) published its World Malaria Report for 2022, assessing global and regional malaria trends over the last year and providing an opportunity to reflect on progress towards global targets.

The message from WHO this year is one of resilience, despite the disruptions of the COVID-19 pandemic to malaria prevention, testing and treatment, malaria endemic countries and their partners largely held the line against further setbacks to malaria control in 2021. The reality is that despite no further significant increases in malaria deaths in the report period, progress is stalling, or reversing. So, what needs to change to buck this trend?

James Tibenderana, Malaria Consortium Chief Executive commented: "To make a lasting impact in reducing malaria cases and deaths, more needs to be done to strengthen the quality and accessibility of primary healthcare, shifting focus from treating disease to preventing it, strengthening structures at all levels of the health system within localised agendas and appropriately resourcing the ambitions of national governments to reduce the impact of diseases, like malaria, on their populations no matter their location or means.”

“This is a priority for Malaria Consortium and has underpinned all our activities this year, working alongside governments and national partners. Our newly published Impact Report demonstrates our commitment to reducing the burden of disease and enabling stronger health systems capable of providing better health for all.”

Health systems rooted in strong primary healthcare services can provide more appropriate, effective care to a greater number of people. It is fundamental to strengthening the resilience of health systems so that they can meet a wide range of shocks, particularly at a time when global financial resources for health and malaria are constrained. Alongside its critical work to eliminate malaria, Malaria Consortium is focused on achieving universal health coverage, delivering tailored interventions that improve equity by providing quality health services to marginalised and hard-to-reach populations.

The WHO Global technical strategy for malaria 2016-2030 (GTS) ambitiously set out the target of reducing malaria case incidence and mortality rates by at least 75 percent by 2025 and at least 90 percent by 2030 against a 2015 baseline. As it stands, the data for 2021 suggests targets are off track by 48 percent and, if this trajectory continues, will be off track by as much as 88 percent by 2030.

Biological risks are rising as mosquitoes that transmit malaria are developing resistance to the insecticides used to repel or kill them and genetic mutations in some malaria parasites are making them less visible to commonly used rapid diagnostic tests, and more resistant to artemisinin, the major drug component of artemsinin-based combination therapies (ACT) for malaria. In the Greater Mekong, resistance to some partner drugs within ACTs have also been confirmed. Meanwhile, a new urban-adapted mosquito species that transmits malaria has begun to spread in Africa.

As a result of these and other challenges, including inadequate funding, the coverage and effectiveness of some essential malaria control interventions is declining. This is especially true of pyrethroid-only insecticide-treated nets (ITNs), which have been the bedrock of a highly successful malaria response for 20 years. Development of insecticide resistance in diverse locations requires targeting based on local data to select the right ITNs and the right approaches to maintain their effectiveness and use. All of these risks raise serious concerns for national malaria programmes and global partners seeking to eliminate malaria and the same determination as that shown when faced with the devasting COVID-19 pandemic, needs to be shown here to overcome these challenges.

For the first time, the report includes sections dedicated to surveillance and response, research and development and emerging threats such as drug and insecticide resistance, further emphasising their importance. To make the progress that is needed, it will be necessary to use the tools and resources that are already available even more efficiently and, crucially, harness the power of innovation so as to optimise impact and get ahead of the curve.

Malaria Consortium advocates strongly for national institutional capacities to be enhanced and greater resources provided towards surveillance and response. This must include developing data-use cultures along information chains from service delivery points to national level, and onwards to regional and global levels. While multilateral and international funding is still vital to driving down the global malaria burden of which there stands a gap of $3.8 billion, greater domestic financing and national leadership are essential in ensuring sustainable, resilient health systems and ultimately reaching elimination.

Despite the stalling in recent years of the significant progress in reducing malaria occurrence and deaths, there is also cause to be hopeful. In addition to ground-breaking developments in bringing malaria vaccines to market, a record 45 million children were reached with seasonal malaria chemoprevention (SMC) and, for the first time, children in Uganda and Mozambique also received this intervention. Malaria Consortium, working closely with national partners, was responsible for delivering SMC to 20 million of this total and is leading the intervention’s expansion into these new geographies.

“The World Malaria Report 2022 is yet again a reminder of the huge disease burden of malaria and the challenges we face in its elimination. It also shows that we can deploy proven interventions at substantial scale. With a world free of malaria as our target, we should remain resolute and focused on the job we collectively need to do”, James Tibenderana.

Read our 2022 Impact Report: Unlocking Universal Health Coverage