London School of Hygiene & Tropical Medicine

Today, the World Health Organization (WHO) released their annual report chronicling the latest statistics in the global fight against malaria. Thanks to the incredible work of governments and implementing organisations, the estimated number of malaria deaths has fallen from 625,000 in 2020 to 619,000 in 2021. This relatively small margin represents a huge success for the malaria community in the context of the ongoing COVID-19 pandemic, demonstrating that despite disruptions to prevention services and the socio-economic impact of COVID-19, we were able to largely hold the line against further setbacks to malaria control.

The elephant in the room

While there is reason to hope, this is still a sobering report that again emphasises the need for a call to arms – politically and financially. The Seventh Replenishment of the Global Fund failed to meet the estimated funding necessary to make serious gains, with approximately $3.8 billion pledged in 2021 of a required US $7.3 billion. A confluence of external factors, such as the war in Ukraine and the COVID-19 pandemic, are contributing to an increase in costs for fuel, commodities, and supply chain logistics. This changing economic environment makes for a more challenging future.

National, regional, global

At a national level, commitment remained strong and reflected the intensive efforts to deliver life-saving prevention, diagnosis, and treatment. With the support of national malaria control programmes, 128 million insecticide treated nets were distributed, 45 million children received seasonal malaria chemoprevention – up from 33.4 million in 2020 – and recommendation of the RTS,S vaccine led to approximately 400,000 children receiving their first dose in Ghana, Kenya and Malawi. This is very encouraging and demonstrates the importance of sustainable and resilient health systems. It is key that multilateral and international funding work alongside governments and local partners to build on the collective effort and expertise in endemic countries.

Unfortunately, the WHO African region continues to shoulder the burden of malaria, with 95% of cases and 96% of deaths. This will be slow to improve unless necessary resources are provided to the most vulnerable, and there is increased research into how to reach these populations.

More research

The WHO detailed the importance of four themes: response, risks, resilience, and research. LSHTM Malaria Centre and our collaborators are ideally placed to move the dial forward on innovative new research and make better, more effective, use of existing strategies in malaria control. Our members have generated key evidence for next-generation nets, are working on trials testing out new, innovative vector control tools and remain key players in the further evaluation of malaria vaccines and strategies for their combinations with other interventions. A new project focusing on evaluating country-designed strategies for Perennial Malaria Chemoprevention promises to deliver pivotal evidence to help lower the burden of cases in the age group who are most impacted. In addition, our work detecting HRP2/3 deletions contributes to the global understanding of parasite mutations, enabling the development of novel, highly sensitive rapid diagnostic tests. Together, we continue to work on innovative and exciting projects designed to further knowledge of the parasite, the vector and its environment, and the human response to malaria, to help achieve reductions in transmission and eventually to reach elimination.

Let’s talk about threats

Control of malaria relies greatly on effective treatment. This year has seen resistance emerge to artemisinin-based combination therapy in three countries in Africa – Eritrea, Rwanda, and Uganda. This worrying finding could pose serious consequences if it spreads more widely.

Likewise, the invasive mosquito species Anopheles stephensi, may hamper disease control efforts in urban environments across Africa. Uniquely urban-adapted, An. stephensi transmits both P. falciparum and P. vivax and has travelled south and west through the African continent since it was first detected in Djibouti in 2012. Across sub-Saharan Africa, the human population is being driven to migrate by powerful forces, including rural poverty and the search for economic opportunities. Today, approximately 40% of the African population is urban, and this proportion is expected to rise to 60% by 2050 – putting many more lives at risk of this new urgent threat.

Resilience to climate change is becoming an ever more important factor when planning malaria programming. Climate change will affect the geographical range, intensity and seasonality of the disease, leaving it harder to predict and causing potential disruption to treatment schedules and delivery of interventions, as well as disruptions to the supply chain. This is alongside the human factor; rural communities who often depend on agriculture are losing their livelihoods, contributing to food insecurity and increased poverty, resulting in more children being at risk of malaria.

What next?

Finally, while we greet this report with cautious optimism, stronger advocacy at a global scale and further resources to support the malaria fight are greatly needed. The R&D pipeline shows promise but requires a significant injection of finances to ensure products are fully evaluated and available for use by endemic countries. Whilst we wait for new tools, we need to work together with control programmes to consider novel strategies to deploy our already powerful interventions in innovative ways, to maximise their coverage and impact.

We remain wholeheartedly committed to the goal of zero malaria – together it is achievable.