Key messages

Malaria by numbers: global and regional malaria burden

In 2018, there were an estimated 228 million cases of malaria in 89 countries. No significant gains were made in reducing malaria cases in the period 2014 to 2018. The estimated number of malaria deaths in 2018 stood at 405 000, a similar number to the previous year.

The WHO African Region accounted for 93% of malaria cases and 94% of deaths worldwide in 2018. More than half of all cases were in 6 countries: Nigeria (25% of cases); Democratic Republic of the Congo (12%); Uganda (5%); as well as Côte d’Ivoire, Mozambique and Niger (4% each).

Global targets and funding

In view of recent data and trends, two critical targets of the WHO Global technical strategy for malaria 2016–2030 – reducing malaria case incidence and death rates by at least 40% by 2020 – will be missed. As such, progress towards the malaria-specific target of the Sustainable Development Goals, which calls for ending malaria worldwide by 2030, is also off track.

In 2018, total funding for malaria control and elimination reached an estimated US$ 2.7 billion, falling far short of the US$ 5 billion funding target of the global strategy. Nearly 70% of malaria funding was provided by international sources. Governments of malaria-endemic countries contributed about 30% of total funding.

Gaps in access to core interventions

The latest World malaria report highlights major coverage gaps in access to core WHO-recommended tools for preventing, detecting and treating malaria, particularly in the world’s highest burden countries.

• In 2018, only half (50%) of the population at risk of malaria in Africa slept under an insecticide-treated net, a similar figure to the previous year and a marginal improvement since 2015.
• About third (31%) of eligible pregnant women in Africa received the recommended 3 or more doses of preventive malaria therapy in 2018.
• Over the period 2015 to 2018, a high proportion (36%) of children in sub-Saharan Africa showing signs of a fever did not receive any medical attention.

“High burden to high impact”

As a response to recent data and trends, WHO and the RBM Partnership to End Malaria have catalyzed “High burden to high impact”,  a new approach to intensify support for countries that carry a high burden of malaria, particularly in Africa. The approach is founded on 4 pillars:

1. Political will to reduce malaria deaths
2. Strategic information to drive impact
3. Better guidance, policies and strategies
4. A coordinated national malaria response

Pillar 1 calls on leaders of malaria-affected countries to translate their stated political commitments into resources and tangible actions that will save more lives. To this end, campaigns that engage communities and country leaders – like “Zero malaria starts with me” – can foster an environment of accountability and action.

“Zero malaria starts with me”

The “Zero malaria starts with me” campaign – first launched in Senegal in 2014 – was officially endorsed at the African Union Summit by all African Heads of State in July 2018. The campaign engages all members of society: political leaders who control government policy decisions and budgets; private sector companies that will benefit from a malaria-free workforce; and communities affected by malaria, whose buy-in and ownership of malaria control interventions is key to success.

Signs of hope

While progress in the global response to malaria has levelled off, a subset of countries with a low burden of malaria is moving quickly towards elimination.  In 2018:

• 49 countries reported fewer than 10 000 indigenous malaria cases, up from 40 countries in 2010
• 27 countries reported fewer than 100 malaria cases, up from 17 countries in 2010.

Countries that achieve at least 3 consecutive years of zero indigenous cases can apply for an official WHO certification of malaria elimination. In 2019, 2 countries were certified malaria-free: Algeria and Argentina. Globally, a total of 38 countries and territories have achieved this milestone.

Some countries with a high burden of malaria are also making strong strides in reducing their burden of the disease.

• India, a country that carries 3% of the global malaria burden, registered 2.6 million fewer cases in 2018 over the previous year.
• Uganda, which carries 5% of the burden, reported 1.5 million fewer cases in 2018 compared to 2017.

Prospects for new interventions

Boosting investments in the development and deployment of a new generation of malaria tools is key to achieving the 2030 global malaria targets. Future progress in the fight against malaria will likely be shaped by technological advances and innovations in new tools, such as new diagnostics and more effective antimalarial medicines.

The WHO Director-General recently issued a “malaria eradication challenge,” calling on the global health community to ramp up investment in the research and development of innovative and transformative tools and approaches.

Vector control

A number of new tools and technologies for malaria vector control have been submitted to WHO for evaluation. If these tools demonstrate efficacy in controlling the disease, WHO will formulate new policy recommendations or amend existing ones to support their deployment in malaria-affected countries. Tools currently under evaluation include, for example, new types of insecticide-treated nets, spatial mosquito repellents, vector traps, gene-drive approaches and sugar baits designed to attract and kill Anopheles mosquitoes. See here for an overview.

Malaria vaccine

In 2019, 3 countries – Ghana, Kenya and Malawi – introduced the RTS,S malaria vaccine in selected areas through a WHO-coordinated pilot programme. The vaccine has been shown through rigorous clinical trials to reduce four in 10 malaria cases in young children. Evidence and experience from the programme will inform future policy decisions on the vaccine’s potential wider deployment.

The vaccine programme has been launched in partnership with Ministries of Health of the 3 countries, PATH, and GSK, the vaccine manufacturer. The programme is funded through contributions from Gavi, the Vaccine Alliance, the Global Fund and Unitaid.