Monica Racovita

Monica Racoviță

The fight against malaria has seen impressive accomplishments, but are we on track to meet the 2030 targets?

25 April 2022

mosquito on a mosquito net

On World Malaria Day, we revisit the UN and WHO goals to tackle this disease with a focus on sub‑Saharan Africa, the hardest‑hit region.

In pre-COVID times, I travelled to East Africa for a work trip. I had to take preventive anti-malaria medication, as the area had a high risk for the disease. I also had to use mosquito repellent on my skin and clothes, and insecticide-infused mosquito nets while I slept. If followed, these strategies should reduce risks for a traveller to a minimum.

For people living in regions affected by malaria, long-term preventive anti-malarial medication is not an option. Its long-term use can interfere with naturally acquired immunity and drive up the parasite’s resistance. Prevention instead includes insecticide-treated nets, indoor insecticide sprayings and/or short‑term chemoprevention during malaria season. It might not seem much, but even these measures were scarce roughly 20 years ago.

Although malaria is preventable and curable, it has a high global burden. In 2020 alone, there were 241 million people living with malaria, and the disease was responsible for 627,000 deaths. Sub-Saharan Africa is heavily affected by malaria: 95% of global cases and 96% of global deaths occur there. Heartbreakingly, over 80% of all malaria deaths in the region occur in children under 5 years old.

young Black male lying on a blanket behind a mosquito net

Sub-Saharan Africa is heavily affected by malaria: 95% of global cases and 96% of global deaths occur there.


Infection from malaria-causing parasites can be fatal

Malaria is caused by one of the five Plasmodium parasites, which are transmitted to people through the bites of infected female Anopheles mosquitoes. In sub-Saharan Africa the deadliest of these species, the P. falciparum, is the dominant one.

Once a person is infected, symptoms appear in 10–15 days and consist of fever, chills, joint pain and headache. Left untreated, malaria can lead to death within 24 hours. In infections with P. vivax and P. ovale, the parasites can sometimes remain dormant in the liver for up to four years. When they emerge from hibernation, the person can become sick again.


The past 20 years has seen significant progress in tackling malaria

A target of the United Nations’ Sustainable Development Goals (SDGs) and of the World Health Organization’s policies, the fight to eliminate malaria has seen impressive global accomplishments in the past 20 years. Mortality rates (deaths per 100,000) were halved in 2015 compared with 2000; incidence (cases per 1,000 people at risk) reduced from 81 in 2000 to 56 in 2019; deaths in children under five years old reduced by 10% in 2020 compared with 2000; and several countries in Asia and the Americas became malaria free. In terms of prevention, 65% of households in sub-Saharan Africa had at least one net treated with insecticide in 2020 (up from 5% in 2000); and the number of children with access to seasonal malaria chemoprevention increased from 0.2 million in 2012 to 33.5 million in 2020.

In 2021, a vaccine for children was announced that would target the deadliest of the parasite species, the P. falciparum. The vaccine can be provided in four doses, from the age of five months. Pilots in Ghana, Kenya and Malawi found that the vaccine was safe, that it showed a 30% reduction in severe, deadly malaria, and that it’s highly cost-effective.


An anti-malaria vaccine being given to a person

The emergence of biological threats is of serious concern for malaria: gene changes in the parasite’s genome render common biomarkers useless, which affects diagnosis and surveillance.


COVID-19 has brought fresh challenges

Bad news in the fight against malaria is the impact of COVID-19 and the service disruptions it has brought. But the fight was losing steam even before the pandemic, with progress plateauing or even declining. The causes are complex but among them the emergence of biological threats is of serious concern: gene changes in the parasite’s genome render common biomarkers useless, which affects diagnosis and surveillance; resistance to artemisinin affects the efficacy of antimalarial treatment; mosquitoes’ resistance to insecticides affects vector control; and an invasive species of mosquito native to parts of Asia and the Arabic Peninsula, resistant to many insecticides, is spreading in the Horn of Africa.

Initial global targets for malaria were a reduction of case incidence and mortality rates by 40% by 2020, 75% by 2025 and 90% by 2030 from a 2015 baseline. The numbers seen in 2020 are off track by approximately 40%.

Sub-Saharan Africa, the hardest hit by the disease, now faces a convergence of threats: on top of biological threats, it deals with the ongoing disruptions of the COVID-19 pandemic, an uncertain economic path and, in certain places, humanitarian disasters.


A great deal has been achieved but much remains to be done

Although in theory preventable and curable, malaria has proven difficult to eradicate. Bringing it down to the ambitious levels set up by the World Health Organization and the SDGs involves behavioural changes, access to prevention strategies, accessible health systems prepared to diagnose and treat promptly, and funding and political will for a concerted and sustained effort.

On World Malaria Day, we rejoice at the success stories and hope for continued efforts to tackle this deadly disease.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.