A bed with mosquito net
Africa bears 95% of malaria deaths as resistance rises
Funding gaps and drug resistance jeopardise malaria fight
Geneva: The World Health Organization (WHO)’s latest malaria assessment arrives with numbers that can be read two ways: as proof that the world already has the tools to curb the disease, and as evidence that the window to sustain that progress may be narrowing. According to the World Malaria Report released today, the deployment of newer interventions — from dual-ingredient mosquito nets to WHO-approved vaccines — prevented an estimated 170 million cases in 2024 and averted roughly one million deaths. To WHO officials, these figures demonstrate that vaccines, updated vector-control strategies, and expanded preventive drug administration are yielding measurable benefits when countries can implement them at scale.
The report chronicles that since 2021, when the WHO recommended the world’s first malaria vaccines for routine immunisation, 24 countries have adopted them into national programmes. Preventive medication for children during high-transmission seasons has broadened to reach about 54 million children in 2024, compared with a base of just 200,000 children twelve years earlier. Meanwhile, dual-ingredient mosquito nets — developed in response to widespread resistance to older pyrethroid-only versions — are replacing earlier generations in multiple high-prevalence regions. Taken together, these shifts point to a structural modernisation of malaria control rather than isolated pilot deployments.
But the same report shows that the global disease burden did not fall last year; it increased. WHO estimates that 282 million malaria cases and 610,000 deaths occurred in 2024 — about nine million more cases than the previous year — and the African Region continued to account for about 95 per cent of malaria fatalities, most of them among children under five. Progress in eliminating the disease has continued in specific geographies — Cabo Verde and Egypt were certified malaria-free in 2024, with Georgia, Suriname and Timor-Leste joining that list in 2025 — yet these successes sit alongside the reality that most high-burden countries are seeing either stagnation or reversal.
The obstacle repeatedly identified in the report is neither public compliance nor the failure of countries to adopt newer tools. It is biological resistance on multiple fronts. Parasites exhibiting partial resistance to artemisinin — the core compound in standard malaria therapies — have now been confirmed or suspected in at least eight African countries. Signs of declining efficacy among the partner drugs typically combined with artemisinin suggest that resistant strains are continuing to evolve. The situation mirrors earlier breakdowns of chloroquine and sulfadoxine-pyrimethamine, and the WHO authors describe the trend as an emerging threat to global elimination efforts rather than a contained anomaly.
Vector control is facing its own erosion. Rapid diagnostic tests, once a decisive tool for high-volume screening, are compromised in areas where parasites lack the pfhrp2 gene targeted by the tests. Resistance to pyrethroids has been confirmed across dozens of countries, weakening the protective effect of earlier generations of insecticide-treated nets. Overlaying that is the spread of Anopheles stephensi, an adaptable mosquito capable of thriving in dense urban centres and resistant to many of the insecticides widely used in public health campaigns. That shift threatens to re-anchor malaria in environments previously considered low-risk: crowded cities with overstretched health systems.
The report does not attribute these biological shifts to single causes but lists a convergence of pressures: intensive insecticide use, incomplete treatment courses, substandard drugs, climate-linked habitat expansion, and growing mobility between regions with different resistance profiles. At the same time, the global funding landscape has stalled. Spending on malaria reached about US $3.9 billion in 2024 — less than half the US $9.3 billion annual target set by the Global Technical Strategy for Malaria 2016–2030. Funding shortfalls translate into lengthened intervals between mosquito-net replacement cycles, delays in vaccine rollouts, reduced data collection and missed treatment campaigns in remote communities. Several planned malaria surveys were cancelled or postponed due to cuts in Official Development Assistance, leaving surveillance systems weaker in high-burden nations.
Environmental volatility has added another complication. Extreme weather events, including floods and rainfall anomalies, have expanded mosquito breeding sites in parts of Africa and South Asia. Temperature fluctuations have shifted transmission seasons in some regions, making planning cycles less predictable. The report notes that while the scientific basis for climate–malaria interactions continues to develop, major outbreaks following cyclones, heavy rains and displacement events have become harder to manage in the absence of robust monitoring systems.
Conflict and instability remain a dominant factor in the places with the highest malaria burden. Disrupted healthcare provision leads to untreated infections, delayed diagnosis and breakdowns in supply chains for rapid tests and medication. Populations on the move — whether displaced by conflict or economic hardship — often arrive in low-capacity regions where health infrastructure cannot keep pace. The WHO analysis portrays this as cyclical: conflict reduces health coverage, malaria rises, health systems strain further, and resources needed for prevention never rebound.
The result is a picture of progress dependent on conditions that are increasingly difficult to secure. The WHO Director-General, Tedros Adhanom Ghebreyesus, said the availability of new vaccines and improved nets justifies optimism but warned that increasing cases and deaths, deepening drug resistance and financial constraints could erase the gains made over the last twenty years if political and financial commitments weaken. His statement was blunt about the stakes: the technologies are working, but the ecosystem in which they operate is becoming more adversarial.
The report also carries a message for research and pharmaceutical innovation. The chief executive of Medicines for Malaria Venture, Martin Fitchet, argued that the development of non-artemisinin combination therapy — citing Ganaplacide-Lumefantrine as an example — indicates that drug pipelines can respond to resistance trends if investment is sustained. For WHO, the operational priority remains translating political commitments into tangible deployments rather than pilot projects. The agency points to the Yaoundé Declaration as a benchmark for malaria-endemic countries to maintain long-term focus, while initiatives such as the Big Push are described as attempts to consolidate external funding and technical support into a coherent field response rather than scattered campaigns.
The report’s data suggests that the fight against malaria is at a hinge point. The most effective interventions ever developed are currently in the field, and they are saving lives on a large scale. Yet the pathogen, vector, climate and financing environments are shifting in ways that favour resurgence. If the next decade becomes defined by drug breakdown, diagnostic limitations and stalled net replacement — rather than vaccine expansion, preventive therapy uptake and strengthened surveillance — the world could enter a period where preventing malaria demands more resources just to hold the line rather than reduce the burden.
Whether the year turns out to be a year of warning or a turning point will depend less on scientific breakthroughs than on policy decisions: whether high-burden countries maintain long-range investments when emergencies compete for resources; whether external funding rebounds; whether replacement drugs reach the field before resistance overwhelms existing regimens; and whether surveillance programmes, rather than becoming budget casualties, expand fast enough to keep pace with shifting mosquito behaviour and climate anomalies. The tools exist. The question the WHO report leaves open is whether the systems needed to use them — money, logistics, stability and political attention — will exist at the scale required.
– global bihari bureau
