New findings published today by the World Health Organization (WHO) in its 2023 World Malaria Report have revealed that the number of malaria cases globally rose between 2019 (pre-pandemic) and 2022. Cases rose by 16 million in this period, from 233 million to 249 million.
This figure is now 7% higher than prior to the pandemic, when cases were at 233 million.
Africa continues to carry the highest burden of malaria overall, with 94% of malaria cases globally and 95% of deaths. However, the five million additional cases observed between 2021 and 2022 were mainly concentrated across five countries: Pakistan, Ethiopia, Nigeria, Uganda and Papua New Guinea. In Pakistan, case incidence jumped five-fold.
In 2022, there were an estimated 608,000 malaria deaths compared to 576 000 in 2019. The COVID-19 pandemic saw major disruptions to malaria services, and malaria incidence and mortality rates rose as a result. Since then, malaria-endemic countries have been able to stabilise rates again with the help of partners around the world. However, the data from WHO shows that the world is in a worse position with malaria now than it was prior to 2019.
For the first time, WHO has also identified climate change as an increasing threat in the fight against malaria. Malaria is extremely sensitive to climate change as temperature, rainfall and humidity all influence several dynamics of malaria transmission, including malaria vectorial capacity. Climate change can additionally have numerous indirect effects on malaria transmission as a result of reduced access to essential health services and disruptions to the supply chain of critical malaria commodities (such as insecticide-treated nets and medicines), as well as population displacement and rising food insecurity and malnutrition.
One of the anticipated impacts of climate change is that malaria cases will be seen in different geographies to where cases are concentrated today. The report warns that a warming of places that are currently malaria-free could result in the disease emerging there; this has already been observed in the African highlands. The new areas impacted could be especially prone to malaria epidemics, given low immunity levels in the local populations. Other areas, meanwhile, could experience fewer malaria cases as they acquire conditions that are unsuitable for mosquitoes.
The rise in extreme weather events experienced around the world is further expected to be problematic, potentially leading to large epidemics of malaria, as seen in Pakistan following the 2022 floods. Numerous indirect effects of climate change are also anticipated, as a result of displaced populations and interrupted supply chains and services.
Dr Michael Charles Adekunle, CEO of the RBM Partnership to End Malaria, said:
"This report should be a stark warning to world leaders that we must do more to address malaria now. Key milestones that were targeted for 2020 have still not been reached owing to many variables such as COVID-19, political uncertainty and inadequate funding. WHO has made it clear that the world is a long way from being malaria-free.
The effects of climate change and extreme weather events are already being felt and new places are seeing malaria cases spike, for example they rose sharply in Pakistan in the wake of floods.
Every year we wait will make elimination that much harder, as climate change accelerates and adds to the pressures we are already facing as a result of strained resources and rising resistance to tools. Ending malaria can still be achieved but only if we act and invest now."
Progress made due to countries' anti-malaria efforts is still encouraging. An estimated 549 million cases and 2.82 million deaths were averted between 2020 - 2022, thanks, among other factors, to malaria programmes, tools and treatments.
Additionally, there have been key developments in malaria prevention this year, with the recommendation of a second vaccine (R21) by WHO, which is now due to be scaled-up alongside the existing RTS,S vaccine. There has been a major scale-up of seasonal malaria chemoprevention (SMC), with the number of children treated in the last decade rising from 0.2 million in 2012 to 49 million last year.
Countries with low case numbers have also been progressing well towards elimination. This year Azerbaijan, Belize and Tajikistan were officially certified malaria-free. Cabo Verde, Timor-Leste, Saudi Arabia, Bhutan and Suriname also all reported zero indigenous cases in 2022.
Nevertheless, this progress is unlikely to be enough to hold back the tide as the threat of climate change converges with the current and growing challenges which include:
- Insecticide resistance
- Inadequate funding
- Rising antimalarial drug resistance in Africa
- The invasion of the Anopheles stephensi mosquito vector in a growing number of countries in Africa
- Humanitarian crises in 41 malaria-endemic countries between 2019 and 2022. Many of these countries saw significant increases in malaria.
Interventions such as bed nets, the vaccine and SMC, while critical, cannot solve the problem alone, and while malaria spending reached $4.1 billion globally in 2022, this is well below the $9.3 billion estimated to be needed by 2025.
Joy Phumaphi, Board Chair of the RBM Partnership to End Malaria and African Leaders Malaria Alliance Executive Secretary said:
"We must act now to address the multiple threats we are facing in the fight against malaria. We must address the serious funding gaps, linked to the ongoing global financial crisis, through integrated and innovative financing, address the threat of drug and insecticide resistance by fast-tracking newer, highly effective next generation medicine, insecticides and mosquito nets and recognise that we cannot turn the tide against malaria if we do not take urgent action to address the increasing threat of climate change on health."
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Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria said:
"The report accurately describes the impact of climate change on health, highlighting shifting geographies, changing seasonal patterns and extreme weather events - all aligned to make it more difficult to shrink the malaria map," said "Ending malaria can still be achieved if we act now. But every year we lose, the effects of climate change will make this harder."
The RBM Partnership to End Malaria is calling on donor countries, leaders and policymakers to increase their support in the fight to eradicate malaria around the world, before it is too late.
At COP28 The RBM Partnership will also be articulating key areas in which governments, multilateral organisations and other key stakeholders can support. This includes asking for support for the guiding principles for financing climate change and health solutions to alleviate the impacts of climate change on malaria, as well as advocating for political leadership to highlight the connection between malaria and climate change and to invest in data and science, to ensure the most effective and equitable response
