Dar es Salaam, Tanzania — Years of progress in the fight against malaria have been disrupted, but there is still hope.
A World Health Organization (WHO) report revealed a worrying setback in the fight against malaria. After years of steady decline, global cases skyrocketed in 2022, reaching a staggering 249 million - a significant increase compared to pre-pandemic levels in 2019. Despite these setbacks, the global health community hasn't given up. The ambitious goal of eliminating malaria by 2030 remains and significant progress has been made.
Malaria, a mosquito-borne infectious disease caused by a parasite, remains a significant global health challenge. Despite being deadly, malaria is preventable and curable.
At the helm of the RBM Partnership to End Malaria stands Dr. Michael Adekunle Charles, leading a unique global force united against this persistent threat. Dr. Charles commands a diverse and dedicated team, all passionately committed to eradicating this devastating disease. Their tireless efforts on a global scale are making a significant impact, but the fight is far from over.
"Our diverse partnership brings together endemic countries, the brightest minds in academia, researchers, the private sector, and government entities - all working in unison to eradicate a century-long scourge," he said.
Dr. Charles outlined the concerning resurgence of malaria. "There are several factors at play," he said. "Significant progress was made between 2000 and 2015. We saw a dramatic decrease in malaria burden, morbidity, and mortality. However, the fight against malaria is ongoing. While we strive for elimination, the mosquito is evolving, developing mutations that challenge our efforts."
He attributed this reversal to several factors, including increased mosquito resistance to insecticides, funding shortfalls for preventative measures, and the emergence of drug-resistant malaria parasites.
"Today, we face new biological threats," Dr. Charles explains. "We're seeing resistance to antimalarial medications and insecticides-treated bed nets. The active ingredients in these nets are no longer as effective in killing mosquitoes."
"Climate change is another significant factor," he added. "The correlation between climate and malaria is well-established. Increased rainfall creates more stagnant water, ideal breeding grounds for mosquitoes, leading to a rise in cases."
Dr. Charles also pinpointed political instability as a hidden driver of the resurgence. He explained that conflicts "disrupt access" to crucial medical supplies, preventing people from seeking essential healthcare, including prenatal care for pregnant women. This disruption, he argued, creates a perfect storm for malaria cases to rise.
"Funding shortfalls are a critical roadblock," he added. "We need roughly $7 billion annually to effectively combat malaria, but we're falling woefully short at just $3.5 billion. This 50% gap cripples countries' ability to procure essential resources at the critical moment and in the most affected areas."
A renewed push for elimination
In a critical step forward against malaria, WHO, alongside partners like Gavi and UNICEF, allocated 18 million doses of the first-ever malaria vaccine, RTS, S/AS01, to 12 African countries between 2023 and 2025. This rollout marks a significant weapon in the fight against a leading cause of death on the continent.
Cameroon was the first nation to integrate the vaccine into its national immunization program in January 2024, following successful pilot programs in Ghana, Kenya, and Malawi. By early February, nearly 10,000 children in Cameroon and Burkina Faso had received the RTS, S vaccine, offering hope for a region where countries like Cameroon battle an estimated six million malaria cases annually. There was a 13% reduction in malaria deaths among eligible children in Kenya, Ghana, and Malawi.
The WHO, Gavi, UNICEF, and other partners are collaborating closely with participating African countries to ensure the successful delivery and rollout of this new vaccine in the fight against malaria.
But can we reclaim the fight?
"Regaining momentum in the fight against malaria is essential," said Dr. Charles. "That's why organizations like the RBM Partnership to End Malaria are urging all stakeholders to join the cause."
"To truly defeat malaria, we need to move beyond healthcare. It's a multifaceted challenge that demands a broader coalition. We need collaboration across sectors - agriculture, education, infrastructure development - because everyone has a role to play in this fight."
"With a unified effort, we can significantly reduce the malaria burden. There is real hope. Let's work together to ensure this hope translates into action, making a real difference in the fight against this disease," he said.
"Promising results from pilot programs in Ghana, Kenya, and Malawi, where the vaccine was successfully tested, paved the way for collaboration with partners like GAVI, the Global Alliance for Vaccine Initiatives," Dr. Charles explained. "Building on this success, the vaccine rollout has now been expanded to 12 new African countries, with a primary focus on protecting children across the continent."
Dr. Charles acknowledged some challenges too.
He highlighted two key challenges: integrating the malaria vaccine with existing childhood immunization programs and ensuring accessibility. "We don't want to burden mothers with multiple trips to health facilities," he explained. "Our focus is on seamless integration and alignment with each country's existing schedule." He further emphasized the importance of accessibility: "Distance to health facilities can be a barrier. We're working with partners to overcome such obstacles and ensure these life-saving vaccines reach the most vulnerable populations."
1,000 children die daily from malaria
Malaria is a severe threat, especially to young children, who are particularly vulnerable due to their lack of immunity and the potential for developing severe malaria, which can lead to complications such as cerebral malaria, metabolic acidosis, severe anemia, acute renal failure, or acute pulmonary edema. The disease is responsible for a shocking number of fatalities, with children under five accounting for a significant portion of these deaths. In 2020, for instance, over 627,000 people died from malaria globally, and approximately 77% of these deaths were children under five, resulting in more than 1,000 daily deaths in this age group. The disease's economic burden also perpetuates a cycle of poverty, particularly in sub-Saharan Africa, where nearly half the population is at risk of contracting malaria and facing the associated medical costs.
Progress made, but challenges remain
"Despite recent setbacks, the fight against malaria in Africa shows glimpses of hope," said Dr. Charles. "Our goal is to accelerate the gains we've already made."
There's been progress in Africa's fight against malaria, with a recent case of Cape Verde being declared malaria-free in January 2024. Three African countries - Mauritius (1973), Algeria (2019), and most recently Cape Verde - have shown remarkable progress in the fight against malaria, joining the ranks of malaria-free nations. Cape Verde's journey to eliminate malaria spanned for decades. In the 1950s, all its islands were ravaged by malaria. Through targeted insecticide campaigns, they achieved malaria-free status twice, in 1967 and 1983, only to face setbacks. The WHO certification, awarded in January 2024, signifies decades of unwavering commitment.
"This is a powerful example of what's possible," he added.
"Eradication remains our ultimate goal," Dr. Charles said, "but critical areas demand immediate attention. We need new tools, increased funding, and solutions to combat resistance. The link between health and climate change can't be ignored. Continued investment and collaborative efforts are crucial to achieve this ambitious vision."
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"Hope is alive, and we're working hand-in-hand with African nations and communities," he said. "Cape Verde's success story is an inspiration. Our collective aim is to see more like it, driving us towards malaria elimination, not regression."
Dr. Charles champions the importance of a collaborative approach at the country level.
"We work with countries, stakeholders, and partners to strengthen health systems alongside fighting malaria," he explains. "It's not about which comes first - a strong health system helps reduce malaria, and tackling malaria can also be a springboard for health system improvements." He emphasizes a holistic approach: "Our interventions need to be integrated to support the whole community. Why save a child from malaria if they might succumb to pneumonia tomorrow? Strengthening health systems as a whole is key."
Priority to end malaria in Africa
"While essential tools like bed nets, medications, diagnostics, and vector control remain crucial," Dr. Charles explains, "the newly introduced vaccines offer another weapon in our arsenal. It's a combined approach that will have the maximum impact on reducing malaria."
He outlines the five-year focus: "Our goal is to unite partners, empower countries with ownership and leadership, and ensure sustainable funding. A holistic and multi-sectoral approach is essential."
"This includes collaborating with relevant sectors - everyone has a role to play," he said.
Is a world without malaria possible?
"I seriously believe it's possible. It's difficult, but as Mandela said in his quote, "It always seems impossible until it's done."
We must unite our efforts, prioritize this fight, and empower communities. We're here to amplify their voices and save lives," he stresses. " Together, I believe, it's definitely possible."
