In Rwanda, as well as in other African nations grappling with the relentless challenges of malaria, public health efforts have been significantly impacted by a range of global and local factors. While substantial progress has been made in combating the mosquito-borne disease over the last two decades, a new report reveals that the battle against malaria remains far from won. Malaria cases surged to an alarming 263 million worldwide in 2023, an increase of 11 million from the previous year. The growth in cases highlights the stalled progress towards malaria eradication, underscoring the need for a renewed focus on the issue.
The surge in malaria cases is attributed to a complex array of factors, including a lack of sufficient funding, the effects of the COVID-19 pandemic on health systems, political instability in regions hardest hit by the disease, and the evolving nature of malaria itself. These factors have compounded the challenges of malaria control, especially in the most malaria-endemic regions, particularly in sub-Saharan Africa. Despite the increase in cases, the global community has managed to avert an estimated 2.2 billion cases and 12.7 million deaths since 2000, thanks to concerted global health efforts. However, the road to malaria elimination has become increasingly complicated.
Dr. James Tibenderana, an epidemiologist and the CEO of the UK-based Malaria Consortium, emphasized the paradoxical situation, noting that while significant strides had been made, the remaining journey is fraught with difficulties. In 2023, several countries, including Azerbaijan, Belize, Cape Verde, and Tajikistan, achieved certification as malaria-free, with Egypt recently joining the ranks. However, the overall global situation remains concerning, with a reported 597,000 malaria-related deaths last year, the same as the previous year. These deaths were predominantly concentrated in Africa, where malaria continues to cause a major health burden.
The main reason malaria remains so difficult to eliminate, including in Rwanda, is its transmission mechanism. The disease is spread by mosquitoes infected with the Plasmodium parasite, which makes it more challenging to control than diseases that are transmitted from person to person. Malaria continues to be endemic in 83 countries, including Rwanda, making global eradication efforts even more complex. Dr. Tibenderana pointed out that while significant progress has been made in malaria control worldwide, the intricacies of the disease’s transmission continue to evade complete elimination, even in areas like Rwanda.
The financial shortfall in malaria funding exacerbates the issue. In 2023, global funding for malaria control efforts reached $4 billion, significantly below the $8.3 billion the World Health Organization (WHO) estimates is needed annually to fight the disease effectively. This shortfall has led to shortages in essential resources such as insecticide-treated mosquito nets and antimalarial medicines, both of which are crucial in reducing the spread of malaria. Dr. Regina Rabinovich, director of the malaria elimination initiative at the Barcelona Institute for Global Health, voiced her concern, noting that the current global financial climate makes it unlikely that new sources of funding will emerge in the near future. The challenges of funding are compounded by the growing effects of climate change, wars, and other competing global health needs.
Climate change is playing an increasingly significant role in malaria’s spread. Extreme weather events, such as flooding and heavy rainfall, have created ideal conditions for mosquitoes to breed in regions previously less affected by the disease. For instance, Pakistan experienced a sharp increase in malaria cases following catastrophic floods in 2022, which led to a fivefold increase in malaria infections. Such climate-related events are exacerbating the already complex issue of malaria control, making it more difficult to anticipate and mitigate outbreaks.
Another major threat to the fight against malaria is the growing resistance of both malaria parasites and mosquitoes to existing treatments and interventions. In recent decades, resistance to antimalarial drugs has become a serious concern. In the late 20th century, for example, chloroquine, once the first-line treatment for malaria, became ineffective due to resistance. Now, there are signs of growing resistance to artemisinin, the current frontline treatment for malaria. A study published in the medical journal JAMA highlighted partial resistance to artemisinin in children with severe malaria in Uganda, and the WHO has confirmed the presence of resistance in Eritrea, Rwanda, and Tanzania. Countries such as Ethiopia, Sudan, Namibia, and Zambia are also suspected to be facing similar challenges.
Additionally, mosquitoes themselves are becoming resistant to the insecticides used in bed nets, which are one of the primary tools for preventing malaria transmission. The evolving nature of the parasite and mosquito species complicates the development of effective interventions. Dr. Tibenderana warned that the growing resistance to both drugs and insecticides could significantly hinder malaria control efforts if new treatments and methods are not introduced soon. He stressed the importance of optimizing the use of existing medicines by combining different drugs to prolong their effectiveness.
Despite these challenges, there have been positive developments in the fight against malaria. The introduction of a new type of insecticide-treated mosquito net has improved the effectiveness of bed nets in preventing malaria transmission. In 2023, 78% of the 195 million nets delivered to sub-Saharan Africa were of this new, more effective type, up from 59% in 2022. The widespread distribution of these nets has been a crucial step forward in controlling malaria in high-risk regions.
Additionally, the rollout of malaria vaccines has shown promising results. Seventeen countries have now introduced WHO-recommended malaria vaccines as part of their routine childhood immunization programs. Pilot studies in Ghana, Kenya, and Malawi between 2019 and 2023 demonstrated a 22% reduction in severe malaria hospitalizations among vaccinated children, as well as a 13% decline in deaths from any cause (excluding injuries). Dr. Mary Hamel, a malaria vaccine expert at the WHO, emphasized that a combination of vaccines, treatments, and other interventions is essential for eventually eliminating malaria. She highlighted that no single tool, such as the vaccine alone, could solve the problem; rather, a multifaceted approach that includes the continued distribution of insecticide-treated nets and other preventive measures is necessary.
Despite these advancements, much work remains to be done to tackle malaria on a global scale. The current funding gap, combined with the challenges posed by drug and insecticide resistance, climate change, and other external factors, means that the path to malaria eradication is more complicated than ever. Malaria continues to pose a significant threat to public health, particularly in sub-Saharan Africa, where it remains one of the leading causes of morbidity and mortality.
The WHO’s report emphasizes that the fight against malaria is far from over and that sustained efforts, both financially and in terms of innovative medical solutions, are needed to prevent further setbacks in the battle against this deadly disease. As global health leaders continue to push for stronger malaria control programs, the importance of international cooperation, funding, and political commitment cannot be overstated. The stakes are high, and the need for urgent action is clear to prevent malaria from once again becoming an uncontrollable public health crisis.
