Globally, the number of malaria cases has plateaued since 2015 and, in certain regions, has even begun to rise. That comes after declining numbers for 20 years. What is happening?
During the 1990s, billions of dollars were devoted by charitable organizations, governments, and private philanthropists to malaria control. By 2010, they aimed to reduce the global mortality toll from malaria by half.
Malaria was one of the world's worst health hazards at the time. Every year, the sickness claimed the lives of at least a million individuals, the great majority of whom being young children.
In 1998, the "Roll Back Malaria" campaign was formally launched. Partner groups began distributing mosquito bed nets and indoor pesticide sprays in afflicted areas with support worth billions of dollars from international institutions such as the World Bank and the World Health Organization. In order to treat patients in regions where mosquitoes had developed resistance to chloroquine, the primary antimalarial medication available at the time, they also devised other medications.
In fewer than 20 years, these initiatives succeeded in cutting the number of malaria fatalities in half.
Stagnation followed by a dramatic rise in the number of malaria cases
However, things began to stagnate in 2015. The estimated number of cases remained constant for a few years before beginning to grow.
Malaria fatalities worldwide reached a six-year peak in 2020. Additionally, the predicted number of malaria cases worldwide increased dramatically from around 230 million in 2014 to over 248 million in 2022.
Nicholas White, a malaria expert and professor of tropical medicine at the University of Oxford, published a plea to the WHO in the Lancet medical journal in response to these depressing projections. He added that their own estimates of the number of malaria cases in 2000 and 2022 were exactly the same.
He wondered what was wrong if this was true. Was it truly true that despite billions of dollars of worldwide investment, years of preventive therapy research, and billions of treatments, instances had not decreased?
The WHO replied to White's query that he had misinterpreted the data since he hadn't included world population increase.
"If the global malaria incidence and mortality rate in 2000 were applied to populations at risk annually to 2020, the investments made over the past 20 years would have contributed to an estimated 11 million lives saved and 1.7 billion cases averted since 2000," WHO said.
The organization's reaction headline said, "The message on malaria is clear: progress has stalled."
An 'arms race' to combat malaria
Organization says delay causes are "complex". In its answer to White, it said sub-Saharan Africa, the malaria-endemic region, had less resources and worse treatment. They claimed "biological threats" undermine tools.Malaria-spreading mosquitoes' capacity to adapt to and avoid measures may explain the stalemate, according to DW experts.
Jackie Cook, co-director of the Malaria Center at the London School of Hygiene and Tropical Medicine, told DW that many malaria-carrying mosquitoes and parasites have become resistant to the main insecticide and to malaria drugs.
For the past 10 years, a new mosquito called Anopheles stephensi has been seen in East Africa. Unlike other malaria carriers, the stephensi can move around in cities, which makes people who live in crowded cities vulnerable.
"You have to see malaria control as an arms race," Umberto D'Alessandro told DW. He is a malaria expert and the head of the Medical Research Council Unit in Gambia for the London School of Hygiene and Tropical Medicine.
He said that mosquitoes and other bugs change as quickly as pesticide sprays, medicines, or quick tests are made. "It's a continuous search for intervention."
Researchers also say that money for malaria study is going down. According to the WHO, funding for malaria research and development hit its lowest point in 15 years in 2022, the most recent year known to have records.
"In 2007, Bill and Melinda Gates announced they wanted it [malaria] eliminated... in their lifetime, which I think is extremely unlikely, but there was a big push to try and do that," Cook explained. "Obviously there have been successes, but I think people are starting to realize it's not going to be a very straightforward thing."
Calling for a close look at the malaria problem
White, a malaria researcher at Oxford, disagrees with the notion that the lack of progress can be fully explained by the vectors' quick ability to avoid treatments.AWH's figures of malaria cases have "not been analyzed in depth," White told DW. "At least that I'm aware of—and I should be aware of it." This is why they think malaria has gotten worse since 2015.
He said he thinks a lot of the slowdown is caused by things that aren't health systems' fault, like "war, poverty, and economic downturn," as well as "things that nobody wants to talk about, like corruption and inefficiency."
The DW asked the WHO for a response. They sent the question to Abdisalan Noor, who wrote the answer to White but no longer works at the WHO. He didn't answer when asked for a statement.
In its 2023 World Malaria Report, the WHO said that the lack of progress in the 11 countries most affected by malaria was due to problems with getting health care, continued wars, COVID's impact on service delivery, a lack of funds, and problems with treatments such as drug resistance.
In the fight against the sickness, vaccines are also becoming more important. The RTS,S and the R21/Matrix M are the only malaria vaccines that have been approved by the WHO so far. The RTS,S has already been sent out, and the R21 will begin to be sent out in May 2024. Experts are hopeful, but they warn that shots aren't a magic bullet.
