The big push to end malaria: Progress, challenges, and the road ahead

Since 2000, malaria control programs have prevented 2.2 billion cases and 12.7 million deaths worldwide. In 2023 alone, over 177 million cases and 1 million deaths were averted. The most significant progress was made in sub-Saharan Africa, where 80% of cases and 94% of deaths were averted. This is a remarkable achievement, but despite this progress, malaria remains a major public health challenge, particularly in Africa, where the disease is so deadly that one person is estimated to die from it every minute.

In 2023, 47 of the 83 malaria-endemic countries reported fewer than 10,000 cases, and 45 countries and territories have been certified malaria-free by the World Health Organization (WHO). These milestones highlight the potential for malaria elimination, particularly when there is adequate financing, strong political commitment, multisectoral collaboration, and community engagement.

Despite these successes, the battle against malaria is far from over. In 2023, there were an estimated 263 million new malaria cases globally, an increase from 252 million in 2022. The global death toll from malaria rose to 597,000 in 2023, up from 578,000 in 2015.

PATH is committed to work catalyzed by the RBM Partnership to End Malaria and the World Health Organization (WHO) to re-energize efforts to end malaria at all levels from global policy to community action. These three key themes guide the strategies and actions of partners like PATH in the fight against malaria.

Reinvesting in malaria control and elimination programs will save lives and generate significant economic returns through increased productivity, reduced health care costs, and improved quality of life. According to a Malaria No More UK report on the malaria “dividend”, a 90% reduction in malaria cases by 2030 could boost GDP in endemic countries by US$ 142.7 billion. While 2023 total investments in malaria control reached US$ 4 billion, this was far below the US$ 8.3 billion target set by the WHO Global Technical Strategy for Malaria.

Governments, donors, and the private sector must increase investment, and failure to do so will mean more cases, more deaths, and a reversal of the progress achieved over the past two decades. Replenishment of the Global Fund in 2025 will be particularly critical to sustaining malaria interventions and accelerating progress toward the WHO's malaria control and elimination targets. In recent years, approximately 65% of global malaria assistance has come from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Full replenishment for Gavi, the Vaccine Alliance, will also be essential to support the introduction and scale-up of malaria vaccines to reach and protect the children that need them most.

Through the Malaria Control and Elimination Partnership in Africa (MACEPA), PATH provides technical assistance to national malaria programs (NMPs) to support pragmatic planning and costing of optimized operational plans intended to maximize cost-effective decision-making. In Nigeria, MACEPA developed an interactive budget visualization tool to simplify complex national budgets and facilitate decision-making for the Pragmatic Costed Operational Plan. In Nigeria and seven additional African countries, MACEPA developed roadmaps to align technical support, evidence, and planning for optimizing Global Fund requests for the next funding round in 2026. These programmatic support initiatives are foundational to investing in data-driven, efficient, and cost-effective plans.

Reimagining innovation for impact is essential to overcome formidable challenges to malaria control. Resistance threatens the effectiveness of current tools, including antimalarial medicines and insecticides used for vector control. Transmission patterns and mosquito habits are shifting in the context of climate change. Continued progress will require monitoring and responding to antimalarial and insecticide resistance, as well as tailoring interventions to local contexts through data-driven strategies. Collaborations between researchers, policymakers, and program implementers are essential to identify critical questions, generate robust evidence, and rapidly translate results into action.

The PATH-led President’s Malaria Initiative (PMI) Insights project has fostered collaborations in 15 African countries between researchers, NMPs, funders, and policymakers to identify critical questions, generate evidence, and support uptake of findings to inform policy and strategy. This work included a partnership in Ethiopia with the Dire Dawa Regional Health Bureau and Dire Dawa University to evaluate larval source management as a strategy to combat the invasive and highly competent urban malaria vector, Anopheles stehensi. Under PMI Insights, an ongoing trial in Ghana led by the Kintampo Health Research Centre in partnership with the Ghana Health Service and the London School of Hygiene and Tropical Medicine is providing evidence to inform strategy around combining interventions to prevent malaria in infants. The randomized controlled trial implemented in the Atebubu-Amantin district is studying the impact of combining malaria vaccination with perennial malaria chemoprevention to reduce the incidence of malaria during the first two years of life.

PATH is supporting NMPs and their partners with evidence to address the threats of antimalarial and insecticide resistance. This work includes evidence generation to monitor antimalarial drug efficacy, assess risks that may contribute to the development of drug resistance, and plan for strategies to mitigate risk. Through the PMI Evolve project, PATH has supported NMPs with evidence generation to evaluate the effectiveness of next-generation insecticide-treated nets and insecticides for indoor residual spray.

PATH’s product development program has contributed to essential strides in improving malaria rapid diagnostic tests (RDTs). While malaria RDTs have greatly expanded the ability to confirm malaria infection prior to treatment, gaps in rapid test capabilities have included a lack of sensitivity to detect low-density malaria infections and false-negative results due to P. falciparum genetic alterations (HRP2/3 deletions). PATH’s work on next-generation RDTs has focused on enhanced sensitivity, addressing HRP2/3 deletion issues, targeting biomarkers for P. falciparum and P. vivax infections, and multiplexed platforms that can improve detection of different malaria species and strains.

Reigniting political will, community engagement, and a sense of global solidarity with a renewed sense of urgency and commitment is critical to accelerating the fight against malaria. Accelerating progress toward elimination demands renewed energy and collaboration across sectors. No single organization or country can eliminate malaria alone. We must forge stronger partnerships between governments, the private sector, research institutions, civil society, and affected communities.

Strong community engagement and community-based approaches are central to the work of the PATH-led PMI REACH Malaria project. Project partner Catholic Relief Services is supporting the delivery of community-based campaigns to deliver seasonal malaria chemoprevention, which reduces malaria cases during the high transmission season by up to 50% among children under five. The project is supporting the rollout of innovations to reach women and children living hours away from health facilities. This includes reaching pregnant women in remote areas with chemoprevention to prevent malaria and providing integrated community case management for children to diagnose and treat malaria and other diseases threatening child health and survival.

PATH’s MACEPA program is working to equip country programs, partners, and communities with better data for decision-making. MACEPA assisted NMPs in eight countries in conducting assessments and developing surveillance and digital roadmaps. This work supports strengthening malaria surveillance systems, improving data quality, and ensuring the availability of information for decision-making.

Continued progress in the fight against malaria calls for a renewed global effort to mobilize resources, innovate to overcome obstacles to elimination, and strengthen collaborations between governments, the private sector, research institutions, civil society, and affected communities. PATH will continue to work with national programs and their partners to build on past successes, overcome present challenges, and unlock critical resources in the big push to end malaria.