Malaria Progress and Ongoing Challenges: A Global Scorecard

Every year on April 25, global health officials and researchers reflect on the fight against malaria, a deadly disease predominantly affecting sub-Saharan Africa. Although significant progress has been made, the battle against malaria is far from over. In 2025, the world observes that while some countries have made remarkable strides toward elimination, setbacks and emerging challenges threaten to stall or reverse gains.

Malaria remains a major public health concern, especially in sub-Saharan Africa, which accounts for approximately two-thirds of all cases worldwide, with 11 countries bearing the greatest burden. Despite efforts to reduce new cases, the global number of malaria infections in 2023 was around 246 million, far exceeding the targeted goal of a 75% reduction from 2015 levels. This stagnation highlights the need for renewed focus and enhanced strategies.

Between 2000 and 2015, there was an 18% decline in new malaria cases, from 262 million to 214 million. Since then, progress has plateaued, with indicators suggesting a risk of regression. Over this period, nearly 2.2 billion cases and 12.7 million deaths have been preventively managed, and 45 countries are expected to be declared malaria-free in 2025, including some in Africa like Egypt, Seychelles, and Lesotho.

However, efforts in eliminating malaria face numerous hurdles. One critical issue is the rapid evolution of the malaria parasite and mosquito vectors. These mosquitoes have adapted to avoid insecticides, especially those used in treated nets and sprayed surfaces, reducing the efficacy of traditional control methods. Resistance to insecticides like pyrethroids has become widespread, complicating vector control.

Meanwhile, the parasites themselves are developing resistance to key antimalarial drugs, notably artemisinins, which are central to current treatment protocols. Resistance has been confirmed in several African countries, including Eritrea, Rwanda, Tanzania, and Uganda. Resistance markers have also been detected in parasites from Namibia and Zambia, raising concerns about future treatment options.

Diagnostic challenges add another layer of complexity. Mutations in malaria parasites are hindering the effectiveness of rapid diagnostic tests, leading countries in the Horn of Africa to modify testing strategies to ensure early detection.

Despite these challenges, innovations and new tools are reshaping malaria control efforts. The WHO approved two vaccines, RTS,S and R21, which are now being deployed in 19 African nations, significantly reducing severe cases and mortality among children under five—by approximately 30% and 17%, respectively. Advances in insecticide formulation, such as improved long-lasting nets with new chemicals, are further enhancing protection.

Emerging strategies, including attractive toxic sugar baits, biocontrol approaches, and the release of sterilized or genetically modified male mosquitoes, are promising avenues for reducing mosquito populations. Additionally, the development of new antimalarial drugs—triple combination therapies and non-artemisinin-based medications like ganaplacide-lumefantrine—is expected within the next year or two, offering hope for combating resistant strains.

Looking ahead, the goal remains clear: to eliminate malaria from as many countries as possible and move toward a world free of the disease. While some nations have yet to achieve this milestone, the advent of innovative tools and strategies puts the international community closer than ever before. With sustained commitment, collaboration, and resource allocation, the dream of eradicating malaria can become a reality.