By Gift Briton

The global malaria cases and deaths remained stable despite continued COVID-19 disruptions to malaria services, a new World Health Organization(WHO) report has revealed.

According to the World malaria report 2022, around 619 000 malaria deaths occurred globally in 2021 compared to 625 000 in 2020. Furthermore, although cases increased from 245 million in 2020 to 247 million in 2021, the rate was slower compared to 2019 where cases increased by over 13 million.

“We face many challenges, but there are many reasons for hope. By strengthening the response, understanding and mitigating the risks, building resilience, and accelerating research, there is every reason to dream of a malaria-free future,” Dr. Tedros Adhanom Ghebreyesus, WHO Director-General said.

In 2021, over 128 million insecticide-treated bednets (ITNs) were distributed globally as a primary vector control tool used in most malaria-endemic countries.  However, eight countries (Benin, Eritrea, Indonesia, Nigeria, Solomon Islands, Thailand, Uganda, and Vanuatu) distributed less than 60% of their ITNs, and seven countries (Botswana, Central African Republic, Chad, Haiti, India, Pakistan, and Sierra Leone) did not distribute any ITNs.

Also, seasonal malaria chemoprevention (SMC) interventions, which are recommended to prevent the disease among children living in areas with highly seasonal malaria transmission, reached nearly 45 million children in 15 African countries, a major increase from 33.4 million in 2020 and 22.1 million in 2019.

At the same time, despite supply chain and logistical challenges during the pandemic, most countries succeeded in maintaining malaria testing and treatment during the pandemic with malaria-endemic countries distributing a record number of 223 million rapid diagnostic tests (RDTs) and estimated 242 million Artemisinin-based combination therapies (ACTs) in 2021 compared to 239 million in 2019.

However, despite significant successes, the report shows that efforts to contain malaria still face many challenges, particularly in the African Region, which shouldered about 95% of cases and 96% of deaths globally in 2021.

Disruptions during the pandemic and converging humanitarian crises, health system challenges, restricted funding, rising biological threats and a decline in the effectiveness of core disease-cutting tools threaten the global response to malaria, with Dr Matshidiso Moeti, WHO Regional Director for Africa urging that new tools—and the funding to deploy them—are urgently needed.

The total funding for malaria in 2021 was US$ 3.5 billion, which still falls below the estimated US$ 7.3 billion required globally to stay on track to defeat malaria. At the same time, a decline in the effectiveness of core malaria control tools, most crucially ITNs, is impeding further progress against malaria. Threats to this key prevention tool include insecticide resistance such as insufficient access, loss of ITNs due to the stresses of day-to-day use outpacing replacement and changing behaviour of mosquitoes, which appear to be biting early before people go to bed, and resting outdoors, thereby evading exposure to insecticides, the report reads.

Other risks are also rising, including parasite mutations affecting the performance of rapid diagnostic tests; growing parasite resistance to the drugs used to treat malaria, and the invasion in Africa of an urban-adapted mosquito that is resistant to many of the insecticides used today.

Key opportunities to accelerate progress

WHO has launched two strategies to support countries in the African continent as they work to build a more resilient response to malaria including a strategy to curb antimalarial drug resistance and an initiative to stop the spread of the Anopheles stephensi malaria vector.

Therefore, the report notes that countries are set to benefit from long-lasting bednets with new insecticide combinations and other innovations in vector control, including targeted baits that attract mosquitoes, spatial repellents and genetic engineering of mosquitoes. New diagnostic tests are also under development, as are next-generation life-saving medicines to respond to antimalarial drug resistance.

From late 2023 onwards, millions of children living in areas of highest risk of illness and death from malaria are also expected to benefit from the life-saving impact of the world’s first malaria vaccine, RTS, S with other malaria vaccines in the product development pipeline.

These opportunities cannot be fully exploited without intensified efforts to ensure that nobody is left behind. Malaria-endemic countries should continue to strengthen their health systems, using a primary health care approach, to ensure access to quality services and interventions for all in need, the report notes.