The eradication of malaria

My career didnt start in a quiet newsroom. As a foreign correspondent for Time magazine, I traveled to remote locations with a notebook and recorder in hand. In the summer of 2005, I found myself in Mae Sot, a small Thai town near the Myanmar border, reporting on global health heroes. My assignment took me to a rural medical clinic operated mostly by and for refugees fleeing Myanmars military government. The overwhelming reason patients sought care there was malaria.

Despite Southeast Asias progress against malaria, it remained a serious problem in Mae Sot. I observed rows of patients lying motionless in mosquito-netted beds, feverish and weak. Returning to Hong Kong a few days later, I contracted malaria myself. After several days of intense chills and high fever, I recoveredbut hundreds of thousands are not so fortunate. In 2023 alone, over 260 million people contracted malaria, and nearly 600,000 died, the majority being young children in sub-Saharan Africa.

Malaria has plagued humanity for over 10,000 years and was long considered an unavoidable burden. Today, however, the disease is preventable. Since 2000, global malaria deaths have been cut roughly in half. The World Health Organization (WHO) estimates that between 2000 and 2023, malaria prevention and treatment efforts prevented about 2.2 billion infections and 12.7 million deaths. Countries such as China, Sri Lanka, and Paraguay have been declared malaria-free, and many others report only a few cases annually. A child born in Africa today faces a far lower risk of dying from malaria than one born in 2000.

Yet progress has slowed. Since the mid-2010s, reductions in malaria cases and deaths have plateaued. Mosquitoes are developing resistance to common insecticides, and malaria parasites in parts of East Africa are showing partial resistance to standard medications. Climate change is extending transmission seasons and spreading mosquitoes into new regions. The COVID-19 pandemic disrupted both bed net campaigns and routine care. WHO data shows 263 million cases and 597,000 deaths in 2023, an increase of about 11 million cases from the previous year, with deaths remaining largely unchanged.

There is, however, promising news. In November, researchers announced a breakthrough in malaria treatment: a new drug called GanLum, combining ganaplacide and a once-daily form of lumefantrine. GanLum achieved a 97.4% cure rate. Ganaplacide attacks the parasite in a novel way, interfering with its protein transport system, and works even against strains partially resistant to other medications in Rwanda, Uganda, and Eritrea. Novartis plans to seek regulatory approval and provide it at no profit in countries where malaria is endemic.

On the prevention side, two effective malaria vaccines are now available for children in high-risk African regions: RTS,S/AS01 and R21/Matrix-M. RTS,S has already been administered to over 1.8 million children in Ghana, Kenya, and Malawi, reducing infections, hospitalizations, and deaths. R21, developed by the University of Oxford and the Serum Institute of India, shows over 70% efficacy in highly seasonal transmission areas and can be produced cheaply and at scale, with a current capacity of 100 million doses per year, priced under $4 each. More than 20 African countries are introducing or preparing to introduce one of these vaccines into routine immunization programs. Vaccinating around 50 million children over the coming years could save over 100,000 lives.

So why are nearly 600,000 people still dying annually? The main barriers are funding and political commitment. WHO reports that global malaria spending falls billions short of targets. Funding from wealthy nations has stagnated or declined. Cuts and freezes to initiatives like the US Presidents Malaria Initiative affect mosquito net distribution, medication supply, and vaccine rollout. Underfunding could result in millions of additional cases and hundreds of thousands of preventable deaths by 2030. Some southern African countries are already experiencing malaria resurgences linked to funding gaps.

Malaria is now more scientifically manageable than ever. The remaining challenge is political and financial. The future of malariawhether deaths continue or declineis now a matter of choice. Reflecting on that clinic in Mae Sot, the once inevitable suffering of children no longer feels unavoidable. We know it is possible to change the outcome. The question is which path we take.

Malaria: The Path Ahead

As we reflect on the progress made against malaria, it's clear that we stand at a crossroads. The battle against this ancient disease has seen significant strides in the past two decades, with the reduction in deaths by nearly 50% and a new generation of vaccines and treatments offering renewed hope. Yet, despite these breakthroughs, malaria remains a persistent global health challenge, claiming nearly 600,000 lives annually.

The introduction of promising treatments like GanLum and vaccines such as RTS,S and R21 signals a turning point in the fight against malaria. However, their success hinges on the sustained political will and financial commitment from the global community. The funding shortfalls reported by the WHO are concerning, as they threaten to undo much of the progress made and set back malaria control efforts. It's not a question of whether we have the tools to eliminate malaria—it’s about whether we choose to deploy them effectively.

The battle against malaria, while more scientifically manageable than ever, is now in the hands of policymakers and global leaders. The true measure of success will be their ability to prioritize funding, support research, and ensure that malaria control programs reach those most in need. If we choose the right path, the suffering that once seemed inevitable can be avoided. The next steps are crucial in deciding whether the progress made can be sustained or if we risk losing ground.

Sources:

• The end of malaria