With malaria vaccines poised to be rolled out on a wider scale in 2024, Dr Jackie Cook addresses the barriers still being faced by those striving to reduce the global burden of this deadly disease

This year’s WHO World Malaria Report makes sobering reading and highlights the persistent challenges hindering further progress towards reducing the malaria burden. Of these, particularly concerning are the spread of the invasive mosquito species, Anopheles stephensi, now found across multiple countries in sub-Saharan Africa; the persistence and spread of drug and insecticide resistance in the parasites and vectors, respectively; and the funding shortfall threatening some of the gains that have already been achieved.

We have tools which work, such as bed nets and chemoprevention, but currently, they are not reaching everyone in need and without further funding or innovative strategies to utilise these tools, it is difficult to see how we will further reduce the malaria burden globally. New interventions for malaria control are slowly becoming available but funding constraints mean that countries are now forced to pick between utilising new tools or funding existing ones.

However, there are also signs for hope in the report: we now have two efficacious malaria vaccines that will begin wider community roll-out imminently, contributing to saving many children’s lives new types of bed nets have been recommended to overcome challenges of resistance, and several countries have made further steps towards elimination, including Cape Verde, Timor-Leste and Saudi Arabia.  

A key focus of the report addresses the impacts of climate change. In the short-term, we’ve already seen increases in transmission in highland areas that were previously malaria-free and the deadly effects in Pakistan, where floods recently resulted in an unprecedented malaria epidemic. Longer-term, climate change is likely to negatively impact on health system structures and potentially increase conflict and population displacement, putting greater numbers of people at risk of disease. We must future-proof health systems and interventions against the impacts of climate change in order to tackle this aspect of malaria control alongside the other big challenges highlighted in the report.