Malaria, one of the most pervasive diseases in human history, has plagued humanity for centuries, causing suffering and death in many parts of the world. Its origins trace back to ancient times, with evidence of the disease found in Egyptian mummies dating over 4000 years ago. The name "malaria" itself originates from the Italian words "mala aria," meaning "bad air," a historical belief linking the illness to foul air in marshy regions. Throughout history, malaria has influenced the outcomes of wars, affected economic development, and shaped societies, particularly in tropical and subtropical regions where the Anopheles mosquito thrives.
With research comes better knowledge and understanding of the disease. This article will show the progress made over time while also highlighting persistent and new challenges hindering elimination.
The University of Pretoria Institute for Sustainable Malaria Control creates a platform for diverse experts to bring their unique skills and knowledge to the table and join forces to address malaria holistically.
Progress in the battle
In recent years, significant progress in understanding and combating malaria has been made on a global scale. The United Nations Millennium Development Goals (MDGs), established in 2000, set an ambitious target to reduce the burden of malaria by 75% by 2015. Over this period, the global community has witnessed a substantial decrease in malaria-related deaths. This initiative brought together nations, organisations, and stakeholders worldwide to prioritise the fight against malaria, catalysing significant investments, especially in sub-Saharan Africa, and contributing to the replacement of failing interventions with more effective ones.
Access to life-saving antimalarial drugs has expanded, particularly in high-burden regions. This has improved the chances of survival for those infected with the malaria parasite. Indoor residual spraying (IRS) with insecticides has been effective in controlling mosquito populations. Additionally, the widespread distribution of insecticide-treated bed nets, which provide a physical barrier against mosquito bites, has played a vital role in reducing the transmission of malaria.
The focus on high-risk groups, such as pregnant women and children, saw initiatives launched to target these vulnerable populations. Preventive strategies tailored to these groups have saved countless lives. Investment in research has led to the discovery of new tools and approaches for malaria control. Collaboration between governments, international organisations, and pharmaceutical companies has resulted in bolstering healthcare infrastructure in affected regions and improving access to essential malaria interventions, including diagnostics and treatment.
Although the MDGs did not achieve their target, they did contribute significantly to substantial progress in malaria control, laying the groundwork for continued efforts in the fight against the disease. Encouraged by the results of this increased effort, the World Health Organization launched the Global Technical Strategy for Malaria, providing guidance on how malaria-endemic countries could reduce malaria transmission, and target a malaria-free world by 2030. However, the tide had already started to turn.
Challenges in the battle
Despite the notable decline in malaria cases and deaths across the region, advancements have regressed in around 13 nations, and progress has plateaued in several others, particularly after 2015. Domestic and international funding leveled off, resulting in various new, pressing challenges. Some of these challenges have been introduced from other regions, but the lack of funding just compounded the problem.
With the high adaptability of both the parasite and vector, concerning biological challenges have been increasing. The emergence of drug-resistant malaria parasites poses a significant threat. Due to parasite resistance against the artemisinin-based combination therapy (ACT) antimalarial drugs in certain regions, it is becoming harder to effectively treat and control the disease. The malaria parasites, especially the deadliest one, Plasmodium falciparum, have started evading detection by the rapid diagnostic tests used to detect the disease in people. Mosquitoes that carry the malaria parasite are becoming resistant to insecticides. This resistance makes it more challenging to control mosquito populations and reduce malaria transmission. These smart little disease-spreaders have also changed their biting habits from indoor to more outdoor feeding, where vector control isn’t focused.
A major concern is the change in climate. Malaria transmission is sensitive to climate conditions. As global temperatures rise and rainfall patterns change, including heightened flooding, malaria can spread to new or previously problematic areas, making it crucial to adapt control strategies to changing environmental factors. A possible example of this is the occurrence of Anopheles stephensi, an Asian malaria vector, in parts of Africa (from the Horn of Africa to Nigeria), which is escalating transmission in urban areas and is extremely difficult to control due to its resistance to various insecticides and its feeding on humans and animals both indoors and outdoors.
In many endemic regions, accessing remote and underserved areas is difficult, limiting the reach of healthcare services and interventions. There is also a need for robust healthcare systems in malaria-endemic countries for the efficient delivery of malaria services. This includes training healthcare workers and improving diagnostic capabilities.
The way forward
Malaria elimination can be achieved by understanding the challenges, and maintaining and even accelerating the momentum in controlling the disease. This is made possible through continued research, the development of new tools, rolling out effective interventions, and strengthening of healthcare systems. However, this all requires funding. Rising expenses linked to the global financial crisis have inflated the delivery costs of malaria interventions. The total annual resources needed in 2025 are estimated at US$ 9.3 billion and US$ 10.3 billion by 2030. But where there is a will, there is a way.
For more information, visit the webpage of the University of Pretoria Institute for Sustainable Malaria Control, a multi-disciplinary research institute making a substantial contribution towards the creation of a malaria-free Africa.