Key messages

Invest

According to WHO’s World malaria report 2022, the funding gap between the amount invested in the global malaria response (US$ 3.5 billion) and the resources needed (US$ 7.3 billion) has widened, particularly over the past 3 years – increasing from a shortfall of US$ 2.6 billion in 2019 to US$ 3.5 billion in 2020 and US$ 3.8 billion in 2021.

Despite the significant contributions of countries and partners, the Seventh Global Fund replenishment raised US$ 15.7 billion against an expected target of at least US$ 18 billion. With the changing economic environment, the funding space for the malaria response has become increasingly challenging.

In this resource-constrained environment, a better targeting of available funding is essential. Funding should be prioritized for the most vulnerable populations who are less able to access services and hardest hit when they become ill. Adequate and predictable financing is essential to sustain progress in efforts to combat malaria.

Innovate

Despite recent setbacks in malaria control, investments in R&D played a crucial role in reducing the global burden of malaria over the last 2 decades. The development and massive roll-out of rapid diagnostic tests (RDTs), insecticide-treated nets (ITNs) and artemisinin-based combination therapies (ACTs) have been the backbone of the malaria response since 2000. Continued investment in the development and deployment of next-generation tools will be key to achieving the 2030 global malaria targets.

In the vector control space, there are 28 new products in the R&D pipeline. Tools under evaluation include, for example, new types of insecticide-treated nets, targeted baits that attract mosquitoes, spatial repellents, lethal house lures (eaves tubes) and genetic engineering of mosquitoes. Should these tools demonstrate efficacy in controlling the disease, WHO will develop new policy recommendations or amend existing ones to support their deployment in malaria-affected countries.

A number of malaria vaccines are currently in development. Like the RTS,S vaccine, many of them target the malaria parasite before it enters the human liver where it can quickly multiply. The most advanced of these candidates is R21, which recently completed Phase 3 clinical trials. Other vaccine candidates seek to stop transmission of the malaria parasite, and still others to protect women during pregnancy.

New diagnostics are also on the way. To address problems around HRP2/3 gene deletions, which compromise the performance of RDTs that detect P. falciparum malaria, researchers are pursuing the development of diagnostics that use alternative biomarkers. Non-invasive diagnosis using saliva and urine is another growing area of investigation, with potential for rapid screening outside of conventional medical settings.

In the field of antimalarial medicines, developing non-ACT treatment options is a priority for researchers in the face of the emergence and spread of partial resistance to artemisinin. Next-generation medicines are in the development pipeline – such as “triple ACTs” that rely on a combination of artemisinin and 2 partner drugs to mitigate the risk of drug resistance. Other medicines under evaluation use different chemical entities as an alternative to artemisinin and its derivates; four such medicines are currently in clinical trials.

Implement

Malaria-affected countries and partners are strongly encouraged to deliver the WHO-recommended tools and strategies that are available now for all at risk of malaria – and particularly those most vulnerable.

According to the latest World malaria report, countries have made some progress in expanding access to malaria services for most-at-risk populations. However, too many people at high risk of malaria are still missing out on the services they need to prevent, detect and treat the disease.

Challenges in expanding access to malaria services have been compounded, particularly in sub-Saharan Africa, by the ongoing COVID-19 pandemic, converging humanitarian crises, restricted funding, weak surveillance systems, and declines in the effectiveness of core malaria-fighting tools.

To address these threats and support countries in building more resilient malaria programmes, WHO recently published new guidance, strategies and frameworks. WHO has also increased the transparency, flexibility and access to its malaria recommendations.

In addition to addressing the technical challenges facing implementation, there is a critical need to address the barriers people face in accessing quality health services. Investments in well-functioning health systems, built on a foundation of primary health care, can address people’s health needs close to where they live and work while, at the same time, reducing the cost of care and enhancing equity.