Summary of World Malaria Report 2021

In 2020, 29 of the 85 countries that were malaria-endemic accounted for 96% of malaria cases. India contributed 1.7% of malaria cases and 1.2% deaths globally.
Between 2019 and 2020, all high burden to high impact (HBHI) countries except India reported increases in cases and deaths (and in India, the rate of reduction decreased compared with pre-pandemic years).
Globally, there were an estimated 241 million malaria cases in 2020 in 85 malaria endemic countries, increasing from 227 million in 2019. Most of this increase came from countries in the WHO Africa Region, which accounted for 95% cases.
Malaria deaths increased by 12% globally in 2020 compared with 2019, to an estimated 627 000. The percentage of total malaria deaths in children aged under 5 years reduced from 87% in 2000 to 77% in 2020.
There were an estimated 14 million more malaria cases and 47 000 more deaths in 2020 compared to 2019 due to disruptions to services during the pandemic. However, things could have been far worse if not for the efforts of malaria-endemic countries to maintain essential health services.

WHO South-East Asia Region

There were nine malaria endemic countries in the WHO South-East Asia Region in 2020, contributing to 2% of the global burden of malaria cases. In 2020, the region had 5 million estimated cases and 8 900 estimated deaths(reductions of 80% and 77%, respectively, compared with 2010), representing the largest decline in any of the WHO regions.
Three countries accounted for 99.7% of the estimated cases in the region. India being the largest contributor (82.5%), followed by Indonesia (15.6%) and Myanmar (1.6%).
India accounted for 83% of estimated cases and about 82% of all malaria deaths in the WHO South-East Asia Region.
In 2020, about 512 000 cases were reported in WHO South East Asia. Indonesia accounted for the highest proportion of reported cases in the Region (49.6%), followed by India (36.4%).
The gap between reported cases and estimated cases in India in 2020 is due to the adjustments made for care seeking and diagnostic testing rates, which were affected in some states by disruptions in services due to the COVID-19 pandemic.
Continuing the declining trend, reported malaria deaths in the Region dropped to 147 in 2020 – a 94% reduction compared with 2010. India, Indonesia and Myanmar accounted for 63%, 22% and 7% of the total reported deaths in the region, respectively.

In the WHO South-East Asia Region, first-line treatments for P. falciparum malaria include artemether-lumefantrine (AL), artesunate-mefloquine (AS-MQ), AS-PY (artesunate- pyronaridine), artesunate plus sulfadoxine-pyrimethamine (AS+SP) and dihydroartemisinin- piperaquine (DHA-PPQ).
Therapeutic efficacy studies (TES) of AL conducted in Bangladesh, India and Myanmar between 2015 and 2020 found high efficacy with all treatments.
In India, overall treatment failure rates with AS+SP remained low, but one study from Chhattisgarh detected a high prevalence of dhfr and dhps mutations, indicating decreased sensitivity to the partner drug, SP.

As part of the Malaria Vaccine Implementation Programme, WHO recommended the RTS,S malaria vaccine for pilot introduction in selected areas of three African countries: Ghana, Kenya and Malawi in January 2016.
Data from the pilot introductions have shown that the vaccine has a favourable safety profile; significantly reduces severe, life-threatening malaria; and can be delivered effectively in real-life childhood vaccination settings, even during a pandemic.
On 6 October 2021, WHO recommended that the RTS,S malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission.