Malaria: Drug resistance and underfunding threaten progress towards eliminating killer disease

The parasitic mosquito-borne disease is both preventable and curable but it remains a serious and deadly global health threat – claiming hundreds of thousands of lives – mostly among young children and pregnant women, predominantly in sub-Saharan Africa.

The WHO’s latest annual update shows impressive progress since 2000: intervention has saved an estimated 14 million lives worldwide over the last quarter of a century, and 47 countries are certified malaria-free.

Nevertheless, malaria remains a deadly concern. There were more than 280 million malaria cases and over 600,000 malaria deaths in 2024, with 95 per cent of cases concentrated in the Africa region – most in just 11 countries.

Resistance ramps up

A major stumbling block to the elimination of malaria is the issue of drug resistance, which warrants a separate chapter in this year’s study: eight countries reported confirmed or suspected antimalarial drug resistance, including to artemisinin, a WHO recommended treatment.

To combat this, the report recommends that countries avoid over-reliance on a single drug, while opting for better surveillance and regulatory health systems.

Underfunding – in a region rife with conflict, climate inequity and fragile health systems – is another major cause.

Some $3.9 billion was invested in the response in 2024, less than half the target set by WHO.

The report highlights that Overseas Development Aid (ODA) from wealthy countries has fallen by around 21 per cent. Without more investment, say the authors, there is a risk of a massive, uncontrolled resurgence of the disease.

‘The red lights are flashing’

“Malaria is still a preventable and treatable disease, but that may not last forever,” warned Dr. Martin Fitchet, the CEO of Medicines for Malaria Venture, a not-for-profit organisation that focuses on delivering new antimalarial drugs, at a WHO press briefing to preview the report.

“We have to act now to increase the scope and coordination of surveillance, so we're not flying blind, and boldly invest in the innovation of the next generation of medicines, so the parasite doesn't get ahead of us.”

Dr. Fitchet raised the spectre of the crisis which resulted from resistance to the anti-malarial drug chloroquine in the 1980s and 1990s.

© UNICEF/US CDC/Daylin Paul

On 25 April 2022, a detail shot of vials of the malaria vaccine at a government cold storage facility in Lilongwe, Malawi.

This led to a humanitarian disaster, with the loss of millions of lives, mainly children.

“Today we can see from this report that the red lights are flashing again with an increasing number of resistant mutations emerging in the African continent. We need to ensure that we prolong the resilience and the effectiveness of the medicines we have now.

“But our long term resilience and eventual victory in the fight against malaria depends on developing the next generation of anti-malarial medicines.”

He said the “complexity and scale of the challenge we face means that no single tool or actor can succeed alone,” he concluded, calling for partnerships that span the whole human health sector including “industry, global health agencies, academia, physicians, investigators, civil society, communities, and funders.”