Each year the World Health Organization (WHO) releases their World Malaria Report (WMR), a global assessment of the latest malaria control and elimination trends. This year’s WMR reviewed four key themes (response, risks, resilience, research) that highlighted the great strides made in the malaria community to prevent malaria cases and deaths – and unpacked the continued and emerging threats towards malaria elimination. Although the COVID-19 pandemic caused disruptions in malaria services as well as country-level impacts on health, social, and economic systems, results showed that the pandemic did not greatly impact malaria control efforts in 2021. While malaria cases continued to rise between 2020 to 2021, they did so at a much slower rate compared to 2019 to 2020, with estimates showing that 2 billion global malaria cases were averted between 2000 to 2021. Dedicated commitment from national malaria control and elimination programes (NMPs) and partners allowed countries to implement multiple malaria control tools and hold the line against malaria setbacks in 2021.
The WHO African Region continues to hold the heaviest burden of malaria, with 95% of global malaria cases and 96% of global malaria deaths. The eleven High Burden to High Impact (HBHI) countries largely held the line against malaria during the pandemic, and five of these countries (Democratic Republic of Congo, Ghana, India, Niger, and the United Republic of Tanzania) had a decline in malaria deaths in 2021 compared to 2020. Countries in the Greater Mekong subregion (GMS) continued their path towards elimination by battling antimalarial drug resistance.
Access to seasonal malaria chemoprevention (SMC) greatly expanded last year, with nearly 45 million children treated in 2021 compared to 22.1 million in 2019. PSI played a role in ensuring access through Impact Malaria’s SMC campaigns in four countries, reaching over 5 million children. Delivery of intermittent preventive treatment of malaria (IPTp) and artemisinin-based combination therapies (ACTs) as well as the use of rapid diagnostic tests (RDTs), remained stable during the pandemic. While most global insecticide treated net (ITN) distribution remained strong in 2021, eight countries distributed less than 60% of their nets and seven countries did not distribute any of their nets as planned during the year.
We are off track to meeting 2030 global malaria goals. Global malaria progress continues to be thwarted by a variety of threats. The pandemic, restricted funding, health system restraints, biological threats, humanitarian crises, and a decline in the effectiveness of core tools were all challenges listed in the 2021 WMR – challenges that must be addressed promptly to achieve global malaria goals.
Despite these challenges, NMPs and partners have demonstrated resilience in their malaria control and elimination efforts, which was exemplified during the pandemic. New tools and strategies have been deployed to help vulnerable countries increase their resiliency, especially those facing threats from climate change, humanitarian crises, drug resistance, and the spread of new vectors. One example of this comes from the Plus Project, which actively engages with the NMPs in the four focus countries to understand and influence policy related to chemoprevention to include or expand perennial malaria chemoprevention (PMC) as part of the MoH’s malaria prevention strategies.
Data surveillance systems, such as the District Health Information System 2 (DHIS2), have been key to surveillance efforts and malaria knowledge management. We work closely with NMPs and partners in each target country to support expansion of DHIS2 implementation, to build capacity on data use, and to ensure tools are integrated into DHIS2 such as data from our eLearning platform, Kassai, and our Health Network Quality Improvement System (HNQIS). Thanks to our close working relationship with the University of Oslo, many features that are available on PSI’s custom HNQIS Android app are now part of core DHIS2.
Finally, a rich research and development (R&D) portfolio is critical to unveiling next generation tools to reduce the global impact of malaria, such as the RTS,S vaccine and future next generation vaccines that will be scaled up for distribution in the coming years.
The development and scale up of long-lasting ITNs, such as pyrethroid-PBO nets, may help overcome high pyrethroid resistance and provide a more durable solution for vector control efforts. Similarly, the development of new ACTs can help mitigate the threat of drug resistance.
PSI’s Call to Action
The results of this year’s WMR motivate us to work harder and smarter in our fight against malaria. Health system strengthening will remain critical to achieving our elimination goals and PSI’s malaria interventions are a critical entry point for strengthening health systems through public, private, and community networks at each level. With priority areas of vector control, chemoprevention, case management, and surveillance, we will continue our work to ensure that people affected by malaria around the world can seek quality prevention, diagnosis, and treatment services.
Director, PSI Malaria