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World Malaria Day 2023: Are we any closer to eradication?

Ending Malaria will save lives and improve the health of millions of people. But in the last 60 years, progress has faltered.

Malaria affects the most vulnerable populations, with 77% of global malaria deaths occurring in children under the age of five years old. Before 2015, significant progress was made towards reducing malaria cases and deaths. The Global Malaria Eradication Programme (GMEP) was one of the first global projects—implemented by the WHO and active from 1955 to 1969—that aimed to achieve a malaria-free world. The GMEP significantly reduced global malaria cases, eliminating the disease in many countries. Following this programme there was a focus shift from eradication to reducing the global burden of malaria, which was deemed a more realistic target. As such, in 2015, the World Health Assembly endorsed the Global technical strategy for malaria 2016-2030, which aimed to reduce the burden of malaria by 90% and eliminate infections from at least 35 more countries by 2030 (in 2021, there were 84 malaria endemic countries).

Unfortunately, since this technical strategy was released, both cases and deaths have started to rise. In 2021, there were an estimated 247 million cases and 0.62 million deaths worldwide, a 7% increase in both cases and deaths from 2015. It is thought that the COVID-19 pandemic is partly to blame for the increase in cases and deaths, due to disruptions to essential malaria services. Yet even before the pandemic, cases and deaths were rising, causing concern for how sustainable available interventions are for achieving eradication.

There are several different interventions that can be used to prevent malaria including seasonal malaria chemoprevention (SMC), indoor residual spraying (IRS), and insecticide-treated bed nets (LLINs). The implementation of preventative tools resulted in an estimated 2 billion malaria cases and 12 million deaths averted between 2000 and 2021. LLINs are considered one of the main drivers of the decline in malaria transmission and are estimated to have averted 68% of malaria cases in sub-Saharan Africa between 2004 and 2019.

In 2021, the WHO recommended widespread use of the RTS,S/AS01 malaria vaccine, the first malaria vaccine to receive recommendation and the result of 30 years of research. Based on data collected during the pilot study, the vaccine efficacy was found to be 36% against symptomatic malaria and 29% against severe malaria. When introduced alongside current preventative tools, the vaccine was found to be highly cost-effective in settings with moderate-to-high transmission.

To be able to meet the large worldwide demand, having more than one vaccine will be crucial to withstand disruptions to supply chains and other issues. Early trial results for a second malaria vaccine, the R21/Matrix-M vaccine, found that vaccine efficacy was 71% in a low-dose group and 80% in a high-dose group. To date, the WHO is still assessing the vaccine’s safety and effectiveness, however, Ghana and Nigeria have already approved this vaccine, becoming the first two countries to do so.

Malaria eradication remains aspirational, however, the development of vaccines, in combination with current cost-effective strategies, brings new hope that a reduction in the burden of malaria could be around the corner.

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