Malaria
Overview
Malaria remains a significant global public health burden, with an estimated 263 million cases and 597,000 deaths worldwide in 2023. The majority of this burden, approximately 94% of cases and 95% of deaths, occurred in Africa, where children under five and pregnant women are particularly vulnerable. Despite substantial progress in reducing malaria incidence and mortality between 2000 and 2015, the decline has slowed since 2015, posing ongoing challenges. These challenges include the emergence of drug resistance (e.g. artemisinin resistance), the evolution of insecticide resistance, stagnant funding, weakened health systems (exacerbated by events like COVID-19), and the overlapping impacts of conflict and climate change.
Malaria is caused by protozoan parasites of the genus Plasmodium, which are transmitted to humans through the bite of infected female Anopheles mosquitoes. These mosquitoes typically bite between sunset and sunrise. The malaria parasite's life cycle unfolds in two main phases: an exoerythrocytic (liver) phase and an erythrocytic (red blood cell) phase. After an infected mosquito injects sporozoites into a person, these parasites travel to the liver, infect hepatocytes, and multiply asexually without causing symptoms for a period of 8 to 30 days.
Beyond deaths directly attributable to malaria, the disease led to the loss of 55.2 million disability-adjusted life years (DALYs) in 2021.
WHY MALARIA MATTERS
Malaria is not merely a health issue; it is a profound societal and economic challenge. It is tragically impactful on children, with those under five years old accounting for 76% of malaria-related deaths in the WHO Africa region in 2023, where 95% of all deaths occur. This pervasive disease has long-term consequences, contributing to ongoing cognitive impairment, reduced lifetime earnings, and lower national prosperity.
Furthermore, malaria disproportionately affects disadvantaged and marginalised populations, who often encounter significant geographical, cultural, financial, and communication barriers to accessing quality healthcare.For instance, Indigenous Peoples in remote, forested areas of countries like Brazil, Venezuela, Colombia, and Peru face high malaria transmission and compound challenges from external pressures such as illegal mining.
Addressing malaria is a "triple win": it leads to healthier children, fosters smarter economies, and contributes to a fairer world, often with cost-effective interventions.
CONFRONTING THE CHALLENGE: STRATEGIES AND INNOVATIONS
The multifaceted nature of malaria necessitates comprehensive prevention and curative approaches, as uncomplicated cases can rapidly escalate to severe malaria if left untreated. Global and national efforts are underpinned by strategic interventions:
Diagnosis: Early and accurate diagnosis is critical. Traditional methods include clinical observation, microscopic detection of parasites from blood smears, and antigen-based rapid diagnostic tests (RDTs). Significant advancements are being made in automated malaria diagnosis using digital microscopy imaging with artificial intelligence (AI) tools, which can enhance detection accuracy and efficiency.
Vector Control: Controlling mosquitoes is a highly effective way to reduce malaria incidence.
Insecticide-Treated Nets (ITNs): Long-lasting insecticidal nets (LLINs) are widely used, with ongoing efforts to scale up coverage, particularly in high-burden countries. New-generation nets are also being deployed in response to pyrethroid resistance.
Indoor Residual Spraying (IRS): This involves applying insecticides to inner surfaces of homes, proving effective in preventing malaria. Countries like Rwanda have implemented IRS in high-endemic districts.
Housing Modifications: Improving housing conditions can also reduce malaria transmission.
Other Methods: Research is exploring innovative vector control tools, including mass drug administration to humans that targets parasites within mosquitoes, and genetic approaches like gene drive mosquitoes to reduce vector populations or their ability to transmit the parasite.
Medications:
Treatment: The World Health Organization (WHO) recommends combination therapy with at least two effective antimalarial agents with different mechanisms of action to combat drug resistance. For example, Proguanil works by inhibiting the malarial dihydrofolate reductase enzyme and is used in prophylaxis, but its weak activity against acute infection means it's often combined with other drugs.
Drug Resistance: The emergence and spread of drug resistance, particularly to artemisinin-based combination therapies (ACTs), especially in Southeast Asia, pose a major challenge.
Prophylaxis: While no prophylactic agent offers 100% protection, the CDC advises augmenting medication with personal protective measures.
Vaccination: The recent recommendations by the WHO for the RTS,S/AS01 malaria vaccine for children at risk, and the approval of the R21 vaccine in Ghana and Nigeria, represent significant progress, with the R21 vaccine showing up to an 80% reduction in malaria cases. However, these vaccines are not yet a "silver bullet" and require integration into national health systems and coordinated global efforts to achieve maximum impact.
Community Engagement: This is a cornerstone of malaria control and elimination, involving communities in designing and delivering interventions. It focuses on raising awareness, increasing knowledge, ensuring local access to rapid diagnostic tests and treatment, and fostering local ownership of programs. This approach is crucial for addressing health inequalities and building trust in health systems.
Research and Innovation: Continuous investment in research and development is vital for identifying new drug targets, developing novel therapies, improving diagnostics, and advancing vector control strategies.
Leading Organisations and Initiatives
There are many fantastic organisations working to combat malaria. Here are some of our top picks:
International Organisations and Partnerships:
World Health Organization (WHO): A central global health authority that defines malaria as a major public health concern and provides guidelines for clinical management.
The Global Fund to Fight AIDS, Tuberculosis and Malaria: A significant funder for malaria programs, which has disbursed US$65.4 billion to support programs in over 100 countries since its inception over 20 years ago. As of the end of 2023, health programs supported by the Global Fund partnership had saved 65 million lives.
Gavi, the Vaccine Alliance: A key partner in the rollout of malaria vaccines and building resilient health systems.
RBM Partnership to End Malaria: A global partnership initiated by WHO, UNDP, UNICEF, and the World Bank in 1998, working to reduce the human and socioeconomic costs of malaria. This partnership monitors the implementation of the "Big Push" framework.
UNICEF (United Nations Children’s Fund): A key partner in global health initiatives, including those related to malaria. The Partnership for a Lead-Free Future is housed at UNICEF.
Unitaid: Supports the uptake of new health products, making them available and affordable for low- and middle-income countries. Since its creation in 2006, Unitaid has unlocked access to over 100 groundbreaking health products for HIV, TB, and malaria.
African Leaders Malaria Alliance (ALMA): Helps defeat malaria through tools like the continental ALMA Scorecard for Accountability and Action, country malaria scorecard tools, and youth engagement initiatives. ALMA works with African leaders to keep malaria a priority on political and policy agendas.
Asia Pacific Leaders Malaria Alliance (APLMA): Works with governments and the private sector to generate leadership, financing, and operational support for malaria elimination in the Asia-Pacific region by 2030.
Pan American Health Organization (PAHO): Contributed to reductions in malaria incidence and other diseases through a primary healthcare approach in the Region of the Americas.
Coalition of Parliamentarians for Ending Malaria in Africa (COPEMA): Formed in March 2024 by African parliamentarians from high-burden nations.
Philanthropic Foundations and Charities:
Gates Foundation: A major contributor to malaria eradication efforts and a top funder of malaria R&D.
Against Malaria Foundation (AMF): A UK-based charity focused on preventing malaria by supplying insecticide-treated nets (ITNs) to malaria-endemic countries.
Medicines for Malaria Venture (MMV): A not-for-profit organisation managing a large portfolio of over 50 antimalarial projects in collaboration with over 100 partners in 38 countries, aimed at drug discovery and development.
Malaria Consortium (MC): An organisation of global health and malaria specialists creating tangible, scalable and sustainable impact.
Malaria No More: Mobilises political commitment, funding, and innovation to achieve the end of malaria within a generation.
The Clinton Foundation: Involved in anti-malaria efforts, having distributed anti-malaria drugs to millions in Africa and Asia, and worked to manage demand and stabilise prices in the artemisinin market.
Further reading
If you’d like to explore the challenge of malaria in more detail, here is some recommended further reading:
World Malaria Report 2024 (WHO): Provides comprehensive data on malaria cases, deaths, and global progress.
Global Technical Strategy for Malaria (WHO): Outlines the WHO's strategic framework for malaria control and elimination.
Cost Effectiveness of Malaria Interventions: Compare the existing cost-effectiveness research on malaria interventions.
Advances and challenges in automated malaria diagnosis using digital microscopy imaging with artificial intelligence tools: A review: Discusses the latest developments and hurdles in AI-driven malaria diagnostics.
Modelling the relative cost-effectiveness of the RTS,S-AS01 malaria vaccine compared to investment in vector control or chemoprophylaxis: Analyzes the economic benefits of malaria vaccines compared to other interventions.
Opportunities to give
The following malaria charities are currently recommended as particularly impactful by the independent charity evaluator GiveWell.
Against Malaria Foundation (AMF): A UK-based charity focused on preventing malaria by supplying insecticide-treated nets (ITNs) to malaria-endemic countries. AMF has a highly transparent and lean operating model, and the charity has been independently rated for 15 years running as one of the world’s most cost-effective for saving lives per dollar spent. It recently opened its first East Asian branch in Korea.
Disclaimer Albion East support the work of AMF through donations and direct support to its work in Korea.
Malaria Consortium (MC): Malaria Consortium (MC) is a highly effective charity preventing and treating malaria, especially in children. GiveWell, an independent charity evaluator, recognizes MC for its strong evidence and cost-effectiveness in delivering seasonal malaria chemoprevention (SMC) programs. These programs provide preventive antimalarial drugs to children in high-burden areas, significantly reducing illness and death. MC's rigorous monitoring ensures efficient use of donations, saving lives and improving health.
