Malaria cases rise for fifth year as disasters and resistance hamper control efforts | Global health

Malaria killed almost 600,000 people in 2023, as cases rose for the fifth consecutive year, according to a new report from the World Health Organization (WHO).

Biological threats such as rising resistance to drugs and insecticides, and climate and humanitarian disasters continue to hamper control efforts, world health leaders warned.

Globally, there were 263m cases last year, 11m more than the previous year; the vast majority (94%) occurred in Africa.

Officials said a $4.3bn (£3.4bn) annual funding shortfall was among further challenges, which also include the spread of a new insecticide-resistant species of mosquito, genetic mutations in the malaria parasite that stop tests working, and the emergence of a new type of malaria parasite in south-east Asia.

Dr Tedros Adhanom Ghebreyesus, WHO director general, said: “No one should die of malaria; yet the disease continues to disproportionately harm people living in the African region, especially young children and pregnant women.”

There was now “an expanded package of life-saving tools” that protected against the disease, he said, but a need for more investment and action in the African countries with the highest rates.

About $4bn went into fighting malaria globally last year, less than half of the $8.3bn that official control plans consider necessary. That has meant gaps in the provision of tools such as medicines and insecticide-treated bed nets, with the most vulnerable groups often missing out, said the report.

Only half of those at risk of malaria in sub-Saharan Africa slept under insecticide-treated nets, and only 45% of pregnant women in the region had the recommended three doses of preventive malaria therapy. About 80 million people in countries where malaria is found are refugees or internally displaced, making it harder for them to access prevention and treatment services.

Meanwhile, the climate crisis is increasing rates of extreme weather events that cause flooding, creating breeding grounds for mosquitoes and disrupting access to healthcare in countries such as Pakistan and Madagascar, the report said.

Earlier this month British health officials warned that they were seeing rising numbers of malaria cases in travellers returning to the UK. In 2023, there were 2,106 cases of imported malaria, up 26% on the 1,555 reported in 2022. Six people died from the illness. Provisional figures recorded 753 cases in the first half of 2024.

A separate report published last month by the Malaria Atlas Project and Boston Consulting Group, with funding from the Gates Foundation, predicts that Africa will see more than 550,000 additional deaths from malaria in Africa between 2030 and 2049 due to extreme weather events such as floods and cyclones.

Resistance to drugs that have been the gold-standard treatment for malaria is spreading, the report said, and mosquitoes are increasingly resistant to the insecticides used to treat bed nets.

However, the report included grounds for optimism, including the introduction in 17 countries so far of malaria vaccines for young children that have cut death rates by 13%. And the development of new bed nets made more effective by using more than one type of insecticide to combat resistance accounted for 78% of nets delivered to sub-Saharan Africa last year.

The WHO has certified 44 countries and one territory to be free of malaria, including Egypt in October. There are 83 countries where malaria is considered endemic and 25 of those now report fewer than 10 cases a year.