WHO Malaria Chief's Year-End Message

Dear colleagues, friends and partners,

As 2024 draws to a close, I'd like to take a moment to express my sincere gratitude for your contributions to the work of the WHO Global Malaria Programme. I am proud of the progress we've achieved together over the last year – progress made possible by your commitment, collaboration, and tireless efforts to advance our shared mission of a world free of malaria.

This end-of-year bulletin will touch on following milestones:

• World malaria report 2024
• Spotlight on equity
• Malaria Ministerial Conference
• Malaria-free certifications
• New technical guidance
• WHO malaria progress report at the World Health Assembly
• New operational strategy

For ongoing updates on our work, I encourage you to subscribe to mailing list. We can also connect on Twitter at: @DrDanielNgamije

Wishing you and your loved ones a safe, restful and joyous holiday season.

Best regards,

Daniel Ngamije

World malaria report 2024

WHO's flagship malaria report, published annually, provides an in-depth update on malaria burden and trends at global, regional and country levels. This year's report presents encouraging data and trends in global malaria control. In 2023, more than 177 million malaria cases and 1 million deaths were averted worldwide. Of the remaining 83 malaria-endemic countries, 25 countries reported less than 10 cases of malaria in 2023, and many more are progressing toward elimination. Some higher burden countries – including Rwanda, Liberia and India – are also making strong inroads, with large reductions in cases achieved in recent years.

Malaria, however, remains a formidable public health challenge. In 2023 alone, there were an estimated 597 000 malaria deaths and 263 million new cases – an increase of 11 million cases over the previous year. In view of current trends, progress towards critical targets of the WHO global malaria strategy is off track.

Among other goals, the strategy calls for reductions in malaria case incidence and death rates of at least 75% by 2025 and 90% by 2030, compared to 2015 baseline levels. The 2023 global malaria incidence rate of 60.4 cases per 1000 population at risk is nearly 3 times higher than the 21.3 cases per 1000 needed to reach the target. In 2023, malaria caused 13.7 deaths per 100 000 at-risk population, more than twice the target of 5.5.

The WHO African Region continues to be hardest hit by malaria, accounting for an estimated 94% of global cases and 95% of malaria-related deaths in 2023. Just over half of these deaths occurred in 4 countries: Nigeria (30.9%), Democratic Republic of the Congo (11.3%), Niger (5.9%) and United Republic of Tanzania (4.3%).

As the WHO Director-General reminds us: "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. An expanded package of lifesaving tools now offers better protection against the disease, but stepped-up investments and action in high-burden African countries are needed to curb the threat."

Countries are grappling with persistent challenges as they work to lower their disease burden. Fragile health systems, weak surveillance and chronic funding gaps endure as major barriers. Rising biological threats, such as drug and insecticide resistance, are undermining the effectiveness of core malaria control tools. Compounding these threats are the overlapping impacts of conflict and violence, natural disasters, climate change and population displacement.

But there are grounds for optimism. Seventeen countries in Africa are now offering WHO-recommended malaria vaccines in selected areas – including most recently, Nigeria, which carries the highest disease burden worldwide. New types of insecticide-treated nets that offer better protection against malaria are being more widely deployed. An estimated 53 million African children were reached with seasonal malaria chemoprevention in 2023, up from just 170 000 in 2012.

Spotlight on equity

Our latest report features, for the first time, a special chapter emphasizing the need for inclusive action to protect those most vulnerable to malaria – communities living in poverty, children and pregnant women, displaced and marginalized populations, and other hard-to-reach groups. The chapter was developed in close collaboration with our colleagues in the WHO Programme for Gender Equality, Human Rights and Health Equity, with contributions from the Centre for Gender Studies and Advocacy at the University of Ghana.

Various factors – biological, environmental, social, structural and economic – heighten vulnerability to malaria and make it harder for certain groups to access preventive and treatment services. These factors often intersect, compounding an individual's risk of a malaria infection and its consequences.

Addressing overlapping vulnerabilities requires data-driven policies and actions that are gender-responsive, equity-oriented, and grounded in human rights. WHO is urging countries to:

1. prioritize primary health care as the backbone of equitable health systems;
2. address gender inequities and other social determinants of health in malaria strategies;
3. invest in robust data systems to monitor and address health inequities;
4. ensure equity, gender equality, and human rights are embedded in antimalarial innovations, with affected communities involved in designing and evaluating new tools.

Equity in access to malaria services was also the focus of this year's World Malaria Day under the theme: "Accelerating the fight against malaria for a more equitable world." WHO joined the RBM Partnership to End Malaria and other partners in highlighting barriers to health equity, gender equality and human rights in malaria responses worldwide, as well as concrete measures to address them.

Malaria Ministerial Conference

Meeting the targets of the WHO global malaria strategy will require stepped-up resources and action in high burden African countries. Earlier this year, Ministers of Health from 11 high burden African countries committed to the principle that "no one should die from malaria" given the tools and resources available. By signing the March 2024 Yaoundé Declaration , they further committed to 7 key actions to accelerate progress against malaria. Now, political leaders must turn these stated commitments into tangible actions and resources that will save lives.

Yaoundé Declaration – key actions

1. Strengthen political will
2. Ensure the strategic use of information for action
3. Provide better technical guidance
4. Enhance coordination and multisectoral action
5. Strengthen national health systems
6. Build collaborative partnerships for resource mobilization, research and innovation
7. Ensure a functional malaria accountability mechanism

Co-hosted by WHO and the Government of Cameroon, the Malaria Ministerial Conference brought together more than 400 stakeholders, including Ministers of Health and senior representatives from the African countries hardest hit by malaria, health leaders, scientists, civil society and other partners. A meeting report summarizes key discussions.

^{The Ministers of Health of Mali, Nigeria, Cameroon, Burkina Faso, Uganda and Sudan signing the Yaoundé Declaration. By May 2024, Ministers of Health from 5 other high burden African countries (Democratic Republic of the Congo, Ghana, Mozambique, Niger and United Republic of Tanzania) had also signed the Declaration. Photo credit: Otto Bakano}

Malaria-free certifications

To date, a total of 44 countries and 1 territory have been awarded a malaria-free status by WHO. The certification is granted when a country can prove, beyond a reasonable doubt, that the chain of indigenous malaria transmission has been interrupted nationwide for at least 3 consecutive years.

As the third most populous country in Africa, Egypt's malaria-free certification by WHO in October 2024 is a significant public health milestone. Malaria was detected in the country as early as 4000 B.C., with genetic markers of the disease identified in Tutankhamun and other ancient Egyptian mummies.

Earlier in the year, the Director-General of WHO travelled to Cabo Verde to celebrate the country's malaria-free status . Cabo Verde is the third country to be certified in the WHO African region, joining Mauritius and Algeria which were certified in 1973 and 2019 respectively.

New technical guidance

WHO's malaria guidance serves as the basis for technical and policy decisions by country-level and global partners in all regions. In 2024, the Global Malaria Programme published guidance that spanned a range of technical areas – including, for example:

• New field guide on community-based deployment of IPTp-SP
• Updated WHO guidance for controlling vector-borne diseases through indoor residual spraying
• Response plan for pfhrp2 gene deletions
• New implementation guide on multiple first-line therapies

In response to ever-increasing financial constraints, and in consultation with national malaria programme managers and technical partners, WHO developed a set of guiding principles for prioritizing high-impact malaria interventions – in particular early diagnosis and treatment, insecticide-treated nets, indoor residual spraying, malaria vaccines and chemoprevention.

Published in May 2024, the guidance aims to support national malaria control programmes in defining the most appropriate mix of interventions in resource-limited settings. The guidance will be refined in 2025 to reflect outcomes of a commissioned multi-model comparison of mixes of malaria interventions in different transmission settings.

On 30 November, WHO also published a revised version of the consolidated Guidelines for malaria , with an updated recommendation for malaria vaccines, new recommendations on the use of near-patients qualitative and semiquantitative G6PD tests to guide anti-relapse treatment of P. vivax and P. ovale, updated recommendations on primaquine, and a recommendation on the use of tafenoquine.