For years, malaria was one of the clearest examples of progress in global health. The expansion of insecticide-treated nets, rapid diagnostic tests, and effective treatments made it possible to reduce the disease steadily. That progress is still there, although the scenario has become more uncertain.
The latest data from the World Health Organization place the number of cases at 282 million and deaths at 610,000 in 2024. The figures remain close to those of previous years; what has changed is the trend. The steady decline stalled almost a decade ago, and since then progress has been uneven, moving away from the targets set for the 2016–2030 period.
Integrated Measures and Vaccines
Its impact depends largely on how it is combined with other measures. In some settings where it has been deployed alongside nets, indoor residual spraying (IRS), or preventive treatment, health teams have observed clear reductions in severe cases and child mortality. These kinds of results, reported on the ground by organizations such as Doctors Without Borders (MSF), coexist with a less visible reality. When these interventions are not sustained over time or do not reach all areas with the same intensity, gains are easily lost.
Available trials show efficacy levels that in some cases approach 75% in preventing the disease and suggest that protection is better maintained with booster doses. This requires health systems capable of follow-up and completing immunization schedules in contexts where campaigns are not always continuous.
Malaria vaccines are not only a scientific breakthrough; much of the underlying knowledge is generated through public or philanthropic funding, but production and access depend on agreements with industry and international procurement mechanisms. At the same time, partnerships between African and European institutions have gained prominence in an effort to address longstanding imbalances. The debate is no longer only about how to develop new tools, but about who sets the priorities and who benefits from them.
Public Investment and Progress Against Malaria
| Initiative | Key Achievements | Funding | Impact |
| Vaccine development (R21 and others) | Clinical trials and validation of new vaccines | Public research + international cooperation (including EDCTP) | High-efficacy vaccines and rollout in African countries |
| Trial networks in Africa | Local research infrastructure and teams | European and African public programmes | Increased scientific capacity in high-burden countries |
| New combination treatments | Evaluation of more effective therapies against resistance | Publicly funded international consortia | Improved treatment in complex settings |
| Surveillance systems | Case tracking and outbreak response | International cooperation and public health systems | Faster detection and better control of transmission |
The Funding Gap
The global response still depends heavily on international funding. Initiatives such as The Global Fund to Fight AIDS, Tuberculosis and Malaria account for a large share of this effort, providing around 59% of all international malaria financing. From its inception in 2002 until 2023, the mortality rate in countries where the Fund invests has fallen by 51%. In 2024 alone, it contributed to the delivery of more than 160 million nets and the treatment of over 170 million cases. Bilateral programmes, such as the U.S. President’s Malaria Initiative (PMI), complement this funding. In Spain, one of the most established efforts is the collaboration with the Manhiça Health Research Centre (CISM) in Mozambique.
However, the donor base is narrowing. The United States, which in 2020 represented more than half of international funding, has seen its contribution drop, and other major donors have also scaled back. Just days ago, it emerged that a U.S.-funded global supply programme responsible for distributing medicines and diagnostics for HIV and malaria is reorganizing and planning further cuts.
Global investment remains far below what is needed. In 2024, it stood at around $3.9 billion, well short of the $9.3 billion estimated by the WHO. This gap results in campaigns that are not repeated, nets that are not replaced, and systems that lose the capacity to respond.
Changing Patterns and Resistance
The context of transmission has also changed. Climate change is no longer a background factor; heavy rainfall and temperature shifts are altering mosquito cycles and extending transmission seasons. In many areas, the effect is an increased intensity where malaria was already endemic.
In parallel, drug and insecticide resistance adds another layer of complexity. The parasite is showing signs of adaptation to artemisinin-based combination therapies (ACTs), while mosquitoes have developed resistance to the insecticides used in nets. The tools still work, but with reduced efficacy, requiring more advanced versions and adjusted strategies.
Who is Most Affected
The distribution of the disease has changed little. Most deaths occur among children under five, especially in rural areas. In many African countries, this group accounts for more than three-quarters of malaria deaths. Among survivors, the disease can leave lasting effects such as severe anaemia or neurological damage.
Despite this, elimination is not a distant goal. Nearly 50 countries have interrupted transmission in recent years. Outside Africa, patterns vary: in Latin America, transmission is concentrated in hotspots like the Amazon, driven by population mobility and mining. In Europe, while not endemic, the disease persists through imported cases and occasional local transmission, keeping surveillance systems on alert.
Malaria remains preventable and treatable. The tools exist, but they must be sustained. When they fail, the disease regains ground quickly, and any delay in supply chains translates into rising cases in a very short period.
