Despite the lingering impact of COVID-19, the number of malaria cases and associated deaths remained stable in 2021

New data released today by the World Health Organization (WHO) show that in 2021 countries around the world largely managed to avoid further setbacks in malaria prevention, testing and treatment services.

According to World report on malaria this year, an estimated 619,000 died from the disease worldwide in 2021, up from 625,000 in the first year of the pandemic. In 2019, before the pandemic started, the number of deaths was 568,000.

The number of malaria cases continued to increase between 2020 and 2021, albeit at a slower pace than in 2019-2020. Globally, it reached 247 million in 2021, up from 245 million in 2020 and 232 million in 2019.

“After a sharp increase in the number of malaria cases and associated deaths during the first year of the COVID-19 pandemic, malaria-affected countries have redoubled their efforts and managed to mitigate the worst effects of COVID-related disruptions- 19 on malaria services,” said Dr.r Tedros Adhanom Ghebreyesus, Director-General of WHO. “We face many challenges, but we also have many reasons to be optimistic. Provided we strengthen the response, understand and mitigate risks, improve resilience and step up research, we have every reason to dream of a malaria-free future. »

The key to success lies in the country’s strong commitment

Insecticide-treated nets (ITNs) are the primary vector control tool in most malaria-endemic countries, and in 2020 they were deployed more than ever before. In 2021, ITN distributions were strong overall, at a similar level to pre-pandemic years: 128 million ITN were distributed, or 75% of the projected 171 million.

However, eight countries – Benin, Eritrea, Solomon Islands, Indonesia, Nigeria, Uganda, Thailand and Vanuatu – have distributed less than 60% of their ITNs, and seven countries, namely Botswana, Haiti, India, Pakistan, Central African Republic, Sierra Leone and Chad, they gave none at all.

Seasonal malaria chemoprevention is recommended for prevention in children living in areas of Africa where seasonal malaria transmission is high. In 2021, scale-up of seasonal malaria chemoprevention reached nearly 45 million children with this intervention in 15 African countries, a significant increase from 2020, when 33.4 million children benefited, and compared to 2019, when it had reached 22.1 million children.

At the same time, most countries have managed to maintain levels of malaria testing and treatment during the pandemic. Despite challenges affecting logistics and supply chain during the pandemic, a record number of rapid diagnostic tests were distributed to healthcare facilities in malaria-endemic countries in 2020. In 2021, 223 million rapid diagnostic tests were distributed there, close to the levels recorded before the pandemic.

Artemisinin-based combination therapy is the most effective treatment for malaria. P. falciparum. An estimated 242 million artemisinin-based combination therapies were administered in malaria-endemic countries worldwide in 2021, up from 239 million in 2019.

The convergence of multiple threats is hampering the fight against malaria

Despite the progress made, the fight against malaria faces many challenges, particularly in the African region, where around 95% of cases and 96% of deaths were recorded worldwide in 2021.

Pandemic-related disruptions and converging humanitarian crises, challenges facing health systems, funding restrictions, worsening biological threats, and declining effectiveness of key disease control tools are all threats to the response global malaria.

“Despite the progress made, the African region remains the region most affected by this deadly disease,” said Dr.ref. Matshidiso Moeti, WHO regional director for Africa. “We urgently need new tools – and the funding to use them – to defeat malaria.”

In 2021, total funding to fight malaria reached US$3.5 billion (USD), an increase from the previous two years, but still well below the estimated $7.3 billion needed globally to defeat malaria as intended.

At the same time, the declining effectiveness of basic malaria control tools, primarily insecticide-treated bed nets, is hampering further progress against the disease. Several threats weigh upon this essential prevention tool: resistance to insecticides, insufficient access to nets, reduction in the total number of MMIs because they are not replaced as quickly as existing nets wear out with daily use, and the change in the behavior of mosquitoes, which seem to strike first, before people go to sleep, and then rest outdoors, avoiding exposure to insecticides.

Other increasing risks are also observed, including mutations in the parasite, which compromise the effectiveness of rapid diagnostic tests, the growing resistance of parasites to antimalarial drugs and the invasion, in Africa, of a mosquito adapted to the urban environment and resistant to many of the insecticides used today.

Key opportunity to accelerate the fight against malaria

WHO recently launched two strategies to help countries on the African continent improve malaria resilience: a strategy to reduce parasite resistance to antimalarials (Strategy to Combat Antimalarial Resistance in Africa) and an initiative to stop the spread of the vector Anopheles stephensi (WHO initiative to stop the spread of Anopheles stephensi in Africa). In addition, a new global framework (Global Framework for Action against Malaria in Urban Settings) for action against malaria in urban settings, jointly developed by WHO and UN-Habitat, provides guidance to urban leaders and stakeholders in the fight against malaria.

At the same time, the rich R&D pipeline should lead to a new generation of anti-malaria tools that will hopefully help us reach globally set goals faster.

Promising opportunities include bed nets impregnated with novel long-acting insecticide combinations and other vector control innovations, including targeted mosquito-attracting baits, aerial repellants, and mosquito-targeted genetic engineering solutions. In addition, new diagnostic tests and next-generation drugs are being developed to combat antimalarial resistance.

It is also expected that by the end of 2023, millions of children living in areas where the risk of illness and death from malaria is highest will benefit from the RTS,S vaccine, the world’s first malaria vaccine. Other malaria vaccines are currently under development.

These opportunities can only be fully realized if efforts to leave no one behind are stepped up, says the report. Malaria-endemic countries must continue to work to strengthen their health systems through a primary health care approach to ensure that all in need have access to malaria services and interventions.

Note to editors

WHO’s work on malaria builds on the global technical strategy for malaria 2016-2030endorsed by the World Health Assembly in May 2015 and updated in 2021 to incorporate lessons learned from 2016-2020 into the global malaria response.

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