New analysis published on The Lancet in March shows that global progress in fighting malaria has slowed significantly, with cases in 2022 reaching the highest level since 2004. 

While efforts to control the disease are ongoing, new and growing challenges are making it increasingly difficult to reduce infections.

Mixed trends across regions and years
The research, which analyzed malaria burden trends between 2000 and 2022, reveals a complex picture of successes and setbacks, including emerging threats. 

Despite notable improvements in some regions between 2015 and 2020, particularly in parts of rural Africa, the overall trend shows stagnation and even reversal in some areas. 

Contributions from global research teams
Key contributors to the analysis are Susan Rumisha and Punam Amratia of Ifakara Health Institute. Alongside international colleagues from Australia, the USA, Singapore, Denmark, and the UK, they helped develop and apply the models used to generate results of the research.

Urban malaria on the rise
Their analysis shows that rural areas, although still carrying the highest burden, have shown consistent declines in cases compared to urban areas — especially densely populated cities — many of which are now seeing malaria risks rise again. 

Researchers believe that delays in rural outreach and a shift in intervention focus may partly explain this trend.

Additionally, new threats such as anopheles stephensi, a mosquito species that thrives in urban environments, and growing resistance to malaria drugs and insecticides, further make control efforts more difficult. 

Climate, conflict amplify challenges
Other challenges, including natural disasters, political instability, and armed conflict, have also disrupted malaria programs in many countries. 

These events, coupled with emerging biological threats, underscore the urgent need for adaptive and targeted intervention strategies underscore the scientists.

“Although the global burden of malaria remains unacceptably high and progress against the disease has been limited since 2015, there remain reasons for optimism… Maintaining progress, however, will require adaptive, data-driven health policies to address emerging challenges,” the authors note.

COVID-19 impact, data gaps
Complicating the picture are data gaps caused by the COVID-19 pandemic, which disrupted health services and data collection systems, creating blind spots in malaria surveillance between 2020 and 2022. 

While countries managed to avert a major surge in malaria deaths by maintaining intervention campaigns, the precise impacts on global malaria burden of control strategies post-2020 remain unclear due to data limitations associated with the COVID-19 pandemic.

“COVID-19-related disruptions led to increased malaria cases and deaths, but the impact was less severe than feared... Nevertheless, improved tools and strategies remain urgently needed to regain momentum against this disease,” the scientists noted.

Limitations in tracking malaria burden
The analysis highlights limitations in malaria monitoring systems. Much of the data is drawn from infrequent national surveys, which can miss outbreaks or overlook patients seeking private or informal care. Inaccurate cause-of-death reporting — especially in sub-Saharan Africa — further complicates the understanding of malaria's true toll.

Unmeasured impact of new interventions
Importantly, the report does not yet fully capture the effects of recent interventions like seasonal malaria chemoprevention or the malaria vaccine RTS,S. – due to limited survey data collected alongside these interventions makes it difficult to model their full impact across regions. As a result, their broader impact across regions remains difficult to quantify.

Progress outside Africa faces climate risks
Outside of Africa, several countries continue to make progress against Plasmodium vivax, another malaria-causing parasite. 

However, this progress remains fragile, as shown by a major outbreak in Pakistan in 2022, triggered by flooding that reversed four years of progress. Experts warn that climate change could make such setbacks more common.

Hope lies in tailored approaches
Despite setbacks, there is reason for optimism, emphasize the authors, underlining that resilience shown by countries in maintaining malaria programs during the pandemic proves that progress is possible. 

To move forward, Dr. Rumisha and colleagues emphasize the need for “tailored approaches to malaria control, with country-led subnational stratification of strategies adapted to local contexts.”

Read the publication here.