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By: Margaret Reilly McDonnell

World Malaria Report 2020: What You Need to Know

November 30, 2020
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Today, the World Health Organization (WHO) released its 2020 World Malaria Report, an annual report that provides a comprehensive update on global and regional malaria data and trends. 

The report tracks investments in malaria programs and research, as well as providing data on malaria prevention, diagnosis, treatment and surveillance. 

This year’s report additionally frames the past two decades of progress against malaria and addresses the new challenges the COVID-19 pandemic poses to the fight against malaria. Here’s what you need to know:  

20 years of progress 

This year, the WHO is publishing a special edition of the World Malaria report that highlights a period of unprecedented success in global malaria control. 

Beginning in the 1990s, the world laid the foundation for a renewed malaria response that contributed to 1.5 billion cases and 7.6 million deaths averted over the past two decades. 

During the last 20 years, many more countries have moved towards the goal of zero malaria: 

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  • All WHO regions have shown reductions in malaria cases and mortality incidence since 2000, and the entire WHO European Region has been free of malaria since 2015. 
  • Between 2000 and 2019, the number of countries with fewer than 100 indigenous malaria cases – a strong indicator that malaria elimination is within reach – increased from 6 to 27.  
  • Over this same time period, 21 countries reported at least three consecutive years of zero indigenous malaria cases, and 10 of these countries were certified malaria-free by WHO. 
  • In 2019, China reported zero indigenous cases of malaria for the third consecutive year; the country recently applied for the official WHO certification of malaria elimination. 
  • In 2020, El Salvador became the first country in Central America to apply for the WHO malaria-free certification.  
  • In the face of the ongoing threat of antimalarial drug resistance, countries of the Greater Mekong subregion made major gains towards their goal of malaria elimination by 2030. 


Moving from high burden to high impact

Despite remarkable progress, the global gains in combatting malaria have leveled off in recent years, and many high burden countries have been losing ground. In 2017, WHO warned that the fight against malaria had reached a crossroads.  

In 2019, malaria cases reached 229 million, an annual estimate that has remained virtually unchanged over the last 4 years. The disease claimed some 409,000 lives in 2019 compared to 411,000 in 2018. 

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To reignite the pace of progress, WHO and the RBM Partnership to End Malaria catalyzed the “High burden to high impact” (HBHI) response, launched in November 2018. HBHI builds on the principle that no one should die from a disease that is preventable and treatable. It is led by 11 countries that, together, accounted for approximately 70% of the world’s malaria burden in 2017.

Funding has stagnated

Insufficient funding – at both the international and domestic levels – poses a significant threat to future progress. Despite a steep increase since 2000, levels of funding have plateaued in recent years and remain insufficient to achieve global targets. According to the report, funding for malaria control and elimination totaled US$ 3 billion in 2019, falling far short of the US$ 5.6 billion target of the global malaria strategy. 

Gaps in funding result in gaps in access

Funding gaps have led to gaps in access to proven, WHO-recommended malaria control tools.

Since 2000, expanded access to WHO-recommended malaria control interventions has played a critical role in reducing the global burden of the disease. However, a large proportion of the population at risk of malaria – particularly in the WHO African region – continues to lack access to prevention, diagnosis and treatment. These gaps in access put vulnerable populations at risk.

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  • Though there has been a considerable increase in the percentage of people sleeping under a bed net since 2000 (from 2% to 46%), there have been no significant gains since 2015. 
  • Indoor residual spraying (IRS) of insecticides is another powerful way to rapidly reduce malaria transmission. Globally, the percentage of the population protected by IRS declined from 5% in 2010 to 2% in 2019. 
  • Intermittent preventive treatment of malaria in pregnancy (IPTp) is a course of antimalarial medicine given to pregnant women at routine antenatal care visits. In 2019, just over one third (34%) of pregnant women in 33 African countries received the recommended 3 or more doses of IPTp. This represents a considerable increase in coverage since 2010 but only a modest increase since 2018  
  • In 2019, an estimated 11.6 million pregnant women living in 33 African countries with moderate-to-high transmission were infected with malaria (35% of all pregnancies). As a result, an estimated 822,000 children in these 33 countries were born with a low birth weight. 
  • Early diagnosis and prompt treatment are critical to reducing severe malaria-related disease and death. According to household surveys from 21 countries in sub-Saharan Africa: Treatment-seeking rates for children with a fever have changed very little over the last 15 years. Surveys from the period 2015 to 2019 show that nearly one third (31%) of febrile children under the age of 5 did not receive care, compared to 36% over the period 2005 to 2011.  


Impacts of the COVID-19 Pandemic 

Because of the way malaria data is collected and analyzed, this year’s World Malaria Report presents data collected through the end of 2019 – meaning all of these numbers reflect the situation immediately before the COVID-19 pandemic. 

However, COVID-19’s spread to all corners of the globe presents a major threat to millions of families at risk of malaria, fragile health systems in malaria-affected countries, and decades of progress against malariaThis year’s World Malaria Report provides useful context on how the pandemic has emerged as a serious additional challenge to malaria responses worldwide and the potential impacts of the pandemic on progress towards malaria elimination. 

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  • According to the report, most malaria prevention campaigns moved forward in 2020 without major delays.  
  • All 28 countries (23 in Africa) that had planned ITN campaigns in 2020 are aiming to complete them by the end of the year. However, as of early November 2020, only 94 million of the expected 222 million bed nets had been distributed. 
  • Of the 24 countries globally with planned IRS campaigns, 15 are on track to complete them by the end of the year.  
  • Disruptions in malaria diagnosis and treatment have been more difficult to quantify. The analysis suggests that in all malaria-endemic countries, disruptions in diagnosis and treatment have ranged from between 5% to 50%.  

According to the report, even with the completion of malaria prevention campaigns, moderate disruptions in access to effective antimalarial treatment could lead to a considerable loss of life. The analysis suggests, for example, that a 10% disruption in access to effective antimalarial treatment in sub-Saharan Africa could lead to 19,000 additional deaths. Disruptions of 25% and 50% in the region could result in an additional 46,000 and 100,000 additional deaths, respectively.


The Path Forward 

“It is time for leaders across Africa – and the world – to rise once again to the challenge of malaria, just as they did when they laid the foundation for the progress made since the beginning of this century,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Through joint action, and a commitment to leaving no one behind, we can achieve our shared vision of a world free of malaria.” 

Many countries, governments, and partners are showing incredible commitment, acting quickly, efficiently, and safely to move ahead with essential malaria programs in the face of the COVID-19 pandemic. Progress can be accelerated through robust political leadership, strengthened malaria surveillance, equity in access to quality health services, and stepped-up investment in research and innovation. Here’s what we need to do: 

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We need to do more with less. 

Given the plateau in funding and the current context with COVID-19, effective use of limited resources will be critical. We need to push towards building resilient health systems that have the capacity to flatten both the curves of malaria and other diseases like COVID-19. 

We need commitment and leadership, domestically and internationally. 

Progress can also be accelerated through robust political leadership, strengthened malaria surveillance, equity in access to quality health services, and stepped-up investment in research and innovation. 

For malaria control efforts to succeed, government stewardship is essential, together with the engagement and participation of affected communities. 

We need improved surveillance, monitoring, and evaluation. 

Reliable health information is critical in the fight against malaria to develop sound strategic plans, ensure resources are targeted efficiently and equitably and measure the impact of interventions. 

We need equity in access to health services. 

All citizens, wherever malaria is present, must have access to quality services to prevent, diagnose, and treat the disease without facing financial hardship. 

We need greater investments in innovation and new tools and approaches. 

In the current context, an effective use of limited resources will be critical to achieving a measurable impact against malaria. Local data and intelligence are vital to inform locally tailored solutions. 

Eliminating malaria in all countries, especially those with a high disease burden, will likely require tools that are not available today. Investing in the research and development of new vector control tools and insecticides, improved diagnostics, and more effective medicines must be a priority. 

Ways YOU Can Help 

We are still facing a critical gap in funding to fight malaria, and we need people like you to contact your members of Congress and urge them to continue the progress we’ve made. Click here to raise your voice in support of living-saving programs like the President’s Malaria Initiative and the Global Fund to Fight AIDS, TB, and Malaria.

December 1st is #GivingTuesday and you can help Nothing But Nets step up the fight to #EndMalaria by giving back. Together, we can protect 150,000 people from malaria by December 31! Click here to learn more. 

Help us and our friends at the RBM Partnership to End Malaria spread the word in your networks. Click here for a toolkit full of suggested social media posts and downloadable graphics. 

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