Funding and a collaborative, intersectional approach vital to malaria elimination
Funding and a collaborative, intersectional approach vital to malaria elimination
[Johannesburg] 11 December 2024 – New data from the World Health Organisation (WHO) reveals that an estimated 2.2 billion cases of malaria and 12.7 million deaths have been averted. However, the disease continues to remain a significant threat to global health, particularly in Africa. Funding and a collaborative, intersectional approach vital to malaria elimination
The annual World Malaria report for 2024 found that over the past two decades, Southern Africa has made remarkable strides in the fight against malaria, with countries like eSwatini leading the way – reducing cases to below 600 and deaths to just seven in 2023. In South Africa, cases declined from over 18 000 recorded in 2000 to 5 291 reported cases in 2023 and deaths dropped from 26 000 to 64 in the same period. However, despite this decade’s long improvement, South Africa experienced a surge in the number of malaria cases and deaths in 2023 compared to the 2 043 cases and 29 deaths reported in 2022.
“The achievements made in the past 23 years reaffirm that with sustained commitment and strategic interventions, we can tackle this disease head on,” says Charles Sherwin, Goodbye Malaria Co-Founder and CEO. “While South Africa has made significant progress in reducing malaria over the years, increases in cases highlight the need to accelerate efforts to offset growing risks. The region must intensify its efforts by addressing funding gaps, strengthening cross-border and multi-sectoral collaboration, scaling up access to diagnostics and treatment, and bolstering preventive measures to ensure no one is left behind in this fight.”
Several emerging risks threaten progress in reducing malaria incidence. These include persistent funding shortfalls, fragile health systems, and escalating biological challenges such as drug and insecticide resistance.
Environmental factors are also playing an increasingly critical role, with natural disasters, sustained heatwaves like those recently experienced in South Africa with temperatures consistently in the mid-30s, and the broader impacts of the advancing climate crisis contributing to conditions favorable for malaria transmission.
“These interconnected threats underscore the urgent need for coordinated efforts to safeguard and accelerate progress in malaria control and elimination, particularly as much of Africa faces resource constraints,” adds Sherwin.
Funding shortfalls threaten progress
The WHO report found that global investments in malaria control, in 2023, reached an estimated $4 billion, falling significantly short of the $8.3 billion funding target set by the WHO Global Malaria Strategy. This funding gap has steadily widened over the past five years, posing a significant threat to progress in malaria elimination, as sustained funding is essential to supporting diagnostics, treatment, and prevention efforts. Without adequate investment, the advancements made in combating malaria risk stalling or even regressing.
The importance of partnerships to bolster contributions to such critical malaria funding therefore cannot be overstated, strengthening their capacity and expanding access to life-saving interventions. For instance, in 2020, Goodbye Malaria – supported by partners including Nando’s, Vodacom and Airports Company South Africa (ACSA) raised a remarkable R85 million for the Global Fund to sustain the MOSASWA (Mozambique, South Africa and eSwatini) regional grant for the 2020-2023 grant cycle.
“Malaria elimination costs money. Closing these funding gaps is not just critical – it’s urgent, particularly ahead of the next funding replenishment cycle,” says Sherwin. “Fully replenishing malaria funds should be tabled as a priority, particularly ahead of the G20 Summit in South Africa in 2025, which offers a key moment for local leaders to influence global policies and ensure Africa’s interests remain central in addressing this critical issue.”
The Global Fund’s 8th Replenishment, covering the 2026–2028 cycle, will take place in 2025, a fully funded Global Fund provides a pivotal opportunity to secure resources. Similarly, meeting Gavi’s target to raise at least $9 billion for its next strategic cycle (2026–2030) must be achieved to help meet immunisation goals.
A multi-sectoral, coordinated approach
According to the WHO, malaria-endemic countries need the support of an effective ecosystem of international and cross-border partners, including governments, global health organisations, the private sector, non-profits, and academia.
The report emphasises the need for more coordinated action that aligns international support with the specific needs of affected countries, urging improved coordination between global, regional, and country-level stakeholders.
“A concerted effort and regional approach is needed if we are to take on the challenge of eliminating malaria while up against rising challenges to our efforts. No one can do this alone. Malaria has no borders and in highly migratory regions such as ours, travels easily,” says Sherwin. “By working together across different sectors, the global community can better address the complex, interconnected factors that fuel malaria transmission and make significant progress toward elimination.”
The importance of equity, gender equality, and human rights in reducing malaria
While significant progress has been made in the coverage and use of malaria interventions – 89% of the 3.3 billion global rapid diagnostic tests distributed between 2010 and 2023, and 99% of the 235 million artemisinin-based combination therapies distributed in 2023 were distributed in sub-Saharan Africa – many people remain underserved, lacking access to the quality care and interventions needed to prevent, detect, and treat the disease effectively.
“This challenge arises in part because malaria is not a one-size-fits-all issue. Numerous factors influence vulnerability to malaria risk and the quality-of-care individuals receive,” says Sherwin. “While the arrival of the first malaria vaccine approved by the WHO was certainly a historic turning point in the fight against malaria, it does not mean that all other efforts should slow down. Vaccination is just one more tool in the toolbelt and we must make use of all our tools to eliminate this very preventable and treatable disease that continues to needlessly claim lives.”
The WHO report prioritises equity-focused action in bridging gaps in malaria care as determinants such as socioeconomic status, gender, disability, ethnicity (including Indigeneity), and migrant status can significantly impact an individual’s risk of contracting malaria and the barriers they face in accessing services. Inequities in healthcare access and quality further compound these challenges, delaying timely interventions and exacerbating outcomes.
For example, malaria prevalence is highest among children under five in impoverished households, with rates declining as economic conditions improve.
Sherwin notes that these disparities highlight the critical need for targeted strategies that address the diverse vulnerabilities of at-risk populations, ensuring that malaria interventions are accessible, equitable, and effective across all demographics.
Additionally, the empowerment of women would also strengthen their decision-making autonomy, increasing their likelihood of accessing malaria treatment and, when pregnant, being able to use the appropriate prevention measures.
“Empowering women is not only critical to achieving health equity but also enhances the effectiveness of our programs. By providing women with training and opportunities to lead our malaria interventions, we’re not just protecting communities from malaria but also addressing broader gender disparities,” he says.
Goodbye Malaria’s elimination programme’s stand out for their emphasis on gender inclusivity, with over 60% of staff being women. This approach aligns with the World Malaria Report 2024, which highlights the need for more equitable and inclusive malaria responses to reach the most vulnerable populations.
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