Global Fight against Malaria: Goals and Achievements 1900-2022

Abstract

This article examines the historical and ongoing efforts to fight malaria, a parasitic disease caused by Plasmodium species and transmitted by Anopheles mosquitoes. Despite over a century of control efforts, malaria remains a major global health issue. In 2022, there were an estimated 249 million cases across 85 countries, leading to approximately 600,000 deaths. In the recently published Global Technical Strategy for Malaria 2016-2030, the World Health Organization (WHO) has prioritized malaria eradication. The main goals are to reduce malaria incidence and mortality by 90% by 2030 compared to 2015 levels. However, as of 2022, progress has been limited, with only a 2% reduction in incidence and a 6% reduction in mortality. This review traces the historical context of malaria, highlighting its ancient origins and the pivotal scientific discoveries in the late 19th century that paved the way for modern control measures. The Global Malaria Eradication Programme launched by the WHO in 1955 initially showed promise, largely due to the insecticide DDT, but ultimately failed to achieve its goals mainly due to logistical problems, vector resistance to DDT, and inadequate funding. Despite significant advances in the early 21st century, including the Roll Back Malaria initiative and increased international funding, malaria eradication remains a distant goal. Persistent challenges, such as weak healthcare systems, parasite and vector resistance to drugs and insecticides, and inadequate funding, continue to hamper global efforts. Therefore, this article underscores the need for a deeper understanding of malaria's history and recent evolution to inform future strategies for eradication.

Keywords: Anopheles; Plasmodium; World Health Organization (WHO); control; elimination; eradication; malaria.

Figure 1

Timeline of the fight against malaria 1750–2024. PASB: Pan American Sanitary Bureau; DDT: dichlorodiphenyltrichloroethane; CDC: Centers for Disease Control and Prevention; WHO: World Health Organization; GMEP: Global Malaria Eradication Programme; RBM: Roll Back Malaria; UN: United Nations; MDG: Millenium Development Goals; ACTs: artemisinin combined therapies; ECDC: European Centre for Diseases Prevention and Control; WHA: World Health Assembly; GPIRM: Global Plan for Insecticide Resistance Management; RTS,S/AS01 and R21/Matrix-M: malaria vaccines both targeting the circumsporozoite antigen (CSP) using the RTS,S vector; mAbs: monoclonal antibodies. For more details, see Box 1.

Figure 2

Proportion of the Funding of The Global Fund to Fight AIDS, Tuberculosis, and Malaria, period 2001–2016, public sector. Data source: the Global Fund, https://data.theglobalfund.org/financial-insights (access on 21 August 2024). From 2001 to 2016, a total of USD 40.7 billion was donated to the Global Fund (20% used for malaria), 95% by the public sector, and 5% by the private and nongovernmental sectors.

Figure 3

“Table 2.4 Summary of trends in reported malaria case incidence 2000–2015, by WHO region” Modified from World Malaria Report 2015 p14, source WHO, see ref [73].

Figure 4

“Table 2.5 Summary of trends in estimated malaria case incidence 2000–2015, for countries in which trends could not be evaluated from reported data but can be assessed through modeling *” Modified from World Malaria Report 2015 p15, source: WHO, see ref [73].