GoKawiilThe tools exist to end this killer disease. It is the money and the will that are lacking.
There will be little to celebrate on World Malaria Day on 25 April. Global malaria cases, which stood at 238 million in 2018, had climbed to 282 million by 2024, the latest year for which figures are available. Deaths from the disease rose from 575,000 to 610,000 over the same period. Malaria remains endemic in 80 countries. Ending malaria epidemics by 2030 is a target of the United Nations Sustainable Development Goals, but progress has clearly stalled.
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Deplorably, this is happening despite the advent of vaccines. In October, it will be five years since the World Health Organization (WHO) recommended the world’s first malaria vaccine, RTS,S. This was hailed at the time as a tool that would “change the course of public health history” by WHO director-general Tedros Adhanom Ghebreyesus. A second vaccine, R21, was recommended two years later.
Since the WHO endorsed these vaccines, 25 countries have begun rolling out immunization programmes. But the vaccines are not reaching some of the populations that are most at risk, particularly in Africa, where more than 90% of malaria cases occur. Tanzania, for example, accounted for 4.3% of global malaria deaths in 2024, but has not yet introduced vaccines.
Malaria can be stopped, as high-income countries and some middle-income countries have shown. Vaccines will form a key part of the armoury, along with longer-established strategies for mosquito control, such as insecticide- treated bed nets and antimalarial drugs. “We have more tools today than we’ve ever had before,” says Michael Charles, chief executive of the global RBM Partnership to End Malaria in Geneva, Switzerland. Success will hinge on governments, international donors and public-health agencies doing a better job of coordinating their efforts. Above all, it will take money — and, at present, funding for global public health is under severe strain.
Malaria is caused by parasites in the genus Plasmodium that are transmitted to people who are bitten by infected female Anopheles mosquitoes. Efforts to develop vaccines began several decades ago, but the process was hard going, because the parasite has a complex life cycle and a canny ability to evade immune detection.
RTS,S, which was developed by the multinational drug company GSK with support from the then Bill & Melinda Gates Foundation, has been shown in a large clinical trial to reduce malaria cases by almost 56% in children aged 5–17 months over the 12-month period after immunization with three doses (The RTS,S Clinical Trials Partnership. N. Engl. J. Med. 365, 1863–1875; 2011). R21, developed by the Jenner Institute at the University of Oxford, UK, achieved an efficacy of 75% in the same age group in areas that have perennial malaria transmission (M. S. Datoo et al. Lancet 403, 533–544; 2024).
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RTS,S targets the sporozoite, the parasite’s infectious stage in humans, by training the immune system to recognize a protein on its surface. Researchers at the Jenner Institute built on this approach, and designed R21 to include a higher proportion of this protein and a different adjuvant — a substance that further boosts the immune response.
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