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By: Margaret Reilly McDonnell,  Tara Bracken

World Malaria Report 2021: What You Need to Know

December 6, 2021
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Today, the World Health Organization (WHO) released its 2021 World Malaria Report, an annual report that provides a comprehensive update on the state of the global and regional malaria fight. The report provides the most recent data on malaria prevention, diagnosis, treatment and surveillance, and tracks global investments in malaria programs and research. 

This year’s report reveals the devastating impacts of the pandemic and other crises on the global fight against malaria, while outlining what we need to get back on track to end this deadly disease for good.  

Here’s what you need to know: 

A new methodology gives us a clearer picture of the global malaria burden – and our past success.

This year’s World Malaria Report used a new methodology to calculate the number of malaria deaths among children under 5 years old. This new methodology is being used across WHO and provides more precise cause-of-death estimates for young children for all diseases – including malaria – going all the way back to 2000It reveals higher numbers of malaria deaths than previously thought, underscoring the urgency of the malaria fight.

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  • There were 627,000 malaria deaths and 241 million malaria cases in 2020. These numbers represent an increase of 69,000 malaria deaths and 14 million cases since 2019.
  • Just over three-quarters (76%) of malaria deaths were children under 5 years old. The report indicates that 7.6% of all deaths in children under 5 are attributable to malaria.
  • Globally, an estimated 1.7 billion malaria cases and 10.6 million malaria deaths were averted in the period 2000–2020, compared to the previous estimate of 7.6 million deaths.
  • New estimates of malaria deaths from previous years back to 2000 can also be found in this year’s report.

The COVID-19 pandemic has disrupted progress in the malaria fight.

Thanks to swift and effective action by endemic countries and global partners, the projected worst-case scenario of a doubling of malaria deaths was averted. For example, the U.S. President’s Malaria Initiative successfully completed all of their planned bed net campaigns in 2020, and the Global Fund to Fight AIDS, TB, and Malaria delivered 188 million bed nets — nearly 32 million more than in 2019. But despite these heroic efforts, even the moderate disruptions in the delivery of malaria services seen in 2020 contributed to significant increases in malaria cases and deaths. 

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  • Though global efforts avoided a worst-case scenario during the pandemic, malaria deaths still increased by 12% from last year, approximately two-thirds of which are attributable to disruptions due to COVID-19.
  • There were moderate levels of disruption in access to clinical services in most moderate and high malaria burden countries in 2020.
  • Of the 31 countries that had planned insecticide-treated mosquito net (ITN) campaigns in 2020, 18 (58%) completed their campaigns by the end of that year. 72% (159 million) of the ITNs from the planned campaigns had been distributed by the end of 2020.

On a global scale, the progress against malaria remains uneven.

According to this year’s report, many countries with a low burden of malaria continue to move steadily towards the goal of malaria elimination. Two countries – El Salvador and China – were certified malaria-free by WHO this year and 25 others are on pace to reach zero malaria cases by 2025. However, most countries bearing a high burden of malaria suffered setbacks over the last year and are losing ground in the fight.

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  • Forty countries (43%) that were malaria endemic in 2015 reduced malaria deaths by 40% or more since 2015, with 32 of them reporting zero malaria cases. However, malaria mortality rates remained at the same level in 2020 as they were in 2015 in 14 countries (15%) and increased in another 24 countries (26%).
  • The 11 highest-burden countries, 10 of which are in sub-Saharan Africa, account for 70% of the global estimated case burden and 71% of global estimated deaths. All of these countries except India reported an increase in cases and deaths in this year’s report and accounted for two-thirds of the total global increases seen between 2019 and 2020.
  • The WHO South-East Asia Region met the 2020 milestones for both malaria cases and deaths, with every country in the region except Bhutan and Indonesia reducing case incidence and mortality by 40% or more.

Gaps in coverage of life-saving tools are significant and growing.

The massive scaleup and use of tools to prevent, detect and treat malaria over the last two decades has led to remarkable progress in the fight against malaria. This year’s report demonstrates these gains, while also highlighting the significant – and in some cases, widening – gaps in access to these life-saving tools for people at risk of malaria.

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  • Since 2017, overall access to and use of ITNs has continued to decline in sub-Saharan Africa. In 2020, 233 million ITNs were distributed globally by National Malaria Programs in malaria-endemic countries. 43% of the population in Sub-Saharan Africa slept under an ITN in 2020, a 3% decrease compared to 2019. 
  • The number of people protected by indoor residual spraying (IRS) globally fell from 161 million in 2010 to 127 million in 2015, and further declined to 87 million in 2020. 
  • In 2020, only 32% of eligible pregnant women received the WHO-recommended three doses of preventative malaria treatment during their pregnancy, a 2% drop since 2019. However, this decrease is less than the overall 8% reduction in women who attended antenatal care in 2020. 
  • A major success in 2020 was the expansion of seasonal malaria chemoprevention (SMC), a preventative antimalarial treatment provided to children to protect them from malaria. 11.8 million more children were protected with SMC in 2020 than in 2019, for a total of 33.5 million children receiving preventative treatment. 

A convergence of threats poses an added challenge to the malaria fight.

The progress made in the fight against malaria remains fragile, especially in sub-Saharan Africa, where the malaria burden remains unacceptably high. Emerging threats put decades of progress at risk, including insecticide and antimalarial resistance, invasive new malaria-carrying mosquitoes in urban areasand parasite mutations that make malaria diagnosis more difficult. The COVID-19 pandemic continues to put strain on endemic countries’ health systems and economies, making it even harder to respond to these urgent threats. Increased investment and prioritization of malaria R&D and innovation are more urgent than ever to fight these new challenges. 

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  • Of the 88 malaria endemic countries that provided data for 2010–2020, 78 have detected resistance to at least one insecticide in at least one type of malaria mosquito and one collection site. Globally, resistance to pyrethroids – the primary insecticide currently used in ITNs – is widespread, being detected in at least one type of malaria mosquito in 68% of the sites reporting data.  
  • Of the 44 countries that have conducted some form of investigation to find them, 37 have seen the presence of parasite mutations that cause false negative results in malaria rapid diagnostic tests. 
  • Total funding for malaria research and development (R&D) in 2020 was US$619 million, falling short of the estimated US$851 million projected to be required to stay on track. This year was the second year in a row that saw a decline in investment in malaria R&D. 

Ways YOU Can Help 

This year’s World Malaria Report underscores the urgent need for a strong and well-resourced global malaria response, including increased investment to develop and deliver innovative tools and strategies to help us rise to emerging challenges. Even before the emergence of COVID-19, progress in the fight against malaria had reached a plateau. Now, critical 2020 milestones of WHO’s global malaria strategy have been missed, and without immediate and dramatic action, the 2030 targets will also not be met.

Since 2000, the U.S. government has led the global fight against malaria through time-tested partnerships, scaling up of proven interventions, and groundbreaking innovations. However, U.S. leadership in the fight against malaria is needed now more than ever to protect decades of progress and ensure no child dies from a mosquito bite. As the host of the Seventh Replenishment of the Global Fund next fall, it is critical that the United States remain dedicated in this fight to encourage the rest of the world to join in and get malaria elimination back on track.

2022 will be a critical year for the malaria fight. We need you to raise your voices in support of vital malaria programs – in particular, the Global Fund and the President’s Malaria Initiative (PMI) – that protect millions of people each year from malaria and keep the world on track towards global eradication.  Mark your calendars to participate in our upcoming virtual Leadership Summit (March 13-15, 2022).

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.

Learn More: 

Read the WHO World Malaria Report 2021 

WHO World Malaria Report 2021 press release  

RBM Partnership to End Malaria statement  

Follow the conversation on social at @nothingbutnets and @zeromalaria

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