World Malaria Report 2023: What You Need to Know

Worldwide 

• There were an estimated 608,000 deaths due to malaria in 2022 – 11,000 (-2%) fewer than in 2021 but still 40,000 (+7%) higher than in 2019 before the pandemic struck.
• There were an estimated 249 million malaria cases in 2022 – 5 million (+2%) more than in 2021 and 15 million (+6%) more than pre-pandemic (2019).
• The 5 million additional cases were mostly concentrated in five countries – Ethiopia, Nigeria, Pakistan, Papua New Guinea, and Uganda – that endured climate shocks, armed conflicts, population increases, and other drivers of malaria transmission.
• Global malaria case incidence (number of cases per 1000 population at risk) and global malaria mortality rate (number of deaths per 100 000 population at risk) have both decreased significantly since 2000 but remain slightly higher in 2022 as compared to 2019 (pre-pandemic).
• Thanks to global efforts to fight malaria, an estimated 549 million cases and 2.82 million deaths were averted from 2020-2022, bringing the total to 2.1 billion cases and 11.7 million deaths averted since 2000. These figures compare actuals to estimated malaria burden if rates remained at 2000 levels.

Regions and populations most at-risk 

• Sub-Saharan Africa (SSA) carries the heaviest malaria burden, with an estimated 233 million cases (94%) in 2022. The top 20 most malaria-affected countries, by cases, are all in SSA.
• Nigeria alone accounted for 27% and 31% of all malaria cases and deaths globally in 2022. Nigeria, the Democratic Republic of the Congo (12%), Uganda (5%) and Mozambique (4%) accounted for almost half of all cases globally.
• Malaria deaths in SSA (an estimated 580,000) declined by 2% from 2021 (593,000).
• Young children, particularly African children with limited access to healthcare, are disproportionately at-risk of malaria: 76% (~462,000) of all malaria deaths in 2022 were children under the age of 5. A child dies every minute from this preventable, treatable disease.
• Pregnant women are also at heightened risk: In 2022, there were an estimated 35.4 million pregnancies in the WHO African Region, of which 12.7 million (36%) were exposed to malaria infection during pregnancy.
• Displaced populations also face a high malaria risk. In 2022, SSA had a record number of refugees and internally displaced people (38.7 million), per Internal Displacement Monitoring Centre and UNHCR.

Countries close to elimination  

• In 2022, 27 countries reported fewer than 100 indigenous cases of malaria, compared to six in 2000.
• In 2022, Belize, Azerbaijan and Tajikistan were certified malaria-free by the WHO.
• Three subregions – Latin America, the Caribbean, and the Greater Mekong – have made significant progress towards regional elimination this century. But regional malaria hotspots in Venezuela, Haiti, Myanmar, and Thailand, caused by political instability and other factors, have jeopardized those regional elimination efforts.

 Prevention Methods

• In 2022, 254 million insecticide-treated bed nets (ITNs) were distributed worldwide in malaria-endemic countries (93% in sub-Saharan Africa). Approximately 56% of young children and pregnant women were sleeping under a net in 2022.
• In 2022, 47 countries implemented indoor residual spraying (IRS) campaigns to prevent malaria. While IRS is widely considered to be highly effective, the relatively high cost continues to constrain its uptake and scalability: overall, only 1.8% (62 million) of the global population at-risk of malaria is protected by IRS.
• The use of Intermittent Preventive Treatment in Pregnancy (IPTp) has increased dramatically over the past decade. 35 African countries have adopted national IPTp programs to reduce the burden of malaria during pregnancy. In these 35 countries, 42% of pregnant women in sub-Saharan Africa (SSA) received a full three-dose regimen of IPTp in 2022, compared to 34% in 2021, which is more than double the rate of 2015.
• The average number of children treated per cycle of Seasonal Malaria Chemoprevention (SMC) steadily increased from about 200,000 in 2012 to almost 49 million across 17 countries in 2022. Nigeria alone treated an average of 25.5 million children per SMC cycle in 2022.
• To date, more than 2 million children have received at least 1 dose of the RTS,S/AS01 malaria vaccine through the WHO-coordinated Malaria Vaccine Implementation Program in Ghana, Kenya and Malawi. At least 28 African countries plan to introduce RTS,S/AS01 into their childhood immunization programs and their national malaria control strategies, as early as next year.

 Treatment & Diagnosis  

• • In 2022, malaria-endemic countries distributed 345 million malaria rapid diagnostic tests (RDTs) and 242 million courses of Artemisinin-based Combination Therapy (ACT), the world’s most widely used anti-malarial treatment.
  • Treatment-seeking rates in malaria-endemic countries remain too low. According to household surveys conducted in SSA, only 66% sought treatment for their most recent fever between 2015-2022, compared to 65% between 2005-2011.
  • However, for those who do seek care, the use of diagnostic tests and ACT’s (compared to older generation drugs) has grown considerably: from 30% and 54% between 2005-2011 to 54% and 65% between 2015-2021.

Climate change

• Malaria is a particularly climate sensitive disease. Temperature changes, shifting rainfall patterns, and extreme weather events are affecting the spread of malaria.
• According to the Intergovernmental Panel on Climate Change (IPCC), climate change has led to an increase in the frequency and/or intensity of extreme weather events.
• Flooding not only reduces access to vital services, but also creates breeding grounds for mosquitoes, thus increasing the risk of malaria while hindering access to treatment.
• Mass flooding in Pakistan in 2022 led to a five-fold increase of malaria.
• Over the past several decades, numerous studies have shown that rising temperatures have contributed to increased malaria transmission in African highland areas that were previously malaria free.
• Evidence of climate change’s long-term impact on malaria transmission is scarce. The magnitude of such impacts are likely to vary across social and ecological systems.

Humanitarian crises  

• • Between 2019 and 2022, 41 malaria-endemic countries experienced health and humanitarian emergencies, not including the COVID-19 pandemic. Many of these countries experienced significant surges in malaria rates.
  • Democratic Republic of Congo, Ethiopia, Haiti, Mozambique, Myanmar, Pakistan, South Sudan, and Yemen  are just a few of the countries that experienced rising malaria rates due to conflict and/or climate-induced humanitarian crises.
  • These crises also contributed to record rates of displacement worldwide. In 2022, SSA had a record number of refugees and internally displaced people (38.7 million), per Internal Displacement Monitoring Centre and UNHCR. Displaced populations are particularly vulnerable to malaria and other infectious diseases.

Mosquito evolutions 

• Widespread mosquito resistance to pyrethroids, the most commonly-used insecticide for insecticide-treated bed nets (ITNs), poses a major threat to malaria control programs that still rely heavily on pyrethroid-treated ITNs.
• Globally, mosquito resistance to pyrethroids has been detected in 89% (78 out of 88) of malaria-endemic countries in which resistance monitoring is taking place.
• The spread of Anopheles stephensi, an urban-adapted mosquito species, is posing an added challenge to disease control efforts in Africa – particularly in the Horn of Africa. Thus far, the invasive mosquito species has been detected in eight African countries: Djibouti, Eritrea, Ethiopia, Ghana, Kenya, Nigeria, Somalia, and Sudan.
• A. Stephensi transmits both of the malaria species that pose the greatest threat to public health — P. falciparum and P. vivax — and is resistant to many commonly-used insecticides. If uncontrolled, its spread may increase the risk of malaria transmission in African cities.

Anti-malarial drug resistance 

• Partial resistance to artemisinin-based combination therapy (ACT), the mainstay for malaria treatment in most malaria-endemic settings, has been detected across the Greater Mekong Subregion, East Africa, and the Horn of Africa.
• Given the heavy reliance on ACTs, particularly in sub-Saharan Africa (SSA), even modest increases in ACT resistance can have serious, far-reaching consequences.

Funding gaps

• In 2022, total funding to fight malaria was estimated at $4.1 billion, a slight increase from 2021 yet well below the estimated $7.8 billion needed to stay on track towards eradication.
• In 2022, investments in malaria research and product development fell by 11%, from $676 million in 2021 to $603 million in 2022 – the lowest recorded funding level in 15 years.

New malaria prevention and vector control tools 

• The use of pyrethroid-piperonyl butoxide (PBO) nets, which are more effective against pyrethroid-resistant mosquitoes, continued to increase in 2022: 51% of the 260 million ITNs delivered to sub-Saharan Africa (SSA) were PBO nets.
• In addition, 2022 saw the continued scale-up of new dual-active ingredient ITNs and indoor residual sprays, which are optimally more effective against pyrethroid-resistant mosquitoes and more costly.
• Researchers and private sector companies are developing and investing in new vector control interventions, including spatial repellents, targeted sugar baits that attract mosquitoes, lethal house lures (eaves tubes), and genetic engineering of mosquitoes.
• The rollout of the RTS,S/AS01 vaccine in Ghana, Malawi, and Kenya led to a 13% drop in early childhood deaths in the communities where RTS,S was administered, compared with communities where the vaccine was not introduced, according to a WHO study.
• In October 2023, the WHO recommended a second safe and effective malaria vaccine, R21/Matrix-M. The addition of R21 will go a long way towards closing the sizeable gap between malaria vaccine supply and the unprecedented demand. Mass rollout of the two vaccines is expected to begin in 2024 (the first non-pilot shipments of RTS,S have already begun).

New malaria diagnostic and treatment tools 

• The malaria diagnostic test market is dominated by RDTs that detect the HRP2 antigen expressed by the P. falciparum malaria parasite. However, the spread of malaria parasites with HRP2 gene deletions presents a major threat to reliable diagnosis. Thus, among the numerous RDTs in clinical trials are tests that better detect non-HRP2 malaria parasites.
• A wide range of next-generation anti-malarial treatments are being developed and evaluated, including improvements to existing ACT drugs, drugs that combat ACT resistance, and drugs with lower-dosing regimens.

• 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 support US funding for vital malaria programs. 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.
• Join the global movement to end malaria by becoming a Beat Malaria Champion! Text CHAMPION to 30644 to learn more about the actions you can take to make a difference year-round in the fight against malaria.
• For non-US supporters who’d like to get involved, take action through the  Zero Malaria Starts With Me campaign.
• You can also lend your support by donating to United to Beat Malaria. This Holiday season, United to Beat Malaria has launched the #UnitedInHealth campaign to support community health care workers on the ground with the trainings and tools they need to diagnose and treat malaria. With your help, we can reach our goal of supporting 549 community health workers, the first and last line of defense against malaria, by December 31st.