Malaria is far more controllable today than two decades ago: deaths have fallen about 50% since 2000 and billions of cases have been averted. Recent advances include a promising new treatment, GanLum, with a 97.4% cure rate, and two deployable vaccines (RTS,S and R21) that can protect children at scale. Progress has stalled because of insecticide and drug resistance, climate impacts and disruptions from Covid, but the biggest constraint now is funding and political will — choices that will determine whether the decline resumes or millions more fall ill.
How Malaria Could End: New Drugs, Vaccines — and a Fight Over Funding
In the summer of 2005 I visited a small clinic in Mae Sot, a Thai border town serving refugees from Myanmar. The ward was full of children and adults under mosquito nets, feverish and listless. A few days after I returned to Hong Kong I fell sick with malaria myself; I recovered after a few harrowing days, but millions of others are not so fortunate.
Where We Are Today
Malaria remains a major global killer. The World Health Organization reported about 263 million cases and 597,000 deaths in 2023, most of them young children in sub-Saharan Africa. Yet the disease is far from inevitable: since 2000 the global malaria death rate has fallen roughly 50 percent, and WHO estimates that control programs averted about 2.2 billion cases and 12.7 million deaths between 2000 and 2023. Several countries, from China and Sri Lanka to Paraguay, have been certified malaria-free.
Why Progress Stalled
After steep declines through the 2000s and early 2010s, progress largely plateaued in the mid-2010s. Multiple forces are at work:
- Insecticide resistance in mosquitoes is reducing the effectiveness of widely distributed treated bed nets.
- The malaria parasite has developed partial resistance to common medications in parts of East Africa.
- Climate change is lengthening transmission seasons and expanding the geographic range of mosquitoes.
- The Covid-19 pandemic disrupted bed-net campaigns, diagnostics, and routine care.
The result: the downward curve in global cases and deaths has flattened. Between 2022 and 2023 there were roughly 11 million more reported cases while deaths remained similar.
New Medical Tools: Better Swords And Shields
There is encouraging scientific progress on both treatment and prevention fronts.
New Treatment — GanLum
In November researchers announced results from a major trial of GanLum, a combination of ganaplacide and a once-daily formulation of lumefantrine. The trial reported a 97.4 percent cure rate. Ganaplacide operates through a different mechanism — disrupting the parasite's protein transport system — and the combination appears effective against partially drug-resistant strains emerging in Rwanda, Uganda and Eritrea. Novartis has described GanLum as the first major therapeutic innovation since artemisinin-based combination therapies and plans to seek regulatory approval while pledging to supply it on a not-for-profit basis in endemic countries.
Vaccines — RTS,S and R21
For the first time there are two vaccines that meet thresholds for broad deployment in high-burden African settings: RTS,S/AS01 and R21/Matrix-M. RTS,S has already been administered to more than 1.8 million children through WHO-coordinated pilots in Ghana, Kenya and Malawi; it is safe, logistically feasible, and reduces childhood malaria, hospitalizations and deaths. R21, developed by the University of Oxford and manufactured by the Serum Institute of India, has shown >70 percent efficacy in some highly seasonal transmission settings and can be produced at scale and relatively low cost. The Serum Institute reports capacity around 100 million doses per year, with plans to increase production and a target price under $4 per dose.
More than 20 African countries have introduced or are preparing to introduce at least one of these vaccines into routine childhood immunization schedules. Global health agencies estimate that vaccinating roughly 50 million children over the next several years could prevent well over 100,000 childhood deaths.
The Real Constraint: Money And Political Will
Scientific breakthroughs do not deploy themselves. The primary constraints now are financial and political. WHO estimates global malaria funding is still several billion dollars short of what is required to meet internationally agreed targets. Donor funding from wealthy countries has flattened or fallen in real terms, and policy decisions in donor countries can shrink programs such as the US President's Malaria Initiative. When major donors scale back purchases of nets, rapid diagnostic tests, or antimalarial drugs, the effects are immediate: clinics run out of supplies and vaccination rollouts slow or shrink.
Researchers warn that ongoing underfunding could cause millions of extra malaria cases and tens or hundreds of thousands of additional deaths by 2030 compared with a fully funded trajectory. Some southern African countries are already experiencing resurgences linked to funding gaps and campaign disruptions.
Which Ending Will We Choose?
Scientifically, malaria is more solvable than ever: better treatments, deployable vaccines, and proven prevention tools exist. The remaining barrier is political and financial: whether the long downward trend in malaria resumes or stalls depends on policy choices and funding commitments. When I picture that clinic in Mae Sot — parents watching children burn with fever under mosquito nets — it no longer feels like an immutable fact of life. We have the tools to write a very different ending; the question is whether the world will choose to fund and deliver them at scale.
Sign-up note: A version of this story originally appeared in the Good News newsletter.
