On World Malaria Day 2026, the data tells two stories at once. Since 2000, coordinated global action has averted an estimated 2.3 billion malaria cases and 14 million deaths, and yet an estimated 282 million people contracted malaria in 2024, with deaths edging up again. Artemisinin resistance is spreading, Anopheles stephensi is urbanising the disease, and funding is falling short of global targets. Why physical barriers remain essential alongside the new vaccines.
Every year on 25 April, the world pauses to mark World Malaria Day. This year's theme, "Driven to End Malaria: Now We Can. Now We Must.", is both a rallying call and a quiet acknowledgement of something uncomfortable: after decades of remarkable progress, the numbers are moving in the wrong direction again.
Globally in 2024, there were an estimated 282 million malaria cases and 610 000 malaria deaths (WHO malaria fact sheet). To put that figure in human terms: children under five accounted for about 75% of malaria deaths in the WHO African Region (WHO).
And yet the same data contains a story of extraordinary achievement. Since 2000, coordinated global action has averted an estimated 2.3 billion malaria cases and 14 million deaths (WHO World Malaria Report 2025). Forty-seven countries have now been certified malaria-free by the WHO, including two in 2024 and three in 2025 (WHO). The question the world is grappling with this World Malaria Day is simple and urgent: if we know how to stop this disease, why are cases rising again?
The Progress That Got Us Here
To understand the backslide, you have to first understand what drove the progress. Between 2000 and the early 2020s, the global malaria burden fell dramatically. The primary tools responsible were not complicated: insecticide-treated mosquito nets, indoor residual spraying, rapid diagnostic tests, and artemisinin-combination therapies (ACTs). These interventions were delivered at scale by governments, the Global Fund, UNICEF, and Gavi across sub-Saharan Africa, Southeast Asia, and the Americas.
Nets remain a core tool. New-generation nets, which provide better protection than pyrethroid-only nets, are becoming more widely available (WHO).
Seasonal malaria chemoprevention gives a full course of antimalarial medicine to vulnerable children at the time of greatest risk (WHO malaria fact sheet). And as of 28 January 2026, 25 countries in Africa have introduced malaria vaccines with Gavi support (Gavi). The two WHO-recommended vaccines, RTS,S/AS01 and R21/Matrix-M, are estimated to save one life for every 200 children vaccinated (Gavi).
This is remarkable science, delivered at remarkable scale. The framework for ending malaria exists. The theme "Now We Can" is not wishful thinking, it is grounded in evidence.
So Why Are Cases Rising?
The answer is a convergence of biological, financial, and logistical pressures.
Artemisinin Resistance Is Spreading
Artemisinin-based combination therapies are the backbone of malaria treatment globally. When a patient contracts malaria, ACTs are the first-line treatment in nearly every endemic country. That cornerstone is weakening as partial artemisinin resistance spreads.
The WHO has confirmed artemisinin partial resistance in four African nations: Eritrea, Rwanda, Uganda, and Tanzania (WHO malaria fact sheet). Partial resistance means the parasite is surviving longer in the bloodstream despite treatment, reducing cure rates and increasing the risk of treatment failure. The history is a warning: chloroquine was once the mainstay treatment, and today the WHO recommends it only for P. vivax in places where the parasite is still sensitive to it (WHO).
The WHO lists containing artemisinin resistance among its priorities.
A New Mosquito Is Urbanising the Disease
For most of modern history, malaria in Africa was predominantly a rural disease. The primary vector, Anopheles gambiae, thrives in the agricultural landscapes and slow-moving water bodies typical of rural sub-Saharan Africa. Urban populations were partially insulated by concrete infrastructure, treated water systems, and reduced vector habitat.
That picture is changing. Anopheles stephensi, a mosquito native to South Asia and the Arabian Peninsula, has been steadily expanding into African cities. Unlike An. gambiae, An. stephensi breeds in artificial water containers, thrives in urban environments, and is highly adapted to the built environment. Critically, it carries significant insecticide resistance.
Africa is already more than 40% urban, so a mosquito that thrives in cities can sustain transmission in dense urban settings (WHO).
The Funding Gap Is Widening
Perhaps the most tractable problem, and the most frustrating, is money. The WHO's World Malaria Report 2025 assesses the funding picture and identifies the gaps in the fight against malaria (WHO).
That shortfall does not translate into an abstraction. It translates into bed nets not distributed, diagnostic kits not deployed, treatment courses not purchased, and community health workers not trained.
The Role of Physical Barriers, Still Essential in 2026
One of the more important things to understand about the malaria prevention toolkit is that its components are complementary, not interchangeable.
Vaccines are arriving, and they are genuinely transformative. WHO reports that R21/Matrix-M and RTS,S/AS01 reduce malaria cases by about 75% when given seasonally in areas of highly seasonal transmission (WHO). That is remarkable for a disease as biologically complex as malaria, which has defeated vaccine development efforts for decades. Even so, a 75% reduction is not full protection, and children in high-transmission settings still face repeated exposure. In populations where exposure events are frequent, sleeping in warm, humid conditions, in areas with high mosquito density, that remaining risk is not trivial.
Physical barriers, mosquito nets, window screens, structural protection, provide a layer of defence that vaccines cannot. They work independently of the parasite's biology, independently of resistance profiles, and independently of individual immune response. They are particularly effective precisely in the settings where malaria transmission is most intense: sleeping hours, in warm environments, with proximity to breeding water.
The WHO's Global Technical Strategy for Malaria 2016-2030 continues to list vector control, including insecticide-treated nets and physical barriers, as a pillar of prevention. The arrival of vaccines does not change this calculus. It strengthens it: layered protection is more robust than any single intervention.
What the "Now We Must" Means
The second half of this year's World Malaria Day theme carries weight. The science is there. The tools are there. The vaccines are being distributed. What is missing is the will to close the funding gap, to contain artemisinin resistance before it becomes treatment failure, and to extend protection into the African cities where An. stephensi is establishing itself.
"Now We Must" is a statement directed at governments, donors, development banks, and multilateral institutions. But it is also a statement about behaviour, about whether the children receiving seasonal chemoprevention are also sleeping under a net, whether the families being vaccinated are also being given the tools to avoid the bite in the first place.
Progress toward a malaria-free world has never been more technically feasible. The gap between what is possible and what is happening is not scientific, it is political, financial, and logistical. That is both the challenge and the reason for cautious optimism: problems made by humans can be solved by humans.
Sources: WHO malaria fact sheet | WHO World Malaria Report 2025 | WHO World Malaria Day 2026 | Gavi malaria vaccine support | WHO malaria vaccines Q&A | WHO Global Technical Strategy for Malaria | WHO An. stephensi alert
Mosticare Editorial is the writing arm of Mosticare.
This article is general information, not medical advice. Ask a doctor or pharmacist about your own health.