The World Malaria Report 2021 applies a new statistical method to calculate the number of children under 5 dying from the disease. The report estimates 627,000 people lost their lives to malaria in 2020 (compared to 409,000 in 2019 based on previous methodology).

“We welcome WHO’s methodological update, which while pointing to a distressingly greater burden of disease than originally estimated, does give us a clearer picture of the problem we are facing,” said Dr David Reddy, CEO of MMV.

The new methodology applies across all childhood diseases and reveals that malaria accounts for a greater share of deaths among children under 5 than previously recognised (7.8% versus 4.8%). On this basis it is estimated a child dies from malaria every minute of every day.

COVID-19 – worst case scenario averted

In April 2020 modelling studies indicated that, in the worst case, the SARS-CoV-2 pandemic could derail malaria control efforts and double malaria deaths. Thankfully, this scenario was averted as the urgent response of malaria-endemic countries ensured malaria campaigns went ahead; campaigns like Seasonal Malaria Chemoprevention (SMC), an MMV-supported initiative, protected 33% more children in 2020 (33.5 million versus 21.7 million in 2019) in 13 countries.

Regrettably, disruptions in the provision of other malaria tools caused by the COVID-19 pandemic resulted in around 47,000 of the additional malaria deaths.  

Trends in global cases remain the same

While the estimated number of people losing their lives to malaria has increased, it is important to note that the overall trends in malaria case incidence between 2000-2020 remain the same – e.g., a reduction in cases by 27%.

Efforts of the malaria community over the last 20 years saved an estimated 10.6 million lives and prevented ~1.7 billion cases. Yet this progress has been levelling off for several years and progress towards the WHO targets to reduce the burden of disease by 90% by 2030 is substantially off track.

New approaches and tools needed

According to the World Malaria Report 2021, to tackle malaria the world needs ‘new approaches and greatly intensified efforts aided by new tools and the better implementation of existing ones. Stepped-up investment is also essential.’

News that the WHO had recently endorsed the RTS,S malaria vaccine for broad rollout resulted in significant optimism in the malaria community. Reporting a reduction of around 30% in severe malaria in children aged 5-18 months, the vaccine is not a ‘silver bullet’. It is, however, a welcome addition to the malaria toolbox and will have a place in accelerating progress against the parasite when used alongside existing tools. Studies combining it with SMC have shown a greater fall in malaria cases and hospitalisations, versus when either intervention is used alone, raising the interest of several countries, which are now considering ways to implement the combination.

Continued research for new tools is critical, particularly in the context of emerging parasite resistance in Africa. MMV has shown progress in advancing new non-artemisinin compounds to counter resistance. In September this year, MMV and Novartis, were delighted to report positive results for a novel combination therapy for uncomplicated malaria in adults and children, ganaplacide–lumefantrine. Depending on the results of ongoing studies, this exciting combination could progress to phase III clinical trials. Meanwhile, working with partners, MMV is also testing other promising combinations, including ZY19489 + ferroquine, and M5717 + pyronaridine, and expects to assess several others from 2022 onwards.

In addition to this we need to look at how we can better serve the needs of at risk-groups, such as pregnant women. The pandemic also slowed the scale-up in coverage of intermittent preventive treatment in pregnancy (IPTp), which dipped to 32% compared to 34% in 2019. Through its Malaria in Mothers and Babies (MiMBa) initiative, MMV is working with key players to support increased coverage of this important intervention as well as to accelerate research into antimalarials for women that are pregnant or breast feeding as well as those that are of reproductive potential.

“The methodological shift in this year’s Report points to what we need more of to defeat malaria,” said Dr Reddy. “Quality, real-time data, that must then used to guide our approaches. Data from different settings and different populations; data on the utility of different tools, alone and in combination; and data, disaggregated for example by sex, on how existing tools work in high-risk populations like pregnant women. While the challenges are great, we have reasons to be optimistic. New tools are already saving lives while others are progressing through the pipeline. To reach fruition they need continued funding and commitment. At MMV, we have no shortage of the latter and together with our partners and the support of our donors we are committed to driving down to zero this unacceptable burden of disease.”