Drug Resistance Threatens Hard-Won Gains As New Malaria Tools Avert One Million Deaths In 2024: WHO Report

Despite the deployment of powerful new tools that helped avert an estimated one million deaths last year, global progress against malaria is stalling and, in some regions, slipping backwards, the World Health Organization (WHO) has warned in its annual World Malaria Report.

According to the report released Thursday, malaria cases climbed to 282 million in 2024, about nine million more than in 2023. Deaths rose to 610,000, up from 598,000 the previous year, underscoring the fragility of gains achieved over the past two decades.

WHO attributed the prevention of 170 million cases and one million deaths to wider use of next-generation tools—including dual-ingredient insecticide nets and the first WHO-recommended vaccines.

Since the approval of the world’s first malaria vaccine in 2021, 24 countries have integrated it into routine immunization programmes. Seasonal malaria chemoprevention has also expanded to reach 54 million children in 20 countries in 2024, up from just 0.2 million in 2012.

Progress on elimination continues, though unevenly. The report notes that Cabo Verde and Egypt were certified malaria-free in 2024, while Georgia, Suriname and Timor-Leste joined the list in 2025. In total, 47 countries and one territory have achieved malaria-free status. Yet these successes sit alongside an alarming rise in global caseloads, the report notes.

The WHO African Region accounted for 95% of all deaths, with children under five remaining the most vulnerable.

However, mosquito continues to sting. A growing threat looms over these efforts: antimalarial drug resistance. Partial resistance to artemisinin—the backbone of modern malaria treatment—has now been confirmed or suspected in at least eight African countries, with early signs of declining efficacy in partner drugs used in combination therapies.

“New tools are giving us hope, but the challenges are escalating,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus cautioned. He warned that rising cases and deaths, expanding drug resistance and shrinking funding could “roll back the progress we have made over the past two decades.”

Other biological threats are compounding the crisis. The report highlights that pfhrp2 gene deletions continue to erode the reliability of rapid diagnostic tests, making early detection of malaria increasingly difficult in several high-burden regions.

Pyrethroid resistance, now confirmed in 48 countries, is further weakening the effectiveness of insecticide-treated nets—one of the most widely deployed and cost-effective malaria prevention tools.

Adding to these challenges is the spread of the invasive Anopheles stephensi mosquito, which is resistant to multiple insecticides and thrives in urban environments. The species has already established itself in nine African countries, posing a serious new obstacle to malaria control in rapidly growing cities.

Climate change, too, is reshaping transmission patterns. Unpredictable rainfall, rising temperatures and extreme weather events are driving outbreaks in new areas. Conflict and instability have disrupted health services, delaying diagnosis and treatment.

The situation is made worse by plateauing global funding. Investments in malaria control reached USD 3.9 billion in 2024—less than half the USD 9.3 billion target for 2025 under WHO’s Global Technical Strategy. Recent cuts to Official Development Assistance have forced countries to cancel surveys, scale down surveillance and grapple with stock-outs of essential interventions.

“The World Malaria Report is clear: drug resistance is advancing,” said Dr. Martin Fitchet, CEO of Medicines for Malaria Venture. He noted that the first non-artemisinin combination therapy, Ganaplacide–Lumefantrine, demonstrates that “new medicines with new mechanisms of action are possible,” marking the beginning of a “new chapter in malaria resilience.”

WHO urged endemic countries to sustain high-level political commitment, particularly through the Yaoundé Declaration, and called for unified action under the Big Push initiative to counter current and emerging threats.

Without sustained investment, scientific innovation and coordinated global action, the report warns, the vision of a malaria-free world will remain out of reach.