Unite against Malaria: challenges and achievements in malaria control around the globe

Abstract

In May 2015, the World Health Organization (WHO) adopted the Global Technical Strategy 2016-2030 with the aim of reducing global malaria incidence and mortality by 90% between 2015 and 2030. To mark World Malaria Day 2026, themed “Driven to End Malaria: Now We Can. Now We Must”, we invited three researchers from three global regions to share their experiences of working towards this ambitious goal and the unique challenges and opportunities that remain. The experts involved are Dionicia Gamboa (an expert in molecular surveillance and vector genomics in the Peruvian Amazon region, Universidad Peruana Cayetano Heredia), Fitsum Girma Tadesse (an expert in malaria molecular epidemiology in Ethiopia and the Horn of Africa working at Armauer Hansen Research Institute in Addis Ababa and London School of Hygiene and Tropical Medicine), and Leanne Robinson (an expert on malaria epidemiology and implementation research in the Asian-Pacific region with a particular focus on Papua New Guinea, Burnet Institute).

Over the past 10-20 years, how have the profiles of malaria incidence, morbidity, mortality, and resistance changed in your region of interest, and what underlying factors have been the main contributors?

Dionicia Gamboa: In Peru, 98% of reported malaria cases are concentrated in Loreto Department in the northwest Amazon region. Plasmodium vivax represents 82% of the cases reported, followed by P. falciparum and the more recently detected P. malariae¹.

Peru has experienced fluctuating malaria transmission, with a sustained decline from 2005 until 2010 achieved by the success of the Global Fund sponsored program, Malaria Control in Border Areas of the Andean Region: A Community Approach (PAMAFRO)². Between 2010–2011, for the second time in Peru’s history, the malaria incidence rate fell to less than 1 case/1000 inhabitants; however, there was a resurgence of cases after 2011 with over 60,000 reported in 2015. This increase is reflected by the absence of sustained control efforts after PAMAFRO ended and severe flooding in Loreto’s riverine communities in 2012³.

In 2017, the Peruvian government committed politically and financially to a long-term initiative called Malaria Zero Plan (MZP)⁴, which, in 2020, successfully led to a 70% case reduction in Loreto. Sadly, the COVID-19 pandemic had a huge impact on malaria control efforts in Peru, especially in Iquitos, the capital of the Loreto Department; during this time, all routine malaria surveillance, interventions and other control activities were postponed, which led to a significant decrease in case notifications. Finally, in 2022, the Peruvian Ministry of Health (MoH) announced the “Plan towards the Elimination of Malaria in Peru”⁵ with the aim of reducing malaria cases by 90% by 2030. This plan includes all regions that reported cases in the last ten years.

Currently, malaria remains highly focal in The Americas, with cases mostly concentrated in hard-to-reach indigenous communities from the Amazon basin (Colombia, Brazil and Venezuela), where there are still health system gaps. Mortality due to malarial infection has significantly decreased due to improved diagnosis and treatment; however, morbidity remains high due to recurrent, submicroscopic and asymptomatic P. vivax infections.

Fitsum Girma Tadesse: Africa’s malaria trajectory has shifted from remarkable early gains to a period of stagnation and, in several settings, resurgence. Between 2000 and the mid-2010s, renewed investment and improved tools enabled historic reductions in disease burden⁶. Since 2015, however, incidence has plateaued and, in many high-burden countries, risen again, underscoring the fragility of earlier gains⁷. The 2024 World Malaria Report estimates of malaria cases and attributed-deaths to be 263 million and 597,000 deaths, respectively, and Africa accounted for >94% of these⁸.

A defining feature of the current landscape is the emergence and expansion of malaria biological threats. Insecticide resistance is now widespread in Anopheles gambiae s.l. and An. funestus, which are the major malaria vectors in Africa, reducing the effectiveness of pyrethroid-only long-lasting insecticidal mosquito nets (LLINs) and indoor residual spraying (IRS)^9,10. The emergence and rapid spread of the invasive urban vector An. stephensi raises concerns about malaria transmission expanding into densely populated urban settings that were previously considered low risk. First detected in Djibouti in 2012, this invasive vector has since been reported in Ethiopia (2016), Sudan (2019), Somalia (2019), Eritrea (2021), Kenya (2022), Nigeria (2023), Ghana (2023), and more recently in Niger (2025)^11–14. Parasite-related threats are also escalating, posing additional risks to case management. P. falciparum parasites with deletions in pfhrp2/3 genes, which evade detection by the widely used HRP2-based rapid diagnostic tests (RDT), have reached significant levels in parts of the Horn of Africa, prompting diagnostic policy shifts. In Eritrea¹⁵ and Djibouti¹⁶, the prevalence of deletions reached as high as >80%, while exceeding 20–40% in Ethiopia^17,18. In parallel, artemisinin partial resistance (ART), associated with specific pfk13 mutations, has been confirmed in Rwanda¹⁹, Uganda^20,21, and the Horn of Africa^22,23, raising concerns about the long-term efficacy of first-line artemisinin combination therapy (ACT).

These biological threats are unfolding against a shifting funding and policy landscape. After a period of rapid scale-up, malaria financing has plateaued in real terms, creating structural vulnerabilities in national programmes.

Leanne Robinson: In the Asia–Pacific region, malaria epidemiology is highly heterogeneous, with all five human-infecting Plasmodium species present, and transmission sustained by more than 19 major vector species^24,25. The region accounts for less than 5% of global malaria deaths but is home to more than 2 billion people at risk of malaria²⁶. In 2024, the region recorded ~6 million malaria cases, remaining relatively stable against 2023 estimates^26,27. In some settings, transmission is highly focal and concentrated in specific geographic and population “hotspots” such as forests, border areas, conflict zones and within migrant or highly mobile populations; transmission is frequently driven by outdoor biting vectors and persistent, difficult to detect asymptomatic parasite reservoirs. Access to prompt diagnosis and treatment in such settings is extremely difficult and conventional indoor-focused vector control strategies are either unsuitable or insufficient to prevent transmission.

Over the past two decades there has been both considerable progress in reducing the burden of malaria, as well as the emergence of concerning new challenges. Between 2005 and 2015, the region achieved large and widespread reductions in malaria incidence, largely through well-funded nationally-led programmatic scale up of effective vector control, RDTs and ACT. From 2016 onwards however, progress considerably slowed and became widely variable both within and between countries, with some progressing towards elimination and others experiencing worrying resurgence.

Despite facing the additional challenges associated with the emergence of Plasmodium falciparum antimalarial drug resistance in 2008, Cambodia, the Lao People’s Democratic Republic and Vietnam have reduced P. falciparum cases by more than 90% are now rapidly accelerating towards country-wide malaria elimination²⁶.

Conversely, Pakistan experienced a marked resurgence of malaria following the catastrophic floods of 2022, with reported cases increasing by over 1.6 million between 2022 and 2023⁸. Papua New Guinea (PNG) and the Solomon Islands continue to experience persistent malaria transmission, driven by resource-constrained health systems, substantial outdoor exposure, and a high burden of Plasmodium vivax. Myanmar and Afghanistan have experienced malaria rebounds associated with conflict, population displacement, and disruption of health services, while Thailand has also reported increased transmission along its western border²⁶.

P. vivax is now the predominant parasite across the region, characterised by frequent relapsing infections that are both difficult to diagnose and treat, hindering control and elimination efforts.

What are the main local clinical and public health strategies to prevent, identify, and treat malaria [within your region]?

Dionicia Gamboa: The main strategies, based on PAMAFRO experience, are outlined in the “Plan towards the Elimination of Malaria in Peru”⁵ which includes diagnostic, treatment and preventive strategies with a community approach.

The gold standard for malaria diagnosis is microscopy. RDTs are used in remote areas and, in the new Technical guidelines for the integral care of uncomplicated and severe Malaria⁵, molecular diagnostic tools are also included like PCR and LAMP; but have not been implemented at Point of Care (PoC) level.

Peru was among the first countries to adopt ACTs for P. falciparum after the first report of Chloroquine resistance (CQR) during the 1990s. The current treatment scheme for P. vivax is Chloroquine (CQ) plus Primaquine (PQ); however, its effectiveness is unclear because administration is not typically supervised. The presence of PQ resistance or compliance has not been systemically assessed under either routine or clinical trial conditions. There is a report from 2010 where treatment adherence to 7-day PQ for the radical cure of P. vivax was estimated at 62.2% among patients along the Iquitos-Nauta road, in the Peruvian Amazon²⁷. In 2024, Brazil was the first country in the Americas that officially integrated single-dose Tafenoquine (TQ) into its National Treatment Guidelines and by September 2025 Peru also approved the introduction of TQ into the National Malaria program²⁸ with the aim to improve patient compliance and accelerate the elimination of P. vivax.

Among the preventive measures, the technical regional guidelines include the use of repellents, distribution of LLINs and IRS, although this has a limited impact in the Amazon region due to vector behavior plasticity. Additional measures include community environment-based management to remove and/or reduce temporary water bodies near houses, larval source management of permanent and large breeding sites.

Active case detection targeting febrile populations and reactive case detection around an index case using microscopy or RDTs are among the surveillance measures used by the National Malaria Control programs to identify malaria infections. Additionally, new platforms like molecular (genomic) and serological tools developed and used by academic research also inform public health officials at local, national, and regional levels.

Fitsum Girma Tadesse: Malaria control across Africa relies on a package of prevention, diagnosis, and treatment strategies delivered through both community and facility platforms. LLINs remain the primary vector-control tool, with many countries transitioning to next-generation dual-insecticide nets to counter widespread pyrethroid resistance⁶. IRS is deployed in targeted high-transmission districts, while seasonal malaria chemoprevention (SMC) has expanded rapidly across the Sahel and is being piloted in new ecological settings. Intermittent preventive treatment in pregnancy (IPTp) remains essential, but coverage remains uneven.

Accurate and timely diagnosis underpins effective case management. While microscopy remains the reference standard, its utility is limited, especially in hard-to-reach areas, by logistical and training related factors. The scale-up of RDTs since the early 2000s transformed access to diagnosis, with diagnostic testing in Africa rising from ~36% in 2010 to >80% by 2018²⁹. However, the spread of pfhrp2/3 deletions now threatens its utility.

ACTs remain the first-line treatment across the continent, with artemether-lumefantrine being the most widely used regimen used to treat >85% of cases. Emerging signals of ART-R and partner-drug tolerance underscore the urgency of preserving lumefantrine efficacy, particularly as triple-ACT regimens³⁰ and new combinations such as ganaplacide-lumefantrine³¹, which also rely on efficacy of lumefantrine, advance toward deployment.

Countries are increasingly implementing genomic surveillance, entomological monitoring, and climate-informed early-warning systems. However, their integration into routine decision-making remains a question. Regional initiatives, through the African Union, IGAD, SADC, E8, and HANMAT/HAMMS are strengthening cross-border coordination. Despite these advances, gaps in coverage, supply-chain fragility, and health-system disruptions continue to limit the reach and impact of these strategies.

Leanne Robinson: Broadly speaking, malaria control in the Asia-Pacific region relies upon the 3 pillars of the WHO Global Technical Strategy: vector control, prompt diagnosis and artemisinin-combination therapy, with an increasing focus on effective radical cure for Plasmodium vivax malaria, strengthened surveillance systems and community engagement.

In moderate to high-transmission settings such as PNG and Solomon Islands, preventative vector control strategies are implemented widely at the population level. In PNG, the National Malaria Control Program, with support from Global Fund, has a strategy of universal ITN campaigns every three years to provide free nets to all at-risk populations below 1600 meters, with continued coverage in outbreak-prone areas above this altitude³². In countries nearing elimination, vector control is focal and reactive, explicitly linked to surveillance data, foci classification, and response, ensuring resources are concentrated where transmission risk persists in forest-goers, mobile populations, residents of active transmission foci or border and forest-fringe communities³³ In the Greater Mekong Subregion, both insecticidal bed hammock nets are distributed, largely by village malaria workers and mobile malaria workers as part of personal protection packages with bed nets for household protection and hammock nets to address outdoor and forest-related exposure among mobile and forest-going populations.

Across the region, case management consists of parasitological confirmation of malaria infection by either RDTs and/or light microscopy, followed by ACT. Whilst initially widely delivered through outpatient clinics at health facilities, many countries in the region have successfully established village-based malaria worker programs to embed case management within communities and increase access to and uptake of prompt RDT diagnosis and effective treatment.

Until recently, effective case management of P. vivax malaria has largely been ignored or considered too challenging. The presence of hypnozoites means the treatment of P. vivax malaria requires the administration of a “radical cure” that combines blood stage schizonticidal treatment in combination with a liver stage hypnozoiticidal treatment. Hypnozoites can only be cleared by 8-aminoquinolines, such as primaquine and tafenoquine, which can cause haemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals, complicating diagnostic and treatment algorithms, particularly in settings where G6PD testing is not routinely available. Most national antimalarial treatment guidelines have recommended a low dose primaquine regimen (3.5 mg/kg) over 14 days to reduce the risk of haemolysis in G6PD deficient patients, however such a prolonged unsupervised treatment regimen results in low adherence. Widespread implementation of safe and effective radical cure has been hindered by these safety and adherence issues, with <12% recurrent infections prevented by unsupervised low-dose primaquine treatment regimens³⁴. Based upon evidence from a meta-analysis showing that patients treated with a high total dose of primaquine (7 mg/kg) have a lower risk of recurrent P. vivax malaria than those treated with standard low dose primaquine regimen (3.5 mg/kg)³⁵ and evidence from clinical trials demonstrating 7 mg/kg primaquine has similar efficacy over 7 days or 14 days^36,37. WHO revised their antimalarial treatment guidelines in late 2024 to recommend a high total dose of primaquine administered over 7 or 14 days for patients with P. vivax malaria after screening for G6PD deficiency. Recently completed implementation research on the safety, tolerability and feasibility of high dose primaquine in routine clinical practice³⁸ will be important to guide widespread implementation of this revised WHO recommendations in the region, and drive down the burden of P. vivax malaria.

[In your region] Which demographic groups are most severely affected by the multifaceted challenges of malaria infection? Has this changed over the past 10-20 years?

Dionicia Gamboa: In the Amazon region, the rural riverine villages, including indigenous populations, characterized by poverty and limited access to health facilities, concentrate an important proportion of reported malaria cases and deaths, being children under five and pregnant women the population at highest risk. In Peru, Loreto Department, the cases are distributed among 45% and 55% of male and female populations, respectively, and predominantly occur in individuals between 0 and 19 years old. These characteristics have remained the same over the last 20 years³⁹.

Given the heterogeneity of malaria transmission in the Amazon region, human movement, particularly related to occupational activities, leads to high exposure to malaria vectors during trips to areas with high local transmission, resulting in importation and subsequent transmission upon their return to their community of origin. This population became an important target for the development or implementation of new malaria control and elimination strategies^40,41.

Fitsum Girma Tadesse: Children under five and pregnant women remain the groups most severely affected by malaria in Africa, accounting for the majority of severe disease and deaths⁸. The demographic profile of risk has become more complex⁴². In areas of unstable or epidemic-prone transmission, such as the Horn of Africa, the Sahel fringe, and highland regions such as in Ethiopia, older children, adolescents, and adults now contribute a substantial share of clinical cases because they acquire immunity more slowly and are frequently exposed to fluctuating transmission.

Urban populations, historically at lower risk, are increasingly affected⁴³. Rapid, unplanned urbanization, inadequate housing, and the spread of the invasive urban vector An. stephensi have created new foci of transmission in densely populated settings. In several countries, malaria is re-emerging in highland and peri-urban areas where population-level immunity is low across all age groups, increasing the likelihood of severe disease in previously low-exposure communities. At the same time, mobile and marginalized groups, including pastoralists, seasonal agricultural workers, migrant labourers, internally displaced persons, and refugees, face disproportionate risk due to limited access to prevention tools, delayed diagnosis, and fragmented care across borders and administrative boundaries⁴⁴.

These evolving patterns underscore the need for adaptive, equity-focused strategies that explicitly account for mobility, urbanization, and ecological change in the design and targeting of interventions.

Leanne Robinson: The demographic groups most severely affected by malaria across the Asia-Pacific region are young children, pregnant women, mobile or migrant populations, adult men in certain occupational groups, ethnic minorities, people living in remote, conflict-affected or border areas.

Children under 5 years of age have the highest risk of severe disease and death due to a lack of acquired immunity and the rapid progression to severe anaemia and cerebral malaria that can occur if malaria diagnosis and treatment is delayed. P. vivax malaria, which is widespread in the region, is a major cause of severe anaemia and excess mortality in young children^45–47. These relapses result in a higher cumulative risk of anaemia making patients more susceptible to concomitant infections such as pneumonia and diarrhoea and increase the risk of mortality⁴⁷.

In numerous countries in the region, residual malaria is concentrated in remote, often poorly accessible border areas where transmission is associated with forest-related activities, such as logging or gem mining. As a consequence, the highest rates of malaria are observed in the adolescent and adult males who engage most in these activities⁴⁸.

Across the entire Asia-Pacific, inequity remains the most significant predictor of malaria risk; factors including geographic and cultural inaccessibility to health systems, exclusion from surveillance programs, and exposure to climate and conflict shocks, all underscore the current and evolving epidemiology of the disease within the region.

In your personal view, what, if any, milestones have been reached towards malaria eradication both globally and within your specific region?

Dionicia Gamboa: The first milestone was the early introduction of ACTs for P. falciparum treatment after the appearance of CQ resistance in the Peruvian Amazon at the beginning of 2000. A second milestone was in 2010, when P. falciparum parasites lacking pfhrp2 gene were reported for the first time in the Peruvian Amazon region⁴⁹, which affected their detection by most commercially available RDTs; this led to a switch to the use of non-HRP2 based alternative RDTs for diagnosis of malaria when the prevalence of false negative results in symptomatic patients caused by confirmed pfhrp2 gene deletion exceeds 5%⁵⁰, in line with WHO guidelines.

A final milestone is in the last years when several countries in The Americas achieved malaria-free certification (El Salvador, 2021; Belize, 2023), with Suriname being the first Amazonian country to achieve this important milestone in 2025²⁶.

Fitsum Girma Tadesse: Over the past decade, several scientific and operational breakthroughs have strengthened the long-term feasibility of malaria eradication. Globally, the introduction of the first malaria vaccines (RTS,S/AS01 and R21/Matrix-M), deployment of next-generation dual-insecticide LLINs, and the emergence of new therapeutics, including triple ACTs and non-artemisinin regimens such as ganaplacide–lumefantrine, and long-acting injectables represent major advances. Data systems have also evolved, with early reporting and sub-national tailoring becoming increasingly feasible. Genomic surveillance further enhances the ability to detect resistance, target interventions, and protect high-risk populations.

The successful elimination of malaria in multiple countries across Asia and the Americas demonstrates that sustained political commitment and strong surveillance can interrupt transmission even in complex settings. In Africa, progress has been uneven but nonetheless significant. Mortality has declined markedly since 2000, and countries such as Algeria, Egypt, and Cabo Verde have achieved WHO malaria-free certification, important proof that elimination is achievable on the continent. Africa has also expanded genomic surveillance capacity. Cross-border initiatives through the African Union, IGAD, SADC, HANMAT/HAMMS, and the E8 have strengthened coordination in historically neglected border zones.

Perhaps the most important milestone is the recognition that malaria control must be embedded within broader health-system strengthening, climate resilience, and humanitarian response frameworks. While the targets remain ambitious, the scientific, operational, and political foundations for accelerated progress are stronger than at any point in the past two decades.

Leanne Robinson: The substantial progress made towards malaria elimination in the region is a major milestone. With 5 countries - Bhutan, China, Malaysia, Sri Lanka and Timor-Leste – having reported zero indigenous human malaria cases or achieved malaria-free certification from the World Health Organization and 3 more countries – Cambodia, Lao PDR and Vietnam - rapidly accelerating towards this achievement. These successes highlight that malaria elimination is possible and provide the region with renewed optimism and drive to develop nationally owned strategies that have strong political leadership, sustained financing, and community ownership required to progress towards this milestone for the region.

What region-specific and research-related challenges impede effective malaria control efforts, and what is the most important next step/development goal to achieve effective control, elimination and eradication?

Dionicia Gamboa: P. vivax is the more prevalent species in The Americas. This species poses an important challenge due to its complex biology which includes the dormant stage in the liver (hypnozoites) and rapid gametocyte appearance during the first blood-stage cycle. Additionally, these parasites preferentially invade reticulocytes which represent less than 5% of the red blood cells, resulting in low parasite densities. Additionally, in the last years cryptic cycles have been reported in the spleen and bone marrow⁵¹. P. malariae have been reported in the Peruvian Amazon in the last years, mainly characterized by low parasitemia, no symptoms and commonly observed in mixed infections.

In both types of malaria infections, most of the submicroscopic infections are also asymptomatic, leading to “silent” reservoirs maintaining malaria transmission. To overcome these challenges, a PoC diagnostic tool capable of identifying submicroscopic infections, including hypnozoites, would be needed for an appropriate and timely treatment.

Implementing molecular and serological surveillance systems to target hotspots in remote areas for sample collection and data acquisition in real time, is also a priority. At regional level, using standardized tools will generate information that will feed platforms to address common issues, like border malaria, to develop regional strategies optimizing time and resources that will also support the goal for malaria elimination in the Americas.

Fitsum Girma Tadesse: A major constraint to malaria control in Africa is the limited integration of clinical, entomological, genomic, and anthropometric data. Surveillance systems often operate in parallel rather than as a unified platform, reducing the ability to detect outbreaks, resistance signals, and shifts in transmission ecology in real time. These gaps are becoming more consequential as the funding landscape tightens. Abrupt reductions in external financing highlight the urgency of strengthening domestic resource mobilization and building self-reliant, climate-resilient health systems.

The most important next step is the development of integrated, multi-disease surveillance systems that combine clinical case data, vector monitoring, genomic sequencing, climate information, and population-movement analytics. Such systems would optimize scarce resources, support sub-national tailoring, and enable rapid, evidence-based response. Coupled with sustained local financing, next-generation vector control tools, diversified diagnostics, and equitable access to treatment, these innovations are essential for Africa to transition from control to elimination.

Leanne Robinson: P. vivax has become the predominant cause of malaria in the region and is currently the major obstacle to malaria elimination in Cambodia, Lao PDR and Vietnam (WHO 2025). P. vivax is more difficult to eliminate than P. falciparum because it forms dormant liver stages (hypnozoites) that can reactivate weeks to months after the initial infection, resulting in recurrent blood stage infections, known as relapses. Relapses cause an estimated 80% of all blood-stage P. vivax infections^52,53, and are responsible for driving P. vivax transmission. A new and promising approach to address this hidden hypnozoite reservoir uses serological screening for recent P. vivax exposure as a proxy for hypnozoites. A validated serological assay that can detect more than 80% of hypnozoite carriers in different populations has been developed⁵⁴ and point-of-contact sero-diagnostic tests are currently in development. Seropositive individuals can then be targeted with effective 8-aminoquinoline treatment to eliminate hypnozoites in a public health style mass screening and treatment approach called, P. vivax serological testing and treatment (PvSeroTAT)⁵⁵. PvSeroTAT is predicted to reduce P. vivax parasite prevalence, requiring fewer resources than mass drug administration and, in combination with strengthened case management, accelerate P. vivax elimination^56,57.

Conventional indoor-focused vector control tools such as ITNs and IRS have been the cornerstone of vector control globally and largely attributed with successfully reducing the malaria case burden in Africa between 2005 and 2015⁶. However, in the Asia–Pacific region a high proportion of mosquitoes bite outdoors and early in the evening, when people are not protected by ITNs or IRS, and these tools are difficult to access and use for forest workers and mobile migrant populations^58,59. Their effectiveness is further eroded by reduced bio-efficacy of ITNs⁶⁰ and risk of emerging insecticide resistance⁶¹. Improved insecticide formulations⁶² and evidence for complementary strategies (such as spatial emanators, as well as personal repellent and longer-lasting insecticide-treated hammocks) tailored to at-risk populations are required to further reduce transmission in this region.

What lessons can we learn from countries that have successfully been declared malaria-free? What type of support is most needed at the global and coordination level to strengthen malaria control and elimination efforts?

Dionicia Gamboa: The key factor that allowed some countries to reach a malaria-free declaration by WHO is a strong and sustained political and economic commitment that support a robust integrated surveillance system with rapid respond targeting residual transmission foci and mobile populations with a strong community participation.

Malaria does not know about frontiers, cross-border collaboration will be needed to coordinate efforts and integration of malaria control and elimination programs into broader health systems and with a multisectoral approach.

Enhanced data sharing and regional coordination, especially in the Amazon basin, promoting locally led research and capacity building. Regional networks including, not only academic researcher, but also the National Malaria Control Programs and regional offices from WHO, will secure the knowledge transfer into policy and practice. There are several examples ongoing^63–65 and a new one on their way to be implemented in The Americas⁶⁶.

The global support priorities must include a sustained and flexible financing, strengthening health systems in remote areas, avoiding reactive response only when outbreaks are reported.

Fitsum Girma Tadesse: Countries that have achieved malaria-free status share a consistent set of enabling conditions that extend far beyond malaria-specific interventions. Sustained political commitment, strong governance, and predictable domestic financing underpin long-term investment in vector control, surveillance, and primary-care systems. These countries-built surveillance platforms capable of detecting and investigating every case, maintained vigilance long after transmission declined, and rapidly contained imported infections to prevent re-establishment. Their success also reflects improvements in housing, water management, sanitation, and overall living conditions, demonstrating that malaria elimination is fundamentally a whole-of-society achievement rather than a vertical program outcome.

For Africa, the most important lessons are the primacy of high-resolution surveillance, the need for data-driven tailored, context-specific interventions, and the central role of domestic leadership and financing, especially as external funding plateaus. Strengthening health systems, integrating malaria within broader primary-care and climate-resilience agendas, and addressing structural determinants such as housing quality and population mobility are essential.

At the global level, the greatest needs are long-term financing, technology transfer, and coordinated regional mechanisms to manage cross-border transmission. A global architecture capable of rapid response to biological threats, such as invasive vectors, diagnostic escape, and drug resistance, is critical. Ultimately, progress toward the elimination targets will depend on aligning scientific innovation with political commitment, domestic investment, and improvements in the underlying living conditions that shape malaria risk.

Leanne Robinson: Countries in the region that have been declared free of human malaria, have highlighted the importance of political will, sustained domestic financing and a systems wide, multi-sectoral approach. These countries have integrated all the essential pillars needed for malaria elimination–community engagement, effective case management, vector control and surveillance as a core part of their health system.

At the global and coordination level, there is a continued need to provide countries with timely access to evidence-informed guidelines to support the integration of new tools and approaches that overcome challenges or can accelerate progress. At the regional level, I believe there needs to be greater investment in genuine partnerships that strengthen local leadership, foster cross-country knowledge exchange and ensure the inclusion of community voice in decision-making.

This interview was conducted by Dr Madlen Luckner.