Next week, on 25 April, the world will celebrate World Malaria Day. This year, the Roll Back Malaria Partnership to End Malaria (RBM) will come together with all countries, donors, and partners to highlight the need for urgent action and further investment to end malaria. For the past two decades, the combined efforts of countries, global partnership and increased investment have significantly impacted the global malaria response, prevented two billion malaria cases and saved 11.7 billion lives. However, in recent years, malaria progress has plateaued due to the low coverage of existing tools, emerging biological threats such as antimalarial drugs and insecticide resistance, climate change and the impact of COVID-19 in disrupting malaria services. As a result, in 2020 there were 241 million malaria cases and 627,000 malaria deaths: compared to 2019, there were about 14 million more cases and 69,000 more deaths, according to the 2022 WHO Malaria Report In addition, the global funding gap for malaria has consistently increased for the past three years. Between 2021-23, global funding for malaria control has fallen short by $ 4.8 billion – that’s around 40% of the total required to deliver national programmes. While many countries stepped up to pledge $15.7 billion to the Global Fund’s Seventh Replenishment last year, this was far less than the $18 billion needed to accelerate the fight against these diseases and achieve global targets, thus leaving an unprecedented shortfall for the years to come. Countries are now faced with the enormously difficult task of increasing malaria control measures with even less funding than before. The Global Fund provides 63% of all international financing for malaria programs and has invested more than $16.4 billion in malaria control programs as of June 2022. Since the start of the COVID-19 pandemic in 2020, thanks to the generous support of donors, the Global Fund awarded over $4.2 billion to 108 low- and middle-income countries and 21 multicountry programs to fight COVID-19 and protect lifesaving malaria, HIV and TB programs. These investments are making an impact. In countries where the Global Fund invests, malaria deaths have dropped by 26% since the Global Fund was founded in 2002. Without these interventions, malaria deaths would have increased by 84% over the same period.

Table 1. Trends in malaria deaths and cases with and without interventions

So: what can we do to ensure that the global malaria response is not ‘business as usual’ and that real efforts are made to identify and employ the real game-changers for malaria to be eliminated?  A good start would be to stop the plethora of initiatives that the donor community is coming up with. Rather than yet another ‘new’ initiative to add to the other vertical initiatives, is the malaria community ready to put its efforts together and align itself better with countries’ needs? Innovations in the pipeline Most countries seem to be implementing the same old strategies, for example, investing in treated bed nets. But things have to change if we are to really tackle the problem. Yes, buy bed nets if they are being used but consider other innovations that can be employed alongside this. The good news is that research and development (R&D) investments have produced the most robust pipeline of malaria interventions over a decade. In May 2015, the World Health Assembly approved the Global Technical Strategy for Malaria 2016– 2030, providing comprehensive technical guidance to countries and development partners contributing to its elimination. It also highlights the urgent need to increase investments across all interventions – including preventive measures, diagnostic testing, treatment and disease surveillance – as well as in harnessing innovation and expanding research. Under the EU FP7 and Horizon 2020 framework programmes, a total of 86 malaria research projects have been funded in the last decade with a support of €160 million. These projects concern diagnosis, vaccine development, vector control, treatment, as well as basic and operational research, research infrastructures and training. Through these research actions the EU aims to contribute to the global research agenda while at the same time strengthening the involvement of relevant stakeholders in the research process and influencing policy-making by making evidence-based recommendations. Leveraging innovation technologies against malaria In a bid to combat malaria epidemics, several technological innovations developed across the world have contributed significantly to malaria responses. Given the existing knowledge gap about the comprehensive technological landscape for malaria responses, a study was undertaken in February 2023 to unveil impactful and contextually relevant malaria innovations that can be adapted in Africa. This systematized review identified key technological innovations that have been developed worldwide targeting different areas of the malaria response. These include surveillance, microplanning, prevention, diagnosis and management. Out of over 1,000 malaria innovations and programmes, only 650 key malaria technological innovations were considered for further review. There were web-based innovations (34%), mobile-based applications (28%), diagnostic tools and devices (25%), and drone-based technologies (13%. The paper provides information that countries and key malaria control stakeholders can leverage with regard to adopting some of these technologies as part of the malaria response in their respective countries. It also highlighted key drivers including infrastructural requirements to foster development and scaling up of innovations. In order to stimulate development of innovations in Africa, countries should prioritize investment in infrastructure for information and communication technologies and also drone technologies. These should be accompanied by the right policies and incentive frameworks. This means of course that the onus is also on governments to drive the response. Need to strengthen global leadership and national resources On World Malaria Day, we join the RBM Partnership to End Malaria in calling countries and global stakeholders to invest, innovate and implement a zero-malaria world. To get the world back on track to progress against malaria, several key issues including sustained malaria funding will need to be addressed with greater country leadership, strong partnership focus and innovation. The key decisions will be inherently political will, supported by solid financial, systems and technical foundations. A strong resource mobilization coordinated by the RBM Partnership is essential to this. There is urgent need to innovate, increase, and make global malaria funding more robust both at global and country level. Countries supported by the Global Fund need to do more with available resources, maximize synergy and integration with other investments and increase domestic funding. To reach global malaria targets, available resources must be used efficiently and leaders must urgently deliver bold investments in malaria control to bridge the funding gap and accelerate progress. This needs sustainable and predictable health financing for universal health coverage (UHC) and a shared vision for primary health care investments that impact public health priorities, such as malaria. Innovation must continue at pace to deliver improved solutions and many proven interventions must be tailored and targeted to those who need them most. The global community must continue accelerating innovation and delivering transformative tools and improved approaches to end malaria. Countries, global leaders, and communities must scale up and urgently deliver malaria control programmes. The Global Fund and other partners should support and  build the capacity of national malaria programmes in effective leadership and management that confidently shapes the path for their respective countries and delivers an impactful implementation of the malaria response. As countries, global communities, and partners work tirelessly to hold the line against malaria through inclusive, multisectoral responses to the disease, it’s time to step up and scale up robust national malaria programmes to deliver lifesaving tools to those who need them most. As the global malaria community comes together this World Malaria Day, we must continue to invest in malaria elimination, innovate to develop and tailor new tools and approaches to those who need them most and implement national strategies to accelerate progress against this age-old disease. It’s time to deliver Zero Malaria.