Global malaria cases rose to 282 million in 2024, up from 273 million the previous year, with an estimated 610,000 deaths, underscoring the fragile progress in the fight against the disease, according to the World Health Organization.
The increase comes despite major long-term gains. Since 2000, global efforts have prevented an estimated 2.3 billion cases and 14 million deaths, while 47 countries and one territory have been certified malaria-free. Yet malaria remains one of the world’s most persistent public health threats.
The burden is overwhelmingly concentrated in Africa. The World Health Organization African Region accounts for 94% of all malaria cases and 95% of deaths, with progress increasingly threatened by drug resistance and the spread of invasive mosquito species such as Anopheles stephensi. Resistance to antimalarial drugs has now been confirmed or suspected in at least eight countries on the continent.
Against this backdrop, research investment is intensifying. Global Health EDCTP3 has committed €92 million to 16 malaria research projects under the Horizon Europe programme, with €51 million directed toward vaccines, €21 million to therapeutics, €4 million to diagnostics, and €16 million to other prevention tools.
“Targeted research in high-burden regions saves lives and enhances health security,” said Michael Makanga, adding that the programme is focused on accelerating research and expanding access to effective interventions. “We aim to accelerate R&D and improve access to medical interventions to drive progress toward malaria elimination.”
One of the most significant gaps in malaria research has been the exclusion of pregnant women—particularly in the first trimester—from clinical trials. Each year, more than 12 million pregnant women in sub-Saharan Africa are exposed to malaria, with about half a million infections occurring during the first trimester alone. Yet treatment options remain limited, with only one widely recommended therapy, artemether-lumefantrine, considered safe at this stage of pregnancy.
A new study is attempting to change that. The SAFIRE (Safety of Antimalarials in First Trimester) project is the first phase III adaptive platform trial designed specifically to evaluate malaria treatments in early pregnancy. The trial compares two commonly used therapies—pyronaridine-artesunate and dihydroartemisinin-piperaquine—against the current standard of care.
“This first-of-its-kind trial addresses an important need for the treatment of malaria during the first trimester of pregnancy,” said Henk Schallig. “It will provide the evidence needed to make additional drugs available and help address the lack of equity in enrolling pregnant women in clinical trials.”
The study reached a key milestone in October 2025 with the enrollment of its first participant in Mali. Recruitment has since expanded to Burkina Faso and Kenya, with dozens of women now enrolled.
Led by the Amsterdam University Medical Center, with partners including the Kenya Medical Research Institute and the University of Sciences, Techniques and Technologies of Bamako, the trial has secured ethical approvals and is building local research capacity through advanced training.
Researchers say the findings could reshape global malaria treatment guidelines, particularly for pregnant women, who face heightened risks of severe disease, anaemia, stillbirth, and neonatal death.
As malaria cases rise and new threats emerge, experts warn that sustaining progress will depend not only on innovation but also on equitable access to prevention and treatment—especially in Africa, where the disease continues to hit hardest.
