There are no shortcuts to the top of a palm tree: Why malaria eradication depends on financing, prioritization, and delivery

Since 2000, there have been significant achievements in the global fight against malaria. By 2024, an estimated 2.3 billion cases and 14 million deaths had been averted, driven by  renewed global commitment under the Millennium and Sustainable Development Goals, and by efforts such as the establishment of the Global Fund and PEPFAR. Just as importantly, this progress was driven by the steady work of countries themselves, alongside bilateral and multilateral partners, other funders, and development partners such as the World Health Organization.

However, the World Malaria Report 2025 provides estimates that give cause for concern. In 2024, global malaria cases increased by more than 9 million compared to the previous year, with most of the increase occurring in sub-Saharan Africa. Again, after almost two decades of steady decline, malaria deaths have now plateaued. Compared to 2015, an estimated 32,000 more people died from malaria in 2024.

These numbers are not abstract. Growing up in a village near Accra in Ghana, I saw firsthand how malaria shapes daily life for families and communities—long before I encountered the disease as an economist. The data now remind us that progress cannot be taken for granted.

These trends are worrying for several reasons. First, the world has more tools to prevent and treat malaria than ever before. In 2025 alone, several positive developments were recorded, as highlighted in an end-of-year message by Martin Fitchet, CEO of Medicines for Malaria Venture. These include results of a Phase 3 trial of ganaplacide/lumefantrine (GanLum), which shows promise in addressing the growing threat of antimalarial drug resistance, and the launch of the first antimalarial treatment for newborns. These advances build on the rollout of malaria vaccines—RTS,S and R21—which are already being delivered in many countries, as well as a growing pipeline of additional prevention tools.

Second, disruptions in global health financing in 2025, and their expected impact on the financing capacity of major initiatives such as Global Fund and Gavi, raise a real concern that malaria cases in 2025 could rise beyond the levels reported for 2024. In essence, there is a strong possibility that the next World Malaria Report will reflect further setbacks.

It is against this backdrop that I reflect on three areas that continue to stand in the way of malaria eradication and that require urgent attention: financing, optimization, and delivery.

Financing

There is no question that we have the ability to innovate and develop the next generation of tools for malaria prevention and treatment. However, financing these remains a major challenge and requires rethinking and recalibration. Historically, malaria spending has depended heavily on development assistance for health, which accounted for about 67% of malaria spending between 2010 and 2014.

While an estimated $9.3 billion annually is required to achieve the near-eradication targets, only $3.9 billion was invested in 2024, down from about $4.3 billion in 2016. Clearly, while global financing will remain critical, particularly to support research, development, and innovation, governments must urgently increase domestic spending beyond the current estimated 33% share.

This will require a combination of increased allocations to health overall, and to malaria specifically, including through additional tax funding, innovative and blended financing approaches, and improved tax efficiency. It will also require addressing capital flight and exploring the role of remittances, alongside better optimization of existing resources.

In a recent report, The Price Of Retreat: How Underinvestment in Malaria Risks Resurgence, Lost Growth, and a Generation’s Future, jointly released by Malaria No More UK and African Leaders Malaria Alliance, our team at MSH modeled the potential impacts of malaria investments on country economies. The analysis shows that investments toward near-eradication could boost GDP by $231 billion by 2030 or $2.5 trillion by 2040, raise future earnings through improved education outcomes, and avert between $10 billion and $112 billion in trade losses between Africa and G7 countries. These findings underscore that malaria eradication is not only a health priority, but also a compelling economic one.

These findings underscore that malaria eradication is not only a health priority, but also a compelling economic one.

Optimization

Optimization must be addressed from two perspectives. First, dwindling global resources mean we cannot continue to recommend an ever-expanding list of products and interventions without determining which future products—or combinations of products—are most likely to produce optimal impact, given limited resources for research, development, and other global public goods.

Second, even when products are available, countries cannot feasibly implement all of them due to financing constraints. Countries therefore need support to determine how to prioritize interventions, delivery modalities, and sequencing decisions based on evidence. Evidence-informed prioritization should neither be an afterthought nor left until products are already developed. Instead, it should be embedded early, with countries engaged from the outset to assess potential efficiency, affordability, and feasibility.

In my experience working alongside country teams, prioritization is most effective when it is embedded in routine planning and budgeting processes, rather than treated as a parallel or one-off exercise. Importantly, country capacities must be built to sustainably institutionalize evidence-informed prioritization within ministries of health and finance. Over time, this can improve efficiency, reduce waste, and unlock additional resources for malaria by redirecting funds away from inefficient processes and channels.

Delivery

Finally, a well-financed and optimized pool of malaria tools will not, themselves, yield health outcomes. Delivery matters. Well-coordinated and well-functioning delivery systems are essential to driving malaria cases and deaths down towards elimination and, ultimately, eradication.

Many countries are currently working to strengthen their primary health care (PHC) systems. This presents an important opportunity to better integrate malaria and other infectious, communicable, and neglected tropical disease programs into PHC systems that emphasize prevention, promotion, and preparedness alongside treatment. Integration is not simply a technical exercise; it is about how systems are planned, financed, and managed.

A major legacy of the current global health financing architecture has been a siloed, vertical approach to disease programs. While this approach may have delivered results in the past, it is increasingly misaligned with the realities countries face today. This must give way to a more integrated approach through country-led PHC systems—not in word, but in action.

We have seen that service integration improves equitable coverage and can strengthen accountability, improve efficiency, and reduce fragmentation across programs. When countries align planning, financing, and frontline delivery through PHC platforms, malaria programs are better positioned to reach the communities that need them most, while strengthening systems for other diseases at the same time.  Importantly, integration also has the potential to unlock additional resources by making better use of existing delivery platforms and investments.

When countries align planning, financing, and frontline delivery through PHC platforms, malaria programs are better positioned to reach the communities that need them most, while strengthening systems for other diseases at the same time. 

A Defining Moment

The world stands at a defining moment in the fight against malaria. We are at risk of losing a once-in-a-lifetime opportunity to eradicate a disease that continues to cause immense harm.

We have the tools—and the know-how to produce new ones. We have the evidence. We have a strong economic case. What remains is the resolve to align financing, optimization, and delivery, and to act with urgency. If we do, malaria eradication can move from ambition to reality within our lifetime.