The World Malaria Report 2025, launched in December, provided a bag of mixed news, five years ahead of the 2030 global malaria elimination deadline. While the reduction in estimated cases in southeast Asia provided definite hope, of serious concern were rising cases of resistance to artemisinin-based frontline treatment for malaria, and falling funding for malaria programmes.
Notably, it is the Asia Pacific region that posted much of the good news. The significant reduction was driven by 10 of the region’s 17 malaria-endemic countries, bringing estimated cases down from over 9.6 million in 2023 to approximately 8.9 million in 2024. The major reduction in estimated cases happened in Pakistan, and historic lows were reported in Cambodia, Lao PDR and Vietnam, the second year running. Among the successes being platformed against one of the most crucial emerging threats against malaria treatment also comes from this region, with the Greater Mekong Subregion’s success in tackling antimalarial drug resistance finding mention in the report.
Uneven progress
The Asia Pacific Leaders Malaria Alliance (APLMA) unites 22 governments that are committed to the goal of eliminating malaria by 2030. Sarthak Das, CEO, APLMA, says the “Asia Pacific region has made tremendous progress over the past two decades, but it is not entirely on track to meet the 2030 malaria elimination target.”
He goes on to explain the current position: “Progress continues to stay uneven – while some countries have experienced a resurgence of cases, others reported substantial declines, and several have successfully attained malaria-free status. Sri Lanka, China, and most recently Timor-Leste have demonstrated that malaria elimination is achievable with sustained political commitment and consistent delivery.”
However, Dr. Das points out that these successes coexist with a concerning plateauing of progress and, in particular, reversal in larger, more complex settings. India illustrates this challenge clearly: after a steep decline post-2015, malaria cases in some regions have rebounded in recent years, signalling that the country overall is off its historical elimination trajectory.
He explains that significant risks still persist, primarily due to two major challenges: securing sustainable long-term financing and ensuring last-mile execution in high-burden countries. “The challenges more often are in ensuring disciplined last mile programme delivery, which is further compounded by the increasing financing shortfalls. The report shows that only about 42% of global malaria financing needs were met in 2024, and funding cuts in 2025 have widened this gap further.”
The WHO has indeed noted a deep funding shortfall that poses a very serious risk of reversing years of progress in malaria control and elimination, particularly in the Asia-Pacific, where high-burden regions are located. If the elimination goal were to be reached, then sustained investment in malaria control is absolutely essential, experts point out.
Is elimination goal feasible?
But is the elimination goal within target at all? In fact, India has set itself the target of achieving zero indigenous cases of malaria by 2027, ahead of the 2030 target. Dr. Das says India’s target is ambitious, but attainable. “India has made extraordinary progress since 2015, achieving steep reductions in cases and deaths, with many districts sustaining zero transmission for multiple years. India has also demonstrated proof-of-concept for elimination through indigenous projects such as AMaN – Malaria Control in Inaccessible Areas in Odisha, and the Malaria Elimination Demonstration Project in Mandla.” However, recent data shows that progress has plateaued and cases have even rebounded in parts of the country, indicating that India is currently off the elimination trajectory required to meet the 2027 milestone, he points out.
Dr. Das explains that to make the leap from control to elimination, three shifts are essential: “First, surveillance must become the central intervention.” India needs real-time, case-based surveillance everywhere – including systematic reporting from the private sector, defence services, railways and urban health systems, so that every infection is detected, classified and responded to rapidly.”
Secondly, he adds, it is important to make elimination geographically precise. “Today, five States and the Northeast account for nearly 80% of the malaria burden. Success will depend on focused, project-mode execution in these remaining hotspots, while near-elimination States must invest in preventing resurgence.” Thirdly, the continuity of financing and operational discipline must be restored. “This is the most vulnerable phase of elimination, and any dilution of funding, staffing or vector control cycles risks reversal – a pattern India has already experienced,” he adds. India must treat malaria elimination as a time-bound national mission, with accountability, sharp targeting and sustained investment through the last mile.
Vaccines for malaria
While factors such as surveillance, vector control and effective case management, have been essential to the achievements of the past years, it was the vaccines that marked a significant breakthrough. Dr. Das says, “Both RTS,S and the newer R21 vaccines represent important milestones. Large-scale pilot implementations in Africa have shown that RTS,S, when delivered through routine immunisation systems, can reduce severe malaria and contribute to measurable declines in child mortality. Evaluations have demonstrated approximately a 13% reduction in all-cause mortality and a 22% reduction in hospitalisations for severe malaria among vaccinated children in high-transmission settings. R21 has shown comparable or higher efficacy in controlled trials.”
These vaccines have understandably been prioritised for rollout in Africa, where the burden of Plasmodium falciparum malaria and childhood mortality is highest. “In the Asia-Pacific, vaccine introduction is likely to be more targeted rather than pan-regional,” he explains, focusing on specific high-risk settings or populations. The countries in the Asia Pacific and the APLMA are actively evaluating how these vaccines could complement existing tools for targeted implementation. In parallel, there is growing focus on improved radical cure options for P. vivax, significant for the region.
Artemisinin resistance
The recent WHO report indicates that artemisinin resistance has emerged as a serious threat to global malaria control. This has been confirmed in many countries in Africa, but has not yet been established in India. Artemisinin-based combination therapies remain the go-to first line of treatment as they are still highly effective, particularly in most endemic settings. Dr. Das points out that in the early 2000s, resistance emerged in the Greater Mekong Subregion (GMS) after partial artemisinin resistance first appeared in western Cambodia before spreading to neighbouring countries.
“In response, the Global Fund launched the Regional Artemisinin resistance Initiative (RAI) in 2014, investing over US $700 million since to accelerate elimination alongside the WHO’s Mekong Malaria Elimination Program. The impact is evident: Cambodia, Lao PDR and Viet Nam are now nearing elimination, having reduced indigenous cases to just 322, 328 and 239 respectively,” he says.
India, which otherwise has a huge anti-microbial resistance burden on the other hand, “has taken a precautionary approach by institutionalising regular therapeutic efficacy studies, strengthening pharmacovigilance, and rapidly updating national treatment policies when early warning signals emerge.” India’s emphasis on universal parasitological diagnosis, strict adherence to combination therapy, and avoidance of oral artemisinin monotherapy has been central to preserving drug efficacy at scale, he adds.
Early detection through routine efficacy monitoring, strict regulation of antimalarial use, strong community-level case management – and critically – regional coordination to prevent cross-border spread are the need of the hour, Dr. Das insists. Resistance cannot be managed country by country; it requires collective action. Protecting artemisinin is not just a technical task – it is a strategic imperative for global malaria elimination, he adds.
Funding constraints
The greatest threat today to the success of the malaria elimination programme, however, is not even with artemisinin, it is dwindling financing. Dr. Das says: “At a time when malaria programs are entering the most difficult and expensive phase of elimination, overall international funding has declined. This shortfall is already forcing countries to scale back proven interventions, increasing the risk of resurgence and reversing hard-won gains.”
In Asia-Pacific, the impact is especially pronounced in high-burden areas that face persistent social and logistical challenges, including those prevalent among mobile and migrant populations and geographically remote communities. Such groups are particularly vulnerable because they often have limited access to health services and are difficult to reach with conventional malaria control measures.
Dr. Das suggests that a fundamental shift in how malaria elimination is financed and owned is required. Global funding will remain important, but it can no longer carry the full burden. National agencies must step up to fill the existing funding gaps, which APLMA supports by strengthening budget advocacy efforts and building evidence-based investment cases.
Dr. Das adds: “This is not simply a cost, but an investment. Evidence consistently shows that every dollar invested in malaria elimination delivers multiple dollars in economic return through reduced healthcare costs, increased productivity, and stronger community resilience. Conversely, underinvestment at this stage is far more expensive: resurgence, emergency responses, and avoidable deaths carry a heavy and recurring price.”
At the end of the day, the fact is that “malaria is unforgiving – it will bounce back unless we reach zero.” There is evidence from 44 countries that it is possible to end malaria. “There is no doubt that elimination of this ancient scourge will lead to greater economic output and less health system burden. Most importantly, malaria elimination is a moral imperative, particularly for our most vulnerable populations,” Dr. Das stresses.
