WHO joins partner organizations in promoting this year?s World Malaria Day theme, Ready to Beat Malaria. This theme underscores the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria. It highlights the remarkable progress achieved in tackling o­ne of humanity?s oldest diseases, while also calling out worrying trends as captured in the 2017 World malaria report:

·  The global response to malaria is at a crossroads. After an unprecedented period of success in malaria control, progress has stalled.

·  The current pace is insufficient to achieve the 2020 milestones of the WHO Global Technical Strategy for Malaria 2016?2030 ? specifically, targets calling for a 40% reduction in malaria case incidence and death rates.

·  Countries with o­ngoing transmission are increasingly falling into o­ne of two categories: those moving towards elimination and those with a high burden of the disease that have reported significant increases in malaria cases.

Without urgent action, the major gains in the fight against malaria are under threat. o­n this World Malaria Day, WHO continues to call for greater investment and expanded coverage of proven tools that prevent, diagnose and treat malaria.

Key facts:

·  Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.

·  In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over 2015.

·  Malaria deaths reached 445 000 in 2016, a similar number (446 000) to 2015.

·  The WHO African Region carries a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths.

·  Total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Contributions from governments of endemic countries amounted to US$ 800 million, representing 31% of funding.

World Malaria Day - 25 April 2018

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

An ACT contains both the drug artemisinin and a partner drug. In recent years, parasite resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Lao People?s Democratic Republic, Myanmar, Thailand and Viet Nam. Studies have confirmed that artemisinin resistance has emerged independently in many areas of this subregion.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion, a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

Consequently, WHO?s Malaria Policy Advisory Committee in September 2014 recommended adopting the goal of eliminating P. falciparum malaria in this subregion by 2030. WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015?2030) at the World Health Assembly in May 2015, which was endorsed by all the countries in the subregion. With technical guidance from WHO, all GMS countries have developed national malaria elimination plans. Together with partners, WHO will provide o­ngoing support for country elimination efforts through the Mekong Malaria Elimination programme, a new initiative that evolved from the ERAR.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. (The certification of malaria elimination in a country will require that local transmission is interrupted for all human malaria parasites.)

Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required o­nce eradication has been achieved.

The rate of progress in a particular country will depend o­n the strength of its national health system, the level of investment in malaria control, and a number of other factors, including: biological determinants, the environment, and the social, demographic, political, and economic realities of a particular country.

In countries with high or moderate rates of malaria transmission, national malaria control programmes aim to maximize the reduction of malaria cases and deaths.

As countries approach elimination, enhanced surveillance systems can help ensure that every infection is detected, treated and reported to a national malaria registry. Patients diagnosed with malaria should be treated promptly with effective antimalarial medicines for their own health and to prevent o­nward transmission of the disease in the community.

Countries that have achieved at least 3 consecutive years of 0 local cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent years, 7 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Vaccines against malaria

RTS,S/AS01 (RTS,S) ? also known as Mosquirix ? is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to (and not replace) the core package of WHO-recommended preventive, diagnostic and treatment measures.

In July 2015, the vaccine received a positive opinion by the European Medicines Agency, a stringent medicines regulatory authority. In October 2015, two WHO advisory groups recommended pilot implementation of RTS, S/AS01 in a limited number of African countries. WHO adopted these recommendations and is strongly supportive of the need to proceed with the pilot programme as the next step for the world?s first malaria vaccine.

In November 2016, WHO announced that the RTS,S vaccine would be rolled out in pilot projects in selected areas in 3 countries in sub-Saharan Africa: Ghana, Kenya and Malawi. Funding has been secured for the initial phase of the programme and vaccinations are due to begin in 2018. These pilot projects could pave the way for wider deployment of the vaccine if safety and effectiveness are considered acceptable.

WHO response

The WHO Global Technical Strategy for Malaria 2016-2030 ? adopted by the World Health Assembly in May 2015 ? provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

·  Reducing malaria case incidence by at least 90% by 2030.

·  Reducing malaria mortality rates by at least 90% by 2030.

·  Eliminating malaria in at least 35 countries by 2030.

·  Preventing a resurgence of malaria in all countries that are malaria-free.

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