Two proven vaccines. Billions of dollars in established interventions. A disease other nations have wiped out entirely. And yet, in 2024, malaria killed 610,000 people — up from 575,000 six years earlier. Cases climbed from 238 million to 282 million over the same period.

This is the malaria paradox, and it is not a medical mystery. It is a political one.

On 25 April, the global health community will mark World Malaria Day under the slogan “Now we can. Now we must.” The slogan is accurate on both counts. For the first time, there are vaccines: the World Health Organization (WHO) recommended RTS,S in October 2021, and a second vaccine, R21, followed two years later. R21, developed by the University of Oxford’s Jenner Institute, achieved 75% efficacy in children aged 5–17 months in areas with year-round malaria transmission. RTS,S, developed by GSK, reduced cases by almost 56% in the same age group.

The money running out

Twenty-five countries have begun immunization programs. But several of the hardest-hit nations have yet to introduce either vaccine, including Tanzania, which accounted for 4.3% of global malaria deaths in 2024. More than 90% of all malaria cases occur in Africa.

The binding constraint is funding. Gavi, the Vaccine Alliance, which finances malaria immunization in the world’s poorest countries, raised roughly $9 billion of its $12 billion target for the 2026–2030 period last year. The shortfall is likely to deepen. US Health Secretary Robert F. Kennedy Jr has said the United States will no longer contribute to Gavi, removing what has historically been one of its largest government donors.

The picture for malaria control more broadly is no better. In 2023, total global spending reached $4 billion — less than half the WHO’s $8.3 billion target. Scarce resources mean governments must choose between rolling out new vaccines and maintaining the bed nets, drug programs, and surveillance systems already in place.

A solvable disease

Malaria is not an intractable problem. Egypt and Cabo Verde have both eliminated it within recent years, treating the effort as a national priority backed by robust surveillance data and community engagement. The parasite, transmitted to humans by infected female Anopheles mosquitoes, is vulnerable to a well-understood suite of interventions: insecticide-treated bed nets, antimalarial drugs, and now vaccines.

“We have more tools today than we’ve ever had before,” says Michael Charles, chief executive of the RBM Partnership to End Malaria in Geneva.

But tools require delivery systems, and malaria vaccines demand four doses per child — a schedule that does not always align with routine immunization calendars and is especially burdensome for rural households far from clinics. William Moss, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, notes that in regions with seasonal transmission, doses should ideally be administered just before the malaria season begins, adding another layer of logistical complexity to already strained health systems.

What $3 a dose could buy

R21’s manufacturer can produce up to 100 million doses annually and has agreed to sell them to Gavi at $2.99 per dose. RTS,S costs more — $9.81 per dose at current production levels of roughly 8 million doses a year — though GSK says it expects the price to fall below $5 by 2028. If both vaccines were widely deployed in areas with moderate to high transmission, the WHO estimates they could prevent half a million deaths by 2035.

The gap between that future and the present is not technical. It is financial and political. The UN Sustainable Development Goals set a target of ending malaria epidemics by 2030. With cases moving in the wrong direction and major donors pulling back, that deadline is slipping out of reach.

“‘Now we can,’ because we have the tools,” Charles says. “And ‘Now we must’ because it’s unacceptable that in the twenty-first century, 600,000 children are losing their lives from a disease that is preventable and curable.”

The tools are on the shelf. The money is not.

Sources