Annual malaria deaths have halved since 2000

Health experts are warning against complacency after the publication of a report showing that the worldwide number of deaths each year from malaria has halved in the past 15 years.

A joint World Health Organization and United Nations Children’s Fund (Unicef) report shows that the number of deaths from malaria has fallen from 839 000 in 2000 to an estimated 438 000 in 2015.1 The number of cases of malaria has also fallen but not by such a large amount, largely because there are many more cases than deaths. In 2000 there were 262 million cases of malaria, while in 2015 the estimated number is 214 million. Most cases (89%) and deaths (91%) occur in sub-Saharan Africa.

The report hails the cut in mortality as an impressive achievement in light of the fact that over the same period the global population at risk of malaria rose by 31%.

Margaret Chan, WHO’s director general, told a meeting to launch the report at the UK Houses of Parliament that malaria had been “tamed.” She added, “But by no means has it been defeated. With diseases like malaria you can never tread water. You either surge ahead or you sink. We want to surge ahead.”

The paper estimated that around 6.2 million deaths from malaria have been averted since 2000. Chan said that every death prevented was a reason to celebrate. She added, “This success is down to the scaling up of interventions: insecticide treated bed nets, artemisinin based combination therapy, and quick diagnosis and treatment—and last but not least indoor residual spraying.”

The year 2000 marked a turning point for malaria control with the launch of the United Nations’ millennium development goals. The sixth goal, which included a target to have halted and begun to reverse the incidence of malaria by 2015, “has been met convincingly,” the report said.

Pedro Alonso, director of WHO’s global malaria programme, described the situation in 2000: vector control in the form of indoor residual spraying had been largely abandoned, just 2% of children under 5 years who were at risk of malaria slept under insecticide treated bed nets, diagnosis was poor, and the only treatment was chloroquine, “a failing drug.”

He said, “Today we have artemisinin based therapies which are highly efficacious in the management of a disease which is highly curable, preventable, and treatable.” But he added, “The gains are still fragile. In the last few months we have seen increases in [the number of cases] malaria in Uganda and Cambodia. This work is far from complete, and the next five years are going to be critical.”

The report showed that an increasing number of countries have moved towards eliminating malaria. Last year 13 countries that had malaria in 2000 reported no locally acquired cases, and a further six countries reported fewer than 10 cases. However, some 15 countries account for around 80% of all malaria cases and 78% of deaths. Nigeria has the largest number of cases, around 30% of the world total, followed by the Democratic Republic of Congo and then India.

A paper in Nature has looked at the effect of the millions spent on malaria control since 2000.2 The researchers estimated that malaria control strategies such as insecticide treated bed nets, indoor residual spraying, and prompt treatment of clinical malaria cases with artemisinin based combination therapy have averted 663 million clinical cases of malaria since 2000. The use of insecticide treated bed nets (around a billion have been distributed in Africa since 2000) has had the greatest effect, averting 68% of the cases, the paper estimated.

Pete Gething, one of the paper’s authors, said that the data on malaria and the effectiveness of strategies to combat the disease had been transformed since 2000. “In 2000 we had no idea of the numbers of people dying from malaria and were making policy decision on a ragbag of evidence,” he said.