Malaria is very much still around. In 2024, there were an estimated 282 million cases and 610,000 deaths worldwide, roughly 9 million more cases than the year before. While dozens of countries have eliminated the disease within their borders, malaria remains one of the deadliest infectious diseases on Earth, concentrated heavily in sub-Saharan Africa and driven by a parasite that has proven remarkably difficult to wipe out.
Where Malaria Hits Hardest
Sub-Saharan Africa bears the overwhelming majority of the global burden: 94% of all malaria cases and 95% of all deaths occur in that region. Of those deaths, 76% are children under five. The parasite responsible for most of these deaths thrives in warm, humid climates with heavy rainfall, exactly the conditions found across much of tropical Africa.
Two parasite species cause nearly all human malaria. The deadliest, most common in Africa, kills more people than any other species and is responsible for the severe, life-threatening form of the disease. The second most common species dominates in South and Southeast Asia, Central America, and parts of South America. It causes a less immediately dangerous infection but can lie dormant in the liver and relapse months or even years later. Three other species infect humans but account for a much smaller share of cases.
Countries That Have Eliminated It
The global picture isn’t entirely bleak. The WHO has been certifying countries as malaria-free at a steady pace. In 2025 alone, Georgia, Suriname, and Timor-Leste earned certification. Cabo Verde and Egypt were certified in 2024, and Azerbaijan and Belize in 2023. These certifications mean the countries have interrupted local transmission for at least three consecutive years and have surveillance systems strong enough to prevent its return.
This progress shows that elimination is possible, even in tropical countries. But the nations still fighting malaria tend to be those with the highest transmission intensity, the fewest healthcare resources, and the greatest logistical challenges in reaching rural populations.
Why It’s So Hard to Eliminate
Malaria is transmitted by mosquitoes, which breed quickly, adapt to insecticides, and are nearly impossible to eradicate from tropical environments. The parasite itself is biologically complex, cycling between the mosquito and the human host in ways that make immune protection incomplete. People in high-transmission areas can be reinfected dozens of times over a lifetime.
Drug resistance adds another layer of difficulty. The current frontline treatments rely on a class of drugs that work by rapidly clearing the parasite from the bloodstream within three days. In parts of Southeast Asia and a handful of African countries (Eritrea, Rwanda, Uganda, and Tanzania), parasites have developed partial resistance to these drugs, meaning they take longer to clear. The good news: treatment still works in nearly all patients as long as the companion drug in the combination remains effective. Full resistance has not been reported. But partial resistance is a warning sign that the global community takes seriously, because losing these treatments without a replacement would be catastrophic.
Bed Nets and Prevention
Insecticide-treated bed nets remain one of the most effective tools against malaria. In community-wide trials across Africa, these nets reduced deaths among children under five from all causes by about 20%. The WHO now recommends universal coverage, meaning every person in a malaria-affected area should sleep under one, not just young children and pregnant women.
The scale of distribution has been enormous. Between 2004 and 2022, manufacturers delivered more than 2.9 billion nets globally, with 86% going to sub-Saharan Africa. Annual deliveries grew from 5.6 million nets in 2004 to 282 million in 2022. Mass distribution campaigns typically happen every three years, since the insecticide coating degrades over time. Nets are cheap, effective, and save lives, but they don’t work if they’re not used consistently, and mosquitoes in some regions have developed resistance to the insecticides used to treat them.
Vaccines Are Finally Here
After decades of research, two malaria vaccines are now being rolled out across Africa. Both reduced malaria cases by more than 50% during the first year after vaccination in clinical trials. When given seasonally in areas with sharply seasonal transmission, alongside preventive medication, they prevent around 75% of malaria episodes. As of now, 25 African countries are offering malaria vaccines as part of their routine childhood immunization programs.
These vaccines aren’t a silver bullet. Their protection is moderate compared to vaccines for diseases like measles, and it wanes over time. But in a disease that kills hundreds of thousands of children each year, even partial protection at scale can save tens of thousands of lives annually.
Climate Change Could Expand Its Reach
Malaria’s geography is tightly linked to climate. The mosquitoes that carry it need warm temperatures, humidity, and rainfall. The parasite itself cannot complete its life cycle inside the mosquito when temperatures drop below about 20°C (68°F). As global temperatures rise, the zones where transmission is possible are expected to shift and expand, potentially bringing malaria to highland areas and regions that were previously too cool.
There is already evidence that the geographic range of disease-carrying mosquitoes has expanded as warmer temperatures spread toward the poles. For countries that eliminated malaria years ago, this raises the prospect of reintroduction. For countries already struggling with the disease, it could mean longer transmission seasons and higher case counts.
The Economic Toll
Malaria doesn’t just kill people. It drags down entire economies. Research from Columbia University found that countries with severe malaria grew 1.3 percentage points slower per year than comparable countries without it, even after accounting for poverty, economic policy, and geography. A 10% reduction in malaria was associated with 0.3% higher annual economic growth. The mechanism is straightforward: sick workers can’t work, sick children miss school, and families spend money on treatment instead of food, education, or savings. Over decades, those losses compound enormously.
By one estimate, a country with 100% coverage of the deadliest malaria parasite could permanently boost its annual growth rate by 3.2% if it completely eradicated the disease. That kind of economic dividend helps explain why malaria elimination is not just a health priority but a development one.
The Big Picture
Malaria is not a relic of the past. It killed more than 600,000 people last year, the vast majority of them African children. At the same time, the world has more tools to fight it than ever before: effective bed nets distributed at massive scale, two approved vaccines rolling out across 25 countries, and treatments that still work in nearly all cases. Countries continue to reach elimination, proving it can be done. But rising case counts, drug resistance on the horizon, and a warming climate all point to a disease that will remain a global health challenge for years to come.