Introduction
In view of the World Malaria Day 2025, the WHO and other partnerships started the campaign “Malaria Ends With Us: Reinvest, Reimagine, Reignite” to promote global policy and community action toward malaria elimination. Malaria control efforts have stalled in recent years due to climate change, wars, and economic decline. Although there is profound knowledge in targeted prevention, treatment, and detection of malaria, people in endemic countries have limited access to these services. In 2020, people in low- and middle-income countries spent 40% of their income on healthcare, a threat in pushing poverty. Malaria is influenced by social inequities such as low education, work in agriculture, and unprotected housing, increasing people’s exposure to mosquito transmission (Carrasco-Escobar et al., 2021).
Therefore, common global approaches have to be performed to overcome contemporary threats in global malaria control. The WHO has currently listed four main threats, namely, i) invasive vector species (Singh et al., 2023), ii) vector insecticide resistance (Suh et al., 2023), iii) antimalarial drug efficacy and resistance (Rosenthal et al., 2024), and iv) parasite pfhrp2/3 gene deletions (Weiss et al., 2025).
Addressing the urgency of novel control strategies.
The Research Topic addresses the urgency of novel control strategies either from the side of the parasite or the transmitting mosquito to ameliorate the reoccurrence of upcoming malaria cases.
A set of articles in this Research Topic focuses on novel control strategies of the parasite and its transmission.
The assessment of the malaria burden will be an important tool for prevention, control, and eradication of the disease. In an integrative study based on retrieved data from the 2021 Global Burden of Disease database (GBD), Zhou et al. assessed the malaria burden in the Comoros in 2021 including indicators like incidence, prevalence, and mortality, as well as disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Although the malaria burden decreased in the Comoros between 1999 and 2021 mainly due to epidemiological changes, the study indicates that women under 40, school-aged children, and adults under 30 in the Comoros still have a higher malaria burden.
Although malaria incidence rates have significantly declined in Indonesia, Lubis et al. recognized the necessity to develop serum conversion rates to survey low-level rates of transmission to immediately start elimination programs. In a cross-sectional study conducted in 2019 in Langkat District, North Sumatra Province, Indonesia, Lubis et al. applied two antigens, i.e., merozoite surface protein-1 (MSP-1) and apical membrane antigen 1 (PfAMA-1), in blood stages of Plasmodium falciparum and Plasmodium vivax. The seroprevalence for P. falciparum was 10.6% for PfAMA-1 and 13% for PfMSP-119. In contrast, the measured serum conversion rates were 18.6% for PvAMA-1 and 7.4% for PvMSP-119. Based on these data, the authors concluded that this assay is suitable for determining epidemiological risk factors and surveillance in low transmission settings.
Blocking transmission is an important issue to control asymptomatic gametocytemia. Mmasi et al. studied the influence on transmission of female Anopheles gambiae sensu stricto (ss) mosquitoes in a direct membrane feeding assay (DMFA) performed with blood from gametocytometic participants under three different conditions: i) the effect of artemether–lumefantrine (AL) treatment, ii) mosquito feeding time (day vs. night), and iii) serum replacement on transmission activity. The results show that mosquito infection rates declined post-AL treatment and were unaffected by feeding time but increased after serum replacement. The obtained data will pave the way for the optimization of the DMFA.
Based on a dynamic transmission model for P. vivax in the Republic of Korea (ROK), Seong et al. investigated the incidence of P. vivax malaria cases in the Democratic People’s Republic of Korea (DPRK). The administration of tafenoquine and the application of rapid diagnostic tests (RDTs) were assessed with respect to the incidence of malaria cases from 2014 to 2018 in the DPRK. The model of the ROK was adjusted to demographic and climate data in the DPRK. Preventable malaria cases were estimated in comparison to the data obtained for microscopic analysis and primaquine treatment. The results impressively show that a 1-day RDT reduces malaria incidence by over 65% over the next decade. A single-dose regimen of tafenoquine versus a 14-day regimen of primaquine reduced 77.5% relapses and 11.3% malaria cases. The combination of tafenoquine and RTDs seems to be a convincing strategy to eradicate P. vivax as a major public health problem in DPRK.
Although Saudi Arabia established a malaria elimination program years ago, a study performed in Jeddah City between 2018 and 2023 by Alghamdi et al. showed the necessity to implement novel, antimalarial prevention protocols. Since Jeddah City plays an important global role as a logistical center for tourism through its air- and seaports, 2,124 imported malaria cases were detected during that time span. Nearly 50% of the imported malaria cases were imported from Pakistan, and more than 30% were from African countries. Moreover, 38% of the malaria cases were caused by P. falciparum, while 57% were P. vivax cases.
One of the effects of the COVID-19 pandemic was the threatening reduction of malaria control in Africa between 2000 and 2022. This was the basis for an investigation to control transmission in Southern Ghana by Amegatcher et al. utilizing a community health education and medical screening (CHEMS) approach. In a cross-sectional survey conducted in Accra and the central regions that enrolled 953 people, 136 participants underwent a malaria prick test in addition to the COVID-19 swab nose assay, both of which were analyzed by PCR. The results demonstrate that 6% in a background of SARS-CoV-2 infections (12%–37%) were infected with malaria, with a clinical background of malaria treatment. Remarkably, 2% of the participants were coinfected with malaria and COVID-19.
A second major focus in this Research Topic is the increasing resistance against commonly used pyrethroids and organochlorines.
Addressing the increasing resistance that develops in A. gambiae against pyrethroid-derived insecticides is an important and challenging issue. Machange et al. described an interesting approach combining bifenthrin, a fluorinated permethrin, and chlorfenapyr, an inhibitor of energy production, in insecticide-treated nets (ITNs) (ProNetDuo). The study was performed in hut trials in M’bé, Côte d’Ivoire, and Lupiro, Tanzania, in 18 experimental huts with free-flying mosquitoes. The obtained results were compared to Interceptor® G2 nets containing alpha-cypermethrin and chlorfenapyr with proven efficacy in malaria reduction. The investigations were based on two endpoints, i.e., the 72-h mosquito mortality (M72), and second, the proportion of mosquito feeding. Conclusively, ProNetDuo exhibited an inferior mortality rate and was superior in preventing blood feeding compared to Interceptor® G2. Thus, ProNetDuo containing bifenthrin offers a valuable alternative against pyrethroid-resistant mosquitoes.
Apart from the development of alternatives against pyrethroid-resistant mosquitoes in ITNs, their acceptance and use in rural and slum areas is low. Therefore, Savi et al. investigated urban malaria dynamics in Accra, Ghana, applying a mathematical model considering demographical and epidemiological factors. These studies identified limited living space and repurposing as the critical factors to reduce malaria prevalence. Based on these results, the authors recommend one-on-one sensitization campaigns to analyze the failures of adoption of ITNs as an important intervention method.
The adherence to ITN utilization is an important control strategy in pregnancy to prevent malaria infection. Minwuyelet et al. demonstrated in a study performed in Shebella Bernata District, in Ethiopia, that utilization of bednets is significantly associated with antenatal care, educational status, and informative messages. However, only 45.1% of pregnant women are using insecticide-treated bednets, which is still below the WHO standard.
The necessity to develop novel insecticides against the most important malaria-transmitting vectors in Africa, i.e., A. gambiae sensu lato and the Anopheles funestus group, has been documented in 61 research articles between 2011 and 2015, as shown by Minwuyelet et al. in a literature study. Severe insecticide resistance was detected against pyrethroids and organochlorines. New candidate insecticides with susceptibility are clothianidin (neonicotinoid), chlorfenapyr (pyrrole), and broflanilide (meta-diamide).