Table 1

Major gaps towards malaria elimination and potential opportunities and actions needed

Gap	Current state	Desired state	Opportunity	Action needed
Malaria control progress staggered and reversed	Resurgence on morbidity and mortality Malaria is still endemic in 85 countries and territories1 37	Malaria fatalities declined to a low level Ultimate goal for a malaria-free world	Over 100 countries have eliminated malaria More countries are moving towards the elimination of malaria Some African countries have eliminated malaria	Global malaria response back on track Increased and improved coverage of current tools
Financial shortage and insufficient government involvement	Backdrop of financial support with population growth Depending on external funding Lack of governmental support and commitment38	Filling the funding gaps Unwavering commitment of government	Progress in world economic development, especially in Africa Commitments from national governments, pharmaceutical companies, the Global Fund, and the Bill and Melinda Gates Foundation	Funding support from the government, private sectors and stakeholders Multilateral cooperation, including both international and subnational
Prioritise malaria among all infectious diseases	Continued gaps in fighting AIDS, tuberculosis, dengue and new emergence diseases Fragile, overwhelmed African health systems The widespread impact of COVID-1939 40	Universal health coverage and access to health services An integrated effective health system	Access to quality of water, sanitation and hygiene conditions Technological advances and innovations in new tools, for example, vaccines	Prevention of new cases of malaria Revamped health systems To reduce the impact of other diseases on malaria
Prevention and treatment	Insufficient access to bed nets Uncovered protection by indoor residual spray (IRS) Lack access to the tools that prevent, diagnose and treat the disease 70% of all malaria deaths occurred under the age of five Not accessing the WHO-recommended regimens for women and children41 42	Expanding key interventions’ access to most vulnerable Delivering malaria control tools to those most in need Flexible and tailored strategies to local contexts Ideal vaccine protection	The WHO Global Malaria Programme put high priority to close gaps in access to proven malaria control tools Increased investment in proven prevention measures Development and deployment of new diagnostic and treatment tools	Scale-up of effective tools, including expanded access to ITNs, IRS and ACTs More comprehensive analysis on gaps in prevention, diagnostic testing and treatment Seasonal malaria chemoprevention (SMC) for children under 5 years of age Community mobilisation
Insecticides and drug resistance	Developing and spread of insecticide resistance in more than 60 countries Mounting evidences on resistance of parasites to artemisinin derivatives Multidrug-resistant parasites and potential spread43	Available therapeutic antimalarial regimen and effective vector control tools Delay the appearance of insecticide resistance Containing artemisinin resistance in subregional and regional areas	Supplemented by other vector control methods Geospatial and temporal mapping of the emergence and spread Parallel, robust investments in the research and development of new tools	Integrated surveillance and monitoring on insecticides and drug resistance To invent active ingredients except pyrethroid To innovate antimalaria drugs To adopt more efficacious treatment regimens