New Tools and Strategies Emerge as Global Malaria Control Faces Mounting Threats

Malaria control efforts have stalled in recent years, and a new editorial published in Frontiers in Malaria argues that the path to elimination now depends on deploying a fresh generation of tools against four escalating threats: invasive vector species, insecticide resistance in mosquitoes, declining antimalarial drug efficacy, and parasite gene deletions that undermine rapid diagnostic tests. Writing ahead of World Malaria Day 2025, the editorial authors, led by Annette Elizabeth Kaiser of the University of Duisburg-Essen, frame the challenges within the World Health Organization campaign “Malaria Ends With Us: Reinvest, Reimagine, Reignite,” which calls for renewed global policy and community action. The editorial accompanies a Research Topic that gathers new studies on surveillance, transmission-blocking interventions, and next-generation insecticide-treated nets, offering a snapshot of where the field stands and where it must go next.

The socioeconomic dimension of malaria looms large in the editorial’s framing. Although profound knowledge exists in targeted prevention, treatment, and detection, people in endemic countries often have limited access to these services. In 2020, people in low- and middle-income countries spent 40 percent of their income on healthcare, a burden that risks pushing households deeper into poverty. Malaria is also shaped by social inequities such as low education, agricultural work, and unprotected housing, all of which increase human exposure to infected mosquitoes. The authors argue that these structural vulnerabilities demand coordinated global approaches rather than fragmented, country-by-country responses, particularly as climate change, wars, and economic decline continue to erode hard-won gains.

Accurate measurement of the disease burden underpins every elimination strategy, and several contributions in the Research Topic address this need directly. Drawing on data from the 2021 Global Burden of Disease database, Zhou and colleagues assessed malaria in the Comoros across indicators including incidence, prevalence, mortality, disability-adjusted life years, years of life lost, and years lived with disability. Their analysis showed that the malaria burden in the Comoros decreased between 1999 and 2021, driven mainly by epidemiological changes. Yet the study also revealed persistent hotspots of vulnerability: women under 40, school-aged children, and adults under 30 continue to carry a higher malaria burden than other groups, signaling where interventions should be concentrated.

In low-transmission settings, conventional case counts lose sensitivity, and serological surveillance offers a way forward. Lubis and colleagues conducted a cross-sectional study in 2019 in Langkat District, North Sumatra Province, Indonesia, where malaria incidence has declined significantly but low-level transmission persists. The team measured antibody responses to two blood-stage antigens of Plasmodium falciparum and Plasmodium vivax: merozoite surface protein-1 (MSP-1) and apical membrane antigen 1 (AMA-1). Seroprevalence for P. falciparum reached 10.6 percent for PfAMA-1 and 13 percent for PfMSP-1(19), while seroconversion rates were 18.6 percent for PvAMA-1 and 7.4 percent for PvMSP-1(19). The authors concluded that this serological assay is suitable for identifying epidemiological risk factors and supporting surveillance where elimination programs must be triggered by the earliest signals of residual transmission.

Blocking transmission from asymptomatic carriers is another critical frontier. Mmasi and colleagues used a direct membrane feeding assay (DMFA) with blood from gametocytemic participants to test how three variables influence infection of female Anopheles gambiae sensu stricto mosquitoes: artemether-lumefantrine (AL) treatment, mosquito feeding time during day versus night, and serum replacement. Infection rates in mosquitoes declined after AL treatment and were unaffected by whether mosquitoes fed during the day or at night, but rates increased after serum replacement. These findings, the authors note, will pave the way for optimizing the DMFA as a standardized tool for evaluating transmission-blocking interventions, a key step toward interrupting the silent chain of asymptomatic gametocytemia that sustains malaria in endemic regions.

Modeling studies in the Research Topic extend these insights to policy decisions. Seong and colleagues built a dynamic transmission model for P. vivax in the Republic of Korea and adapted it with demographic and climate data from the Democratic People’s Republic of Korea (DPRK), then evaluated the impact of tafenoquine administration and rapid diagnostic tests (RDTs) on malaria incidence from 2014 to 2018. The results are striking: a 1-day RDT would reduce malaria incidence by over 65 percent over the next decade, while a single-dose regimen of tafenoquine, compared with the standard 14-day regimen of primaquine, would prevent 77.5 percent of relapses and 11.3 percent of malaria cases. The combination of tafenoquine and RDTs, the authors conclude, appears to be a convincing strategy for eliminating P. vivax as a major public health problem in the DPRK, where the relapsing nature of the parasite makes diagnosis and radical cure especially challenging.

Imported cases pose a different kind of threat to elimination programs. Saudi Arabia established a malaria elimination program years ago, yet a study by Alghamdi and colleagues in Jeddah City between 2018 and 2023 documented 2,124 imported malaria cases, underscoring the need for novel antimalarial prevention protocols. Jeddah’s role as a global logistical hub for tourism through its air- and seaports makes it particularly exposed. Nearly 50 percent of the imported cases originated from Pakistan, and more than 30 percent came from African countries. Parasitologically, 38 percent of cases were caused by P. falciparum, the species responsible for most malaria deaths, while 57 percent were P. vivax infections. The findings illustrate how international travel and trade can reintroduce parasites into malaria-free areas, demanding vigilant screening at points of entry.

The COVID-19 pandemic’s disruption of malaria services in Africa between 2000 and 2022 provided the backdrop for another investigation. Amegatcher and colleagues implemented a community health education and medical screening (CHEMS) approach in Southern Ghana, conducting a cross-sectional survey in Accra and the Central regions that enrolled 953 people. Of these, 136 participants underwent both a malaria prick test and a COVID-19 nasal swab, with both samples analyzed by PCR. The results showed that 6 percent of participants were infected with malaria against a background of SARS-CoV-2 infection rates ranging from 12 to 37 percent, and notably, 2 percent were coinfected with both malaria and COVID-19. The study demonstrates how integrated community screening can simultaneously address two overlapping epidemics and maintain malaria surveillance during health system shocks.

Insecticide resistance emerged as the second major focus of the Research Topic, with at least four articles dedicated to the problem. Machange and colleagues evaluated a new combination net, ProNetDuo, which pairs bifenthrin, a fluorinated pyrethroid related to permethrin, with chlorfenapyr, an inhibitor of cellular energy production. In experimental hut trials at M’be in Cote d’Ivoire and Lupiro in Tanzania, using 18 huts with free-flying wild mosquitoes, the team compared ProNetDuo against Interceptor G2 nets, which contain alpha-cypermethrin and chlorfenapyr and have proven efficacy in malaria reduction. Using two endpoints, 72-hour mosquito mortality and the proportion of mosquitoes that successfully blood-fed, the researchers found that ProNetDuo showed inferior mortality but was superior in preventing blood feeding. The authors conclude that ProNetDuo, with its bifenthrin component, offers a valuable alternative against pyrethroid-resistant Anopheles gambiae populations.

Even the best nets fail if people do not use them. Savi and colleagues modeled urban malaria dynamics in Accra, Ghana, incorporating demographic and epidemiological factors, and identified limited living space and bed-net repurposing as critical barriers to reducing malaria prevalence. They recommend one-on-one sensitization campaigns to understand why adoption of insecticide-treated nets lags in urban and slum settings. In Ethiopia’s Shebella Bernata District, Minwuyelet and colleagues found that bed-net use among pregnant women was significantly associated with antenatal care attendance, educational status, and exposure to informative messages, yet only 45.1 percent of pregnant women used insecticide-treated bednets, well below WHO standards. A literature review by the same authors covering 61 research articles published between 2011 and 2015 confirmed severe resistance to pyrethroids and organochlorines in the principal African vectors, Anopheles gambiae sensu lato and the Anopheles funestus group, while highlighting three candidate insecticides with retained susceptibility: clothianidin, a neonicotinoid; chlorfenapyr, a pyrrole; and broflanilide, a meta-diamide.

The editorial closes with a sober warning. Beyond the scientific progress documented across the Research Topic, reductions in international donor funding from the US administration and other stakeholders since 2025 threaten to undermine all achievements, a scenario recently modeled for tuberculosis with substantial impacts on mortality and morbidity. The authors emphasize that modern scientific tools exist in abundance, but only careful observation, coordinated responses, strong quality assurance systems, and sustained investment, particularly for vulnerable groups such as children and pregnant women in rural areas, will convert these tools into elimination. One contribution also addresses the threat of invasive vector species, documenting the spread of a malaria-transmitting Anopheles mosquito into a previously malaria-free area west of Johannesburg, while six contributions illustrate the necessity of novel monitoring mechanisms to detect infections early in areas of low transmission. The message is clear: the tools are ready, but the funding and political will to deploy them remain the decisive variables.

Subject of Research: New tools and strategies for addressing contemporary threats to global malaria control, including insecticide resistance, invasive vectors, drug efficacy, and surveillance in low-transmission settings

Article Title: Editorial: Addressing contemporary threats to global malaria control: new tools and strategies

Article References: Kaiser, A. E., Messenger, L. A., Oxborough, R., & Matowo, N. S. (2026). Editorial: Addressing contemporary threats to global malaria control: new tools and strategies. Frontiers in Malaria, 4, Article 1776838. https://doi.org/10.3389/fmala.2026.1776838

Image Credits: AI Generated

DOI: 10.3389/fmala.2026.1776838

Keywords: malaria, insecticide resistance, Anopheles gambiae, insecticide-treated nets, tafenoquine, rapid diagnostic tests, Plasmodium vivax, Plasmodium falciparum, seroprevalence, transmission blocking, global malaria elimination, vector control