By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
News
On the sidelines of the Group of 20 (that is 19 without the US) meeting in South Africa, a number of attending countries pledged to raise 11.34 billion dollars for the Global Fund to Fight AIDS, Tuberculosis and Malaria over 2017-2019, as reported by Reuters. That fell short of the Global Fund’s stated hope of 18 billion.
Gavi, the Vaccine Alliance and “UNICEF have struck a new pricing deal that will sharply cut the cost of a key malaria vaccine and make it possible to protect nearly seven million additional children by 2030, the agencies announced [on 23 November.] Under the agreement, the price of the R21/Matrix-M vaccine will fall to $2.99 per dose within a year – a reduction expected to save up to $90 million. Those savings should allow countries to secure more than 30 million extra doses over the next five years.” https://news.un.org/en/story/2025/11/1166432
The 212-page World Malaria Report 2025, with subtitle of Addressing the threat of antimalarial drug resistance was published on 4 December. It is available from this reviewer or at https://www.who.int/publications/i/item/9789240117822. On the same day, Peter Sands, Executive Director of the Global Fund commented on the rise of cases and deaths between 2023 and 2024 and predicted that even more problems will be found in data from 2025. His call to action is to restore financial support for the preventive and suppressive efforts that are now ongoing at diminished intensity, due to diminished support.
Starting in early December, Malaria Journal began publishing articles without reference number and with the caveat that they had not undergone peer review yet. These articles will not be cited in these reports until they receive reference numbers.
PEER REVIEWED ARTICLES
Prevention
Vaccines
“In pursuit of a second-generation malaria [circumsporozoite] vaccine that surpasses the protection elicited by attenuated sporozoites and current subunit vaccines, [Wu NR & al.] developed self-assembling nanoparticle immunogens.” In mRNA Delivery of Circumsporozoite Protein Epitope-Based Malaria Vaccines Induces Protection in a Mouse Model, NPJ Vaccines. 2025 Nov 18; 10:238, https://doi.org/10.1038/s41541-025-01296-6, the authors describe the process in a mouse model of malaria infection. “… immunization with protein nanoparticles displaying different CSP epitope regions showed a reduction in liver burden ranging from minimal to 90%, …. mRNA-delivered nanoparticle and membrane-anchored immunogens displaying both the junctional and … repeat epitopes were most effective, exhibiting 99% reduction in liver burden and sterilizing immunity from parasitemia in some mice.”
Ekhator E & al., Public Awareness and Acceptance of Malaria Vaccine in Sub-Saharan Africa: A Systematic Review, BMC Public Health. 2025 Nov 11; 25:3890, https://doi.org/10.1186/s12889-025-25196-5 isa review of 33 publications on the subject of public reaction to the two malaria vaccines currently is use. “Malaria vaccine awareness ranged from 7.26% in the Democratic Republic of Congo to 95.6% in Ghana, with healthcare workers as the main information source. Acceptance levels also varied widely, from 10.3% to 100%, and were generally higher in Nigeria and Ghana. Beyond acceptance, participants from both countries were also willing to recommend the vaccine to others. … Education and occupation were consistently associated with greater awareness and acceptance, while factors such as age, gender, and income showed inconsistent or limited influence. In three African nations (Uganda, Ghana, and Nigeria), higher education was associated with a greater likelihood of vaccine awareness. Employed people also had higher awareness and acceptance of the vaccines in SSA.”
Vectors
Using governmental data from 2009 to 2021, Chinula D & al. assessed the effects of insecticide treated nets (ITNs) and indoor residual spraying (IRS) “on rates of inpatient admissions with severe malaria and total confirmed malaria cases. IRS treatments included various pyrethroids …, the organophosphate pirimiphos-methyl [and] clothianidin.” They conclude in Impact of Malaria Vector Control Interventions Implemented in Luangwa District Southeastern of Zambia: A 13-Year Observational Time Series Analysis of Malaria Trends, PLoS One. 2025 Nov 10; 20(11):e0336099, https://doi.org/10.1371/journal.pone.0336099 that “IRS with durable non-pyrethroid insecticide formulations and improved access to diagnosis and treatment were both clearly associated with substantial incremental reductions of malaria incidence. While no epidemiological effect could be attributed to [ITNs], this presumably occurred because coverage was already high at the outset and remained so throughout the study.”
Mwebesa E & al. “aimed to identify the pooled prevalence and factors associated with ITNs use among pregnant women, [utilizing] Malaria Indicator Survey (MIS) data from seven malaria high-burden countries” in sub-Saharan Africa. “The pooled prevalence of ITNs use among these countries was 63.8 …, low in Ghana (49.2%) and high in Niger (90.5%). Having a primary level of education … compared to those with no formal education, having given birth to one to two children … compared to those with no births yet were associated with higher odds of ITN use.” The paper is Pooled Prevalence and Factors Associated with Insecticide-Treated Net Use Among Pregnant Women in Malaria High-Burden Countries in Sub-Saharan Africa: A Multilevel Mixed-Effects Analysis, Trop Med Health. 2025 Nov 19; 53:166, https://doi.org/10.1186/s41182-025-00855-w.
Mwenya RM & al. “analyzed the association between [ITN] distribution and trends in malaria incidence in terms of monthly cases confirmed by rapid diagnostic testing during January 2010-December 2021. The abstract of Malaria Incidence Before and After Long-Lasting Insecticidal Net Distribution in Four Zambian Provinces, 2010-2021, Trans R Soc Trop Med Hyg. 2025 Nov 20: traf129, https://doi.org/10.1093/trstmh/traf129 simply states that there was “a statistically significant decline in monthly malaria incidence rates following implementation of [ITN] distribution, attributable to the immediate protective effects of nets; the binomial regression model showed up to 35% reduction in seasonally adjusted malaria incidence…” and the article was not available for review.
Amara MF & al. “assessed i) the insecticide resistance status of Anopheles gambiae sensu lato and ii) key entomological indicators of malaria transmission in” a region in Burkina Faso. They report “high resistance levels to dichlorodiphenyltrichloroethane and pyrethroids, …. Fortunately, a susceptibility to bendiocarb and pirimiphos-methyl was found in the majority of localities. The restoration of pyrethroid susceptibility following piperonyl butoxide pre-exposure suggests the involvement of metabolic resistance mechanisms” in Insecticide Resistance and Malaria Transmission Indicators in Anopheles gambiae s.l. in Bobo-Dioulasso, Burkina Faso: Implications for Vector Control Strategies, Trop Med Health. 2025 Nov 19; 53:165, https://doi.org/10.1186/s41182-025-00853-y. Nonetheless, “Anopheles populations exhibited high Plasmodium infection rates, indicating ongoing transmission.”
“Despite their potential to complement and enhance malaria prevention, mosquito repellents remain underutilized in endemic regions like Uganda, where outdoor transmission and insecticide resistance threaten current interventions.” Kemigisha G & al., Knowledge, Attitudes, Practices and Determinants of Mosquito Repellent Use for Malaria Prevention in Nangabo Ward, Wakiso District, Uganda, Malaria J, 2025 Nov 27, 24:430, https://doi.org/10.1186/s12936-025-05649-3 reports that “while 63.8% of the participants were aware of repellents, and 59.5% had [p]ositive attitudes towards them, there was low consistent use of only 8.2%. Although over 77.3% reported ever using mosquito repellents, occasional use was reported to be at 44.9%. Additionally, … only 38.4% of respondents understanding that repellents were safe for children under 5 years old, and 35.7% for pregnant women. Key barriers included cost … and policy gaps … Multivariable analysis demonstrated that age 60 years and above was strongly associated with non-use…”
Machani MG & al. studied human vector interactions in a region where malaria rates are high despite widespread use of ITNs. Based on studies that included human landing catches, Human and Vector Behavioural Determinants of Malaria Transmission in the Nandi Highlands, Western Kenya, Malaria J, 2025 Dec 8, 24:438, https://doi.org/10.1186/s12936-025-05681-3 concludes that “most exposure occurred indoors for unprotected sleepers and individuals awake (53–55%), followed by outdoor exposure in the early evening and late morning (16–44%).” The authors also concluded that ITNs prevented anywhere between 24.5% and 44.9% of bites, depending on the area studied and the rainfall. This study could be cited under Epidemiology
Please see van der Deure T & al., Climate Change Favors African Malaria Vector Mosquitoes, Glob Chang Biol, 2025 Nov 16, https://doi.org/10.1111/gcb.70610 below, in Epidemiology/ Climate Change etc.
Chemoprophylaxis
“Deployment of seasonal malaria chemoprevention (SMC) for young children using monthly sulphadoxine-pyrimethamine-amodiaquine (SPAQ)” was implemented in Northern Mozambique as a pilot program. Bonnington C & al., Parasitological Efficacy of Seasonal Malaria Chemoprevention in Nampula, Northern Mozambique, Trans R Soc Trop Med Hyg. 2025 Nov 13: traf127, https://doi.org/10.1093/trstmh/traf127 discloses the results. “After SPAQ, parasitaemia prevalence decreased from 68% to 41%. Among children followed successfully for 28 d, malaria parasitaemia prevalence declined from 71% to 44%. Preventive efficacy was 97% for Plasmodium ovale and 42% for Plasmodium falciparum…” The authors state that “[t]here was a clear chemoprevention exposure-response relationship evident for desethylamodiaquine, but not for sulphadoxine or pyrimethamine” but the evidence for this is not cited.
Some of the same authors contributed to Bonnington C & al., Pharmacometric Evaluation of Sulfadoxine-Pyrimethamine-Amodiaquine and Dihydroartemisinin-Piperaquine Seasonal Malaria Chemoprevention in Northern Uganda, Clin Infect Dis. 2025 Nov 13: ciaf615, https://doi.org/10.1093/cid/ciaf615. In this study, they report that “[a]djusted protective efficacies against all malaria parasitemia, P. falciparum parasitemia, and clinical malaria were SPAQ; 56% …, 46% …, and 60% … and for DP; 84% …, 86% … and 86% … respectively. Some asymptomatic P. falciparum infections were not cleared by SPAQ.” Thus the conclusion that “SPAQ SMC had low clinical and parasitological chemopreventive efficacy in Northern Uganda whereas dihydroartemisinin-piperaquine was effective.”
“Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a key intervention for preventing malaria during pregnancy in areas with moderate to high malaria transmission.” Osborne A & al., Inequalities in the Use of Three-Dose of Intermittent Preventive Treatment in Pregnancy with Sulfadoxine-Pyrimethamine Among Women in Sierra Leone, 2008–2019, Malaria J, 2025 Nov 25, 24:424, https://doi.org/10.1186/s12936-025-05511-6 is an inquiry into “trends and inequalities in using three doses of IPTp-SP among pregnant women in Sierra Leone… Economic inequalities among pregnant women in Quintile 5 (richest) and Quintile 1 (poorest) increased from a difference of −1.4 percentage points in 2008 to −5.2 percentage points in 2019. Disparities in education-related outcomes among pregnant women with secondary or higher education compared to those with no education decreased … The disparities in place of residence among pregnant women in urban versus rural areas decreased from a difference of 1.4 percentage points in 2008 to −6.3 percentage points in 2019. Provincial inequalities increased from a difference of 4.1 percentage points in 2008 to 18.4 percentage points in 2019.”
Inusah A-W & al. investigated “wealth-based inequalities in IPTp-SP3 coverage across 15 West African countries … Using the WHO Health Equity Assessment Toolkit (HEAT), the study analysed secondary data drawn from the Demographic and Health Surveys (DHS), Malaria Indicator Surveys (MIS) and Multiple Indicator Cluster Surveys (MICS) conducted from 2015 to 2021.” They report in Wealth-Based Inequalities in the Uptake of Three or More Doses of Intermittent Preventive Treatment in Pregnancy in West Africa, 2015–2021, Malaria J, 2025 Dec 9, 24:440, https://doi.org/10.1186/s12936-025-05669-z that the “lowest IPTp-SP3 coverage, 11.2% was recorded in Mauritania, whilst Burkina Faso recorded the highest coverage of 57.7%. The results revealed substantial wealth-related inequalities… However, near-equitable access to IPTp-SP3 was observed in Liberia, Nigeria and Sierra Leone.”
Unger HW & al. note that IPTp-SP has been found to be beneficial in reducing low birthweight infants even in some settings in which the antibiotics were found ineffective in prevention of malaria in pregnancy. Their paper, Beyond Malaria: Can Intermittent Preventive Treatment with Sulphadoxine-Pyrimethamine Reduce the Number of Small Vulnerable Newborns Globally? Lancet Glob Health. 2025 Nov 17: S2214-109X(25)00405-X, https://doi.org/10.1016/s2214-109x(25)00405-x proposes studying this potential beneficial effect in areas where malaria is not endemic.
Ndoye T & al. aimed to improve the acceptability of IPTp. They conducted “111 semi-structured interviews and 16 focus group discussions to explore stakeholders’ perspectives on c-IPTp in … high malaria-endemic districts in” Senegal. “Pregnant women found c-IPTp acceptable, appreciating the risks of malaria in pregnancy and perceiving SP to be effective. However, they expressed concerns regarding adverse events and socio-cultural issues around unplanned pregnancies.” Key recommendations in Initiating Community Intermittent Preventive Treatment of Malaria in Pregnancy in Senegal: Qualitative Evaluation of Stakeholder Acceptability and Experience, Malaria J, 2025 Nov 25, 24:426, https://doi.org/10.1186/s12936-025-05646-6 “include ensuring supplies of SP and pregnancy tests, improving reporting mechanisms, incentivising community health workers, gaining acceptance from pregnant women, and securing consistent funding.”
Other
Ivermectin prevents the transmission of Plasmodium gametocytes from infected persons to mosquitos that may bite them. “Mass drug administration (MDA) of ivermectin is currently being evaluated for malaria control.” Wangari W & al., Community Experiences and Perceptions of the Broad One Health Endectocide-Based Malaria Intervention in Africa Trial of Ivermectin Mass Drug Administration: A Longitudinal Qualitative Study in Kwale County, Kenya, Am J Trop Med Hyg. 2025 Nov 11:tpmd250145, https://doi.org/10.4269/ajtmh.25-0145 relates experiences with a trial that involved frequent and intensive interaction with villagers in communities where ivermectin MDA was implemented. The researchers report that “during the trial, addressing needs and confidence in the implementing institution fostered participation, whereas previous negative experiences with MDA interventions and perceived exclusion from community engagement activities reduced involvement. The MDA was widely perceived as effective in reducing mosquitoes and malaria in both arms of the trial”, in addition to reducing bedbugs.
Diagnosis
General diagnostics
None this month
Field diagnostics
Thein KS & al., The Underperforming Abbott-Bioline Malaria Ag P.f/P.v Rapid Diagnostic Test: A Whiter Shade of Pale – Where the Truth Is Not Plain to See, Malaria J, 2025 Dec 15, 24:441, https://doi.org/10.1186/s12936-025-05638-6 originates from Myanmar, but its information is highly relevant to all regions where P. vivax is a significant cause of malaria, such as Ethiopia. The authors report that sensitivity of the test kit for detecting P. vivax infection was 24%, compared to microscopy. Yet they assert that when they reported this to the relevant agency of WHO, their report was ignored and the underperforming product continues to be marketed.
New diagnostic methods
None this month
Treatment
Treatment results
In situations of malaria recurring “late” but within a month of previously treated infection, the question of treatment failure arises. Mehra S & al., Probabilistic Classification of Late Treatment Failure in Uncomplicated Falciparum Malaria, Nat Commun. 2025 Nov 10; 16:9880, https://doi.org/10.1038/s41467-025-64830-z proposes a method of distinguishing reinfection from treatment failure that does not involve extensive genetic testing of the parasite. The importance of making the distinction lies in making certain that there is no overestimation of treatment failure, which may result in misjudging the efficacy of antimalarials.
Side effects and complications
None this month
Guidelines
None this month
Drug resistance
None this month
New drug research
Sarangi S & Mahapatra RK describe the laboratory approach to the identification of a potential new drug that appears to inhibit a vital enzyme of P. falciparum. However, the abstract of their paper, Phytochemical-Based Discovery of a Potent Antimalarial Candidate Targeting Pfpi4k: A Hybrid Structure-Based and Deep Learning Approach, Exp Parasitol. 2025 Nov 19; 279:109064, https://doi.org/10.1016/j.exppara.2025.109064 is unclear what the connection to plant-derived chemicals is and the article is unavailable for review.
Plant extracts and traditional treatments
None this month
Campaigns and Policies
Thembakazi MT & al. “explored the experiences of community members and healthcare workers with malaria control programmes in … a rural community” adjacent to Mozambique in Experiences of Community Members and Health Workers Regarding Malaria Control Programmes in the Rural Ingwavuma Community, uMkhanyakude District Municipality, KwaZulu-Natal Province, South Africa, Public Health Chall. 2025 Nov 8; 4(4):e70132, https://doi.org/10.1002/puh2.70132. “Community members generally viewed malaria control activities positively, particularly health education, indoor residual spraying (IRS) and vector surveillance. Rapport between malaria control personnel and communities was strong, with respectful engagement that enhanced programme acceptance. However, healthcare workers highlighted challenges in malaria surveillance linked to illegal cross-border movement between South Africa and Mozambique. Local social protests occasionally disrupted spraying activities, with a few communities blocking access to their homes. Some participants reported negative experiences with IRS.”
Lusiyana N & al., Imported Malaria: A Silent and Forgotten Threat in Malaria Free Zones? Malaria J, 2025 Nov 24, 24:421, https://doi.org/10.1186/s12936-025-05639-5 arrives at recommendations for countries and regions that have been declared malaria-free, yet host malaria vectors and therefore are at risk of local transmission and resurgence. Based on a review of 24 articles on the subject, they state that “case-based surveillance alone is insufficient; it must be complemented with additional interventions and context-specific activities to ensure sustained elimination and prevent reintroduction.”
Between May 2021 and June 2022, a malaria control campaign was conducted in a high endemic area in Mozambique. Lequechane JD & al. conducted studies of community awareness and attitudes both before and after the campaign. They report in Knowledge, Attitude and Practice in High Endemic Settings for Malaria: A Cross-Sectional Study in a Rural Community in Central Mozambique, Malaria J, 2025 Nov 28, 24:431, https://doi.org/10.1186/s12936-025-05652-8 that “[h]eads of households [showed] no differences on KAP regarding symptoms, mode of transmission, prevention and treatment of malaria when intervention and control or before and after intervention were compared.” The article does not state the malaria incidence outcome of the project but implies that it was ineffective. Further, the authors conclude that “the higher malaria cases in the study area are not related to the malaria knowledge, attitude and practice of householders.”
Epidemiology
Climate change, biodiversity and environment
van der Deure T & al. “estimate the future human exposure to each of six dominant African malaria vector species” in Climate Change Favors African Malaria Vector Mosquitoes, Glob Chang Biol, 2025 Nov 16, https://doi.org/10.1111/gcb.70610. They state that their modeling “results align with observed historical range shifts of Anopheles species but stand in contrast to earlier studies that have predicted climate change would have little effect on or even reduce malaria transmission. [The authors] find that climate change impacts on malaria vectors are highly species-specific, emphasizing the need for longitudinal field studies and integrated modeling approaches to address the ongoing redistribution of malaria vectors.”
Among the findings of Quiner CA & al., Epidemiology of Plasmodium spp. Detection Among Acute Febrile Illness Patients in Two Regions of Nigeria, Clin Infect Dis. 2025 Nov 20; 81(Supplement_4):S168-S176, https://doi.org/10.1093/cid/ciaf468 we read the following: “No statistical significance among climatic predictors was found; however, a systematic directionality in minimum temperature effects across lag periods was observed. The magnitude of association varied by site with percent positivity in Edo State being more influenced by minimum temperature.” Other risk factors mentioned are largely the same as those reported elsewhere.
Risk factors
Using hospital data over four years, Amugongo JS & al. report that among 2610 hospital admissions of children aged 1 to 18 years, 40.6% were diagnosed by microscopy as having malaria. Their paper, Sociodemographic and Ecological Factors Associated with Malaria and Malaria Recurrence Risk in Children in Msambweni, Kwale County, Kenya, Malaria J, 2025 Nov 28, 24:433, https://doi.org/10. 1186/s12936-025-05657-3 states that malaria risk was associated with ages 2-5 as compared to less than two years. “Increased malaria risk was also associated with poor ventilation and limited windows.” “Recurrent malaria was linked to poor-quality housing, particularly dirt floors and proximity to mosquito breeding sites such as rice fields.” Protective factors included higher maternal education, piped/well water inside the compound, and electricity/solar lighting.
General epidemiology
The purpose of Merga H & al., Modeling Urban Malaria Infection in Anopheles stephensi Hotspot Area in Eastern Ethiopia: Application of Structural Equation Modeling, BMC Infect Dis. 2025 Nov 5; 25:1502, https://doi.org/10.1186/s12879-025-11841-2 is to “model the direct and indirect effect of factors affecting the risk of urban malaria infection in eastern Ethiopia where an invasive malaria vector has been recently detected.” The authors used a technique called Structural Equation Modeling (SEM), which they applied to information about 329 urban dwellers presenting in health care facilities with fever. The authors conclude that SEM is an effective technique that identified the direct and indirect effects of wealth index, ITN utilization, knowledge, attitude and history of travel on risk of urban malaria infection.
As a result of literature review from all regions of malaria endemicity, Oo WH & al., Implementation and Fidelity of Reactive Surveillance and Response Strategies for Malaria Elimination: A Systematic Review and Meta-Analysis, BMJ Public Health. 2025 Nov 13; 3(2):e001180, https://doi.org/10.1136/bmjph-2024-001180 report on the follow up on surveillance. “In Africa, many countries undertook reactive case detection alone as their reactive surveillance and response strategy (19/34 studies) … the implementation fidelity measured by completeness and timeliness of each step of reactive surveillance and responses was 100% … and 97% …, respectively [in China]. Lowest fidelities … were …: 56% .. in Africa and 57% … in Greater Mekong Subregion.”
Abdi MY & al., Prevalence of Asymptomatic Malaria and Associated Factors Among Pregnant Women in Mogadishu, Somalia: A Cross-Sectional Study, Malaria J, 2025 Nov 24, 24:420, https://doi.org/10.1186/s12936-025-05665-3 reports that among 171 asymptomatic pregnant women studied over a month, 2.9% had Plasmodium falciparum detected by microscopy. “While no factors were significantly associated with asymptomatic Plasmodium infection, the findings suggest that younger age, urban residence, and ITN utilization may have protective effects.”
“The Amhara Region [of Ethiopia] has recently experienced a significant resurgence, threatening to reverse previous progress. [Lake MW & al.] examine trends, spatial expansion, and control challenges associated with malaria resurgence in” Resurgence of Malaria in the Amhara Region, Ethiopia (2014–2024): Trends, Spatial Expansion, and Control Challenges, Malaria J, 2025 Nov 25, 24:425, https://doi.org/10.1186/s12936-025-05668-0. “During the study period, 7,710,733 malaria cases and 162 deaths were reported. Adults (≥ 15 years) contributed 62% of cases. A single trend inflection point occurred in late 2018, marking a shift from a significant decline (Annual Percent Change [APC]: −13.2%) to a sharp resurgence… Plasmodium vivax became increasingly prominent…. Its incidence surged 11-fold between 2018 and 2024 (… In 2024, a resurgence occurred in 83% of districts; hotspots expanded into urban centres and previously low-transmission highland areas.” No cause for the resurgence is offered by the article.
Please see Machani MG & al. Human and Vector Behavioural Determinants of Malaria Transmission in the Nandi Highlands, Western Kenya, Malaria J, 2025 Dec 8, 24:438, https://doi.org/10.1186/s12936-025-05681-3 above, under Prevention/Vectors
Spatiotemporal studies
Aidé ES & al., Malaria Hotspots and Risk Factors Among Children Under-Five Years of Age Across Eight West African Countries: A Geospatial Analysis of DHS Data, Malaria World J 2025 Dec 1, 16:19, https://doi.org/10.5281/zenodo.17777419