Science is getting closer to beating malaria, so what’s still in the way? 3 areas where action can make an impact

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Malaria elimination has become a realistic objective for an increasing number of countries. Over the past two decades, improved prevention, diagnosis and treatment have reduced deaths from this infectious disease, which is caused by a parasite and spread by mosquitoes.

Four major scientific advances have helped in this fight:

• two malaria vaccines

• more sensitive diagnostic technologies

• parasite genomics and drug-resistance surveillance

• satellite-based environmental monitoring and predictive modelling.

These advances are at different stages of development and use. But together, they have strengthened the malaria response.

Progress remains uneven, however. Particularly in sub-Saharan Africa. The region still accounts for around 95% of all malaria cases and deaths worldwide.

As researchers at the University of Pretoria's Institute for Sustainable Malaria Control, we have collaborated with national malaria control programmes in southern Africa. Over the past 15 years we have noticed that scientific advances do not always turn into effective action.

Drawing on some of our research and the work of other academics, we can identify three things that stand in the way.

• Prediction versus preparedness. Reliable warnings of potential malaria outbreaks don't always lead to timely decisions and responses.

• Evidence versus implementation. Scientific knowledge has to inform policy decisions and actions to protect communities.

• Awareness versus behaviour. Practical and socioeconomic barriers may prevent people from taking action to protect themselves, even when they know about malaria prevention.

To turn scientific information into action, malaria programmes should:

• link early warnings to practical preparedness plans

• make prevention and treatment accessible rather than relying on awareness alone

• strengthen leadership, resources and coordination of programmes.

From science to action

Since the 1990s, researchers have used satellite imagery to investigate environmental conditions associated with malaria transmission. These conditions include rainfall, temperature and vegetation. Modern remote-sensing approaches also monitor surface water. This helps identify potential mosquito breeding habitats. Combined with mosquito surveillance and malaria case data, these observations can help identify areas where transmission risks may increase.

Ethiopia provides an example. In 2020, an early-warning, alert and response system helped authorities in Bahir Dar to identify an unusually high malaria burden. That information didn't just produce a warning: it got people to prepare. It showed how early detection could inform planning.

District health authorities would also need closer surveillance, enough diagnostic supplies, targeted mosquito control and coordination across services.

These are operational decisions.

In southern Africa, our Remote Sensing for Malaria Control in Africa programme similarly explores how satellite and environmental data can inform malaria risk mapping and forecasting. The aim is to support more targeted responses.

Identifying threats is only the beginning. Preparedness depends on whether information reaches decision-makers. Those decision-makers, in turn, must have the authority and resources to respond.

Knowing isn't everything

Health education encourages people to recognise malaria symptoms, prevent mosquito bites and seek timely diagnosis and treatment. But awareness doesn't always produce action.

A study involving more than 7,500 people in Zambia and Zimbabwe illustrates this. Among adult participants, 85% correctly identified mosquito bites as the cause of malaria. And 95.5% could identify at least one symptom. But, even knowing this, they didn't always use bed nets. For some, mosquito nets were too costly or unavailable. Larger households were less likely to have enough nets for everyone. Children aged 5-14 were less likely to sleep under nets than younger children.

Someone may understand the importance of mosquito nets but lack access to one. In April 2025, the World Health Organization reported that more than 40% of planned campaigns to distribute insecticide-treated nets, intended to reach 425 million people, were delayed or at risk of disruption. Nearly 30% of seasonal malaria chemoprevention campaigns, intended to protect 58 million children, were also off track.

Science has also made great strides in diagnosis and treatment. Rapid diagnostic tests enable quicker detection. Artemisinin-based combination therapies have transformed treatment.

Yet a review of care-seeking for children under five in Africa found that financial constraints, distance to health facilities and limited access to healthcare delayed treatment. This increased the risk of severe illness and death.

What's missing?

Closing the gap between scientific advances and their real-world impact requires action on three fronts:

• strengthening health systems to deliver proven interventions

• improving community access to prevention and locally relevant health education

• coordination between researchers, decision-makers and malaria programmes.

Firstly, weaknesses in the systems need to be fixed. In an earlier article on shrinking malaria funding, we argued for smarter investment, stronger local capacity and African ownership of malaria responses.

But it takes more than financing. Scientific evidence and quality data must inform operational plans, surveillance systems and resource allocation. Programme managers need the skills, authority and flexibility to respond to changing conditions.

Initiatives such as the Advanced Leadership Programme for the Elimination of Malaria seek to provide those skills through practical leadership and management training.

Secondly, the goal shouldn't simply be greater awareness. Preventive action must be understandable, relevant, accessible and achievable.

It's essential to understand health beliefs, whether people feel at risk, and what may be preventing them from acting. This is more so when developing responses that communities can realistically adopt. Community engagement, education and innovative science communication, including storytelling, music and creative collaborations, may offer ways to reach audiences.

Thirdly, effective responses require coordination and the capacity to adapt research findings to how things really work. This is particularly relevant in southern Africa. Here malaria crosses national borders and countries face different disease burdens, resources and priorities.

Our research in Malawi illustrates why this matters. A 2016 study showed how locally generated evidence informed changes to national malaria treatment policy. Building on this work, a 2017 study proposed ways for researchers and decision-makers to work together.

The next advance in ending malaria will depend not only on what science discovers. How that knowledge is turned into decisions and action with an impact on society will be key.

Tiaan de Jager receives funding from the Gates Foundation.

Taneshka Kruger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

By Taneshka Kruger, UP ISMC: Project Manager and Coordinator, University of Pretoria And

Tiaan de Jager, Director: UP Institute for Sustainable Malaria Control, University of Pretoria