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Today marks a crucial point in the global fight against the devastating malaria epidemic that has plagued humankind since we existed as a species. “Sustain gains, save lives, invest in malaria” forms the theme of this year’s event, which marks a decade of incredible achievement in reducing malaria-related mortality around the world through investment in cost-effective programmes in malaria control.

Wide availability of inexpensive medicines such as chloroquine and sulfadozine-pyrimethamine, and initiatives to supply insecticide-treated bed nets to those at risk have decreased the impact of the disease by as much as 50% in some areas, with infant mortality reduced by 20% in regions where malaria control methods have most dramatically increased.

However, malaria remains one of the most devastating global health crises. With approximately 216 million reported cases a year and an estimated 655,000 deaths, nearly half of the world’s population is still at risk from infection.

F1000 Faculty Member, Phil Fischer, the Mayo Clinic, USA, kindly agreed to shed a bit more light on the current problems faced by clinicians and aid workers fighting the disease around the globe. I caught up with Phil this week while he was in Somalia teaching common paediatric infections to a group of clinical-year medical students.

F1000: Outside of Sub-Saharan Africa, malaria seems to be much more of a minor issue. What makes malaria so hard to combat in the heart of the African continent?

Phil: First, many malaria-endemic areas are in places where there is limited access to curative medical care. Second, preventive interventions (insecticide-treated bed nets, intermittent preventive therapy) are not widely used. Third, Plasmodium falciparum is relatively more common in Africa than elsewhere, and it is this species which is most often associated with severe malaria. Women and children are most vulnerable to the effects of malaria, and they suffer doubly – from the infection and from resource limitations.

F1000: Recently, we have seen the emergence of artemisinin-resistant malaria in Southeast Asia. What kind of impact could this have on the region?

Phil: Rural areas of Cambodia have been the initial sites of resistance to several anti-malarials; fortunately, resistance does not always spread rapidly. The finding of artemisinin resistance there serves as a warning that resistance could spread to other areas. We must not become complacent in our efforts to prevent malaria while also seeking new curative medications.

F1000: How important is the RTS,S vaccine? Do you think that the future of malaria prevention lies in that particular direction?

Phil: I think that a good vaccine will go a long way toward winning the war against malaria. The RTS,S vaccines have shown good promise and could prevent many cases of malaria. Nonetheless, further research is needed as modifications of the vaccine and vaccination schedules seek to provide long-term protection to more than “just” 50% of recipients.

F1000: The primary objective of World Malaria Day is a future of ‘zero mortality from malaria’. Do you think this is possible?

Phil: Yes, and we should certainly strive for that. Malaria has been essentially eradicated from Europe and North America. We should be able to see the same success in areas of Africa and Asia that are currently resource-limited.

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It seems that winning the war against malaria will depend greatly on how much support is invested into the cause. In the last 10 years, a huge amount of momentum has gathered around the issue, which has led to fantastic stories of success. However, long-term eradication of the disease will depend very much on continued and new investments in research for novel curative therapies and vaccines that can combat resistant strains of the disease and offer lasting, economically viable protection on a global scale.