Great news for mosquito haters

I was scrolling Reddit recently when I saw a video of a mosquito trying and failing to suck someone’s blood. Some of the replies were pretty funny, but I noticed that most of them were just some form of “How do I get this person’s superpower?” It was a great reminder of how universally hated these bloodsuckers are.

But I have good news—for Reddit users and everyone else: Real progress has been made in the fight against mosquitoes and specifically against malaria, the deadliest disease they carry. And I believe we’ll soon have the transformational tools needed to end malaria entirely.

Eradication is a goal Melinda and I set back in 2007, when we stood before a group of global health leaders and called for something many considered impossible: wiping malaria out completely from every country. And until that happened, our goal was—and is—to save as many lives as possible by maximizing the impact of the tools we already have. Eradicating the disease wasn't a new idea; the World Health Organization had made a similar declaration back in 1955. But that earlier campaign, while successful in many wealthier parts of the world, had fallen short across Africa, Asia, the Middle East, Eastern Europe, Central and South America, the Caribbean, and Oceania. Despite half a century of effort, malaria was still infecting up to half a billion people—and claiming a million lives—annually .

Today, the landscape has changed dramatically. In 2022—the last year we have data on—there were 249 million cases worldwide and 608,000 deaths . Those are staggering numbers, but they’re also improvements from where the world was back in 2007. Since then, 17 additional countries have been declared malaria-free by the World Health Organization. Outside of Africa, deaths from the disease have mostly been eliminated.

Even where elimination hasn’t been fully achieved, there are stories that give me real hope. Take Tanzania, for example. It used to be one of the countries hardest hit by malaria, but thanks to a functional health system and widespread use of interventions, they've managed to dramatically reduce their disease burden . Or look at Cambodia, which I visited and wrote about a decade ago for the first Mosquito Week on Gates Notes. They’d set an ambitious goal for elimination by 2020 and didn’t make it. But no one there has died from malaria in six years. Cambodia is now on track to achieve malaria-free status—declared when a country has no local malaria transmission for three years straight—in 2025.

These successes show us what's possible when we combine effective tools with strong health systems and sustained commitment. They’re a testament to the strength of our current arsenal against malaria: insecticide-treated bed nets, indoor insecticide sprays, rapid diagnostic tests, treatments, first-generation vaccines, and preventive medications. Together, these solutions have saved millions of lives, and we need to keep using and investing in them.

But alone, they aren’t enough. Malaria is caused by a remarkably adaptable parasite that's constantly changing and developing resistance to our drugs and interventions. Fighting it is like playing a global game of high-stakes whack-a-mole: Just when we think we've got it under control, it pops up somewhere else or in a new form.

Recent years have brought additional challenges. The COVID-19 pandemic dealt a significant blow to our progress, with malaria cases and deaths rising since 2020; they still haven’t returned to pre-pandemic levels. Climate change is expanding mosquito habitats, threatening to explode the malaria map and expose millions more people to the disease. At the same time, we're seeing growing drug resistance, which threatens to make current treatments less effective. And malaria still hits vulnerable groups hardest—killing one child every minute.

As long as malaria exists anywhere, it poses a threat everywhere. That’s why, at the Gates Foundation, our approach to the disease has always been two-pronged: Using current interventions to save lives and alleviate suffering, while laying the groundwork for a malaria-free future.

Scientists around the world are on the cusp of breakthroughs that make ending malaria possible.?

This is where things get exciting. Scientists around the world are on the cusp of breakthroughs that make ending malaria possible. These aren't just incremental improvements; they're potential game-changers that could finally give us the upper hand against this ancient foe.

• Two recently approved first-generation malaria vaccines, while landmark and lifesaving, have limitations . They’re made for young children who are most vulnerable to severe disease and death. But they require multiple doses, don’t provide long-lasting protection, and don’t stop transmission. (They might keep you from getting sick, but you can still get the malaria parasite from a mosquito bite and pass it on to someone else.) So researchers are now working to develop next-generation malaria vaccines that could work for all ages, need fewer doses, offer broad immunity against multiple malaria strains, and significantly reduce or halt transmission. Several options are being explored, including ones that use mRNA, and some are already in trials.
• Gene drive could revolutionize our fight against malaria and other mosquito-borne illnesses. This approach, currently still in the research phase, involves combatting malaria by using genetic alterations that reduce the female Anopheles mosquito population, since only they bite and transmit the disease. In London, researchers are editing the doublesex gene to give female mosquitoes a proboscis that’s too flimsy to break human skin—which is what the Reddit video was depicting. While this powerful technology requires careful consideration (as I discussed in a previous blog post ), its life-saving potential is enormous.
• A single shot that replaces daily pills to protect you from malaria: That's the idea behind various injectable prevention tools. At first, there was a lot of hype around monoclonal antibodies—lab-made proteins designed to mimic how our immune system fights off harmful pathogens. Instead of triggering our bodies to produce antibodies the way a vaccine would, this approach involves just injecting them directly. But now, scientists are also exploring another solution called long-acting injectable medicines, or LAIs, which could provide months of protection and help serve the same purpose as monoclonals—especially in areas with seasonal malaria transmission, or where healthcare access is limited. We're expecting results from late-stage LAI trials by 2028, and the data so far looks promising.
• Currently, treating malaria usually involves taking a cocktail of drugs—most often artemisinin-based combination therapies, or ACTs. But imagine if doctors could cure malaria in just one dose, while also making patients temporarily toxic to mosquitoes. That's the goal of a new type of treatment called single encounter radical cures, or SERCs, with endectocides. The hope is to use these in widespread public health campaigns to clear parasites and stop transmission in large populations. A new SERC combination is in late-stage trials and could be approved as soon as 2026.
• Attractive targeted sugar baits, or ATSBs, exploit mosquitoes' need for sugar by offering a sweet treat laced with insecticide. While first-generation ATSBs had a few weaknesses, scientists are working on improved versions with synthetic baits that are less vulnerable to environmental factors, work in different climates, have other active ingredients, and even include visual cues to attract mosquitoes more effectively. Field testing of these prototypes, designed for when prevention methods like bed nets can’t be used, will soon be underway. ?
• New technologies like drones and AI are already helping us find and attack mosquito breeding sites more effectively, giving us the potential to cut off malaria at its source. This is tech-enabled larval source management, and it’s particularly useful in urban areas. As we get closer to elimination, mosquito surveillance and vector control like this will become even more important—and easier, with technology enabling anyone with a phone to act as an entomologist .

In the next five to eight years, I think we’ll have the transformational tools we need to make eradication possible. The question then becomes: Will we have the global commitment needed to use these tools effectively?

One of our biggest challenges isn't scientific; it's financial and political. Despite the incredible return on investment of malaria interventions, attention and funding have been declining. The world has many competing priorities, and unfortunately, malaria often gets overlooked. But the dream of eradication is alive and well, even if it’s not always in the spotlight. We need to make sure the resources exist to make it a reality.

Right now, a child dies from malaria every minute. Imagine a world where no child dies from it, ever. That’s what the end of malaria will mean. It means millions of children growing up healthy, attending school regularly, and reaching their full potential. It means parents who can work and provide for their families. It means stronger economies, more resilient communities, more robust healthcare systems, and a more equitable world. Together, we can get there. ?