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Each year on 25 April, the world marks World Malaria Day, a moment to reflect on progress in the fight against malaria and renew global commitment to ending a disease that continues to affect millions of lives globally. This year’s theme, “Malaria Ends With Us: Reinvest, Reimagine, Reignite,” calls for sustained investment, bold innovation, and stronger partnerships across all sectors.

In Malawi, malaria remains a persistent public health threat. Despite notable progress in reducing cases and deaths, the disease continues to place immense pressure on the health system and disrupt the wellbeing of families and communities. With a national target to reduce malaria incidence and mortality by 90 percent by 2030, Malawi is at a critical juncture, one that demands not only more resources, but also smarter, more integrated approaches.

This article reflects on Malawi’s malaria elimination efforts to date and examines a critical but often overlooked dimension of the challenge: how large-scale irrigation and/or dam development projects may be influencing malaria transmission, and other vector-borne diseases, and what policy responses are urgently needed.

Malawi’s malaria elimination ambition

Malawi’s ambition to eliminate malaria as a public health threat by 2030 is both bold and necessary. The aim to reduce malaria incidence and mortality by 90 percent is anchored in the National Malaria Strategic Plan (2023–2030), which aligns with global commitments under the WHO’s Global Technical Strategy for Malaria (2016–2030).

Malawi has significantly scaled up access to preventive interventions and effective treatment. Between 2000 and 2022, the national malaria prevalence among children aged 2–10 dropped from 43.9% to 10.5 %, and all-cause under-five mortality decreased by 48%. Ownership of at least one insecticide-treated net (ITN) per household rose from 38% in 2006 to 82% in 2017, while intermittent preventive treatment for pregnant women (IPTp3+) increased to 56% coverage by 2022, with a new target of 85% by 2030.

The introduction of the RTS,S malaria vaccine, the scale-up of community case management, and innovative programming—such as school-based malaria testing and treatment pilots—have further strengthened the country’s malaria response. These gains provide a strong foundation on which to build momentum toward elimination.

However, progress is stalling. Between 2021 and 2022, the malaria incidence rate stagnated at 219 cases per 1,000 population at risk. While overall national prevalence has dropped, transmission is now increasingly heterogeneous and focal. Persistent hotspots, particularly in the Shire Valley, lakeshore zones, and central plains, continue to record high case burdens.

The overlooked risk: Irrigation and malaria transmission

The expansion of irrigation is central to Malawi’s development ambitions. Projects like the Shire Valley Transformation Programme (SVTP) in Chikwawa district, southern Malawi are designed to transform livelihoods by boosting agricultural productivity, strengthening climate resilience, and improving food and income security. However, while the economic and nutritional benefits of irrigation are well understood, its public health implications, particularly in relation to malaria transmission—are often overlooked.

Irrigation schemes, especially those developed on a large scale, can create ideal breeding environments for malaria-carrying mosquitoes. Poorly managed canals, stagnant water pools, and flooded fields become hotspots for vector population proliferation. In high-transmission zones such as the Shire Valley and the central plains, the expansion of irrigation without integrated vector control threatens to undermine national malaria elimination efforts.

The risks are further compounded by gaps in policy and planning. Most notably, the recently launched Malawi National Irrigation Policy (2024)—a key document guiding the country’s future irrigation development—does not mention vector-borne diseases or malaria at all. While it acknowledges the need to “promote practices that minimise waterborne diseases,” this reference remains broad and non-committal, with no operational guidance for mitigating malaria or mosquito-related risks. This omission is striking, especially given the well-established relationship between irrigation and increased malaria exposure in Malawi’s lowland areas.

Findings from the Shire Valley Vector Control Project (Shire-Vec) project, a research collaboration between the Liverpool School of Tropical Medicine, Malawi College of Medicine, Malawi Liverpool Wellcome Programme, Lilongwe University of Agriculture and Natural Resource, and African Institute for Development Policy, show that malaria prevention is rarely integrated into the planning or implementation of irrigation schemes. Environmental assessments often focus narrowly on water use, land productivity, and soil quality, with little to no attention paid to health risks. Local irrigation staff and community health workers work in silos, lacking a shared framework for addressing the intersection of agriculture and disease.

This disconnect between irrigation policy and malaria control efforts represents a major gap in Malawi’s elimination strategy. Unless addressed, it risks enabling a cycle in which development gains come at the cost of rising health burdens—particularly among rural communities that are already vulnerable.

Shire-Vec’s policy recommendations

Extensive research from the Shire-Vec project has shown that it is practical to advance food security through irrigation farming without escalating the malaria risk. Malawi can therefore systematically take advantage of this and avoid compromising on the gains made over the years in the fight against malaria. To achieve this balance, we urge various policymakers to consider the following:

• Ministries of health, water and agriculture integrate malaria control and management with irrigation farming systems. The current irrigation-related policies should be reviewed to incorporate malaria control and management.
• Policymakers and implementers should ensure that communities in and around irrigation schemes are actively involved in malaria control interventions. This would ensure wider acceptance of the malaria control and management initiatives.

Conclusion: Ending malaria requires integrated thinking

Malawi’s progress in reducing malaria over the past two decades is undeniable, but sustaining that momentum requires acknowledging and addressing emerging threats—particularly those linked to irrigation expansion. As the country pursues ambitious agricultural and development goals, it must ensure that malaria prevention is not left behind. The omission of vector control in the 2024 National Irrigation Policy highlights a critical gap that demands urgent attention. If Malawi is to meet its 2030 malaria elimination target, development policies must actively support public health objectives. Malaria ends with us—all of us—and achieving elimination will depend on how boldly and collaboratively we act across sectors.

This article was originally published in Malawi news (May 3- 9 2025)