Karachi: Pakistan’s malaria burden has jumped to one of the highest in the Eastern Mediterranean Region, with the new ‘World Malaria Report 2025’ warning that rising drug resistance could undermine global malaria control and push high-burden countries like Pakistan into a deeper health crisis if urgent measures are not taken.
According to the WHO report, Pakistan now records more than three million malaria cases a year, placing it among the region’s largest contributors after Sudan. The report notes that Pakistan is one of the few countries where malaria incidence and mortality have more than doubled since 2015, despite global targets calling for sharp reductions by 2025.
Globally, malaria continues to climb, WHO says adding that an estimated 282 million cases and more than 610,000 deaths occurred in 2024, driven largely by conflict, climate-linked disasters and funding shortfalls. Africa remains the epicentre, accounting for more than 90 percent of global deaths, while countries in the Eastern Mediterranean, including Pakistan, Afghanistan, Somalia and Yemen, have also registered steep increases after climate emergencies.
In Pakistan, the 2022 floods triggered the country’s sharpest spike in malaria infections. More than 30 million people were affected, over a thousand health facilities were damaged, and widespread stagnant water created ideal breeding conditions for mosquitoes. Mass displacement, overcrowded shelters and disrupted primary care allowed malaria to flare across flood-hit districts.
A major public health response led by national and provincial authorities, supported by WHO and partners, helped bring down cases in 2024. Expanded screening, vector control, diagnostic availability and rapid treatment prevented more than a million infections. But the WHO report makes clear that Pakistan remains off track for the 2030 global milestones.
Pakistan’s malaria control strategy relies heavily on artemisinin-based combination therapies, particularly artemether–lumefantrine plus primaquine for Plasmodium falciparum and chloroquine plus primaquine for Plasmodium vivax. Free testing, free treatment and nationwide mosquito-net distribution form the backbone of national policy.
The WHO report’s biggest warning centres on antimalarial drug resistance. Partial artemisinin resistance has now been confirmed in several African countries and suspected in parts of the region. These mutations delay parasite clearance and place heavier reliance on partner drugs like lumefantrine and amodiaquine, raising fears that frontline treatments could lose their effectiveness.
The report cautions that drug resistance is spreading faster than existing surveillance systems can detect. Weak private-sector regulation, presumptive treatment, poor drug quality and the circulation of falsified medicines all accelerate the threat — conditions common in many high-burden countries.
Pakistan’s vulnerability is compounded by climate variability, uneven regulation of private drug markets and a high proportion of P. vivax cases, a parasite known for relapse and more complex treatment pathways. WHO says countries like Pakistan must urgently strengthen molecular surveillance, expand therapeutic efficacy studies, regulate drug quality and improve data flow.
The report also encourages the adoption of multiple first-line therapies to distribute drug pressure and prolong the useful life of existing medicines.
Experts warn that without stronger monitoring and sustained investment in prevention and diagnostics, Pakistan risks losing the gains made after the post-flood surge. A rise in treatment failure, they caution, could set back national malaria control efforts by years.
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