Progress in eliminating malaria has stalled in recent years, the World Health Organization said Monday, with more than 400,000 people once again estimated to have died from the disease last year.

In its World Malaria Report 2020, the WHO said progress against the mosquito-borne disease was plateauing, particularly in African countries bearing the brunt of cases and deaths.

In 2019, the global tally of malaria cases was estimated at 229 million -- a figure that has been at the same level for the past four years.

Meanwhile, the once rapidly-falling death toll has effectively come to a standstill in the last two years. After steadily tumbling down from 736,000 in 2000, the disease claimed an estimated 411,000 lives in 2018 and 409,000 in 2019.

"A better targeting of interventions, new tools and increased funding are needed to change the global trajectory of the disease and reach internationally-agreed targets," the WHO said.

Call to arms

The UN health agency said a funding shortfall posed a "significant threat", with only $3 billion of a $5.6 billion target raised in 2019. "Funding shortages have led to critical gaps in access to proven malaria control tools," it said.

Rather than a uniform approach, countries have recently begun to adopt tailored responses based on local data and intelligence, in order to try to keep up the pressure on malaria.

More than 90 percent of the disease burden is in Africa. The continent accounted for an estimated 384,000 malaria deaths last year.

"It is time for leaders across Africa -- and the world -- to rise once again to the challenge of malaria," said WHO director-general Tedros Adhanom Ghebreyesus. "Through joint action, and a commitment to leaving no one behind, we can achieve our shared vision of a world free of malaria," the former Ethiopian health minister said.

In 2019, four countries accounted for nearly half of all malaria cases globally: Nigeria (27 percent); the Democratic Republic of the Congo (12 percent); Uganda (five percent) and Mozambique (four percent).

Coronavirus concerns

The WHO's report found that most malaria prevention campaigns went ahead without major delays throughout the coronavirus pandemic.

But there were concerns that with efforts to tackle the disease flatlining, the ongoing Covid-19 crisis could prevent further progress. "Covid-19 threatens to further derail our efforts to overcome malaria, particularly treating people with the disease," said Matshidiso Moeti, the WHO's regional director for Africa.

"Despite the devastating impact Covid-19 has had on African economies, international partners and countries need to do more to ensure that the resources are there to expand malaria programmes which are making such a difference."

The WHO said that even a moderate disruption in access to anti-malarial treatment could lead to considerable loss of life.

Its report said that a 10-percent disruption in access to effective treatment in sub-Saharan Africa could lead to 19,000 additional deaths.

Progress worldwide

The report said 21 countries had eliminated malaria over the last two decades. Outside of Africa, it said India had continued to make impressive gains over the last two years, with an 18-percent reduction in cases and a 20-percent reduction in deaths.

And despite the ongoing threat of antimalarial drug resistance, the six countries of the Greater Mekong subregion of southeast Asia were making major gains towards their goal of malaria elimination by 2030, it said.

The reported number of malaria cases in the subregion fell by 90 percent from 2000 to 2019.