There were around 11 million more cases of malaria in 2023 than in 2022, up to an estimated 263 million, according to a new World Health Organisation report, marking another year of negligible progress against the age-old killer.

There were 597,000 deaths, a similar total to 2022, the vast majority among African children aged under 5 years old, the WHO said.

“No-one should die of malaria; yet the disease continues to disproportionately harm people living in the African region, especially young children and pregnant women,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement.

Malaria cases and deaths fell significantly between 2000 and 2015, but since then progress has stalled and even reversed, with a particular jump in mortality during the COVID-19 pandemic.

Case numbers are not only going up as populations grow. In 2015, there were 58 cases for every 1,000 people deemed to be at risk; in 2023, there were 60.4, nearly three times higher than the WHO’s target. There were 13.7 deaths per 100,000 people at risk, more than twice the target.

There are new tools available to fight the mosquito-borne disease, including two vaccines as well as next-generation bed nets, but climate change, conflict and displacement, drug and insecticide resistance and a lack of funding have all combined to challenge the response, the WHO said, despite progress in some countries.

In 2023, $4 billion was available to fight malaria, compared with an estimated $8.3 billion needed, the U.N. health agency added.