One Paleopathology: A Deep-Time Framework for Predicting Malaria Resurgence in the Climate Crisis

Malaria, the deadliest vector-borne disease in human history, is resurging under climate change, land-use change, shifting public health priorities, and declining global funding. In this Personal View, we argue that One Paleopathology, an interdisciplinary framework that integrates bioarchaeology, paleogenomics, historical (written) sources, paleoclimatology, and disease ecology, offers critical insights into malaria's climate-driven expansions and contractions over the past 10,000 years. Deep-time evidence shows how anthropogenic environmental modification, from ancient irrigation and urban expansion to wetland management, has shaped transmission dynamics across millennia, and how past communities used biocultural strategies to reduce malaria's burden. We advance two arguments for the framework's value: first, that deep-time analysis reveals how human–environment interactions structure malaria transmission; and second, that past disease outcomes, such as skeletal indicators of malaria and infant and child mortality, can serve as historical baselines to validate and improve predictive models. Integrating reconstructed paleoenvironments, built environments, subsistence and socioeconomic factors, and morbidity and mortality data with climate-informed mechanistic models and an expanded eco-syndemic perspective can strengthen projections of future risk zones. We urge planetary health researchers and policymakers to treat the past as a laboratory, so that surveillance and mitigation in climate-vulnerable regions, from the Mediterranean to the American South, address systemic drivers rather than transient hotspots.