This article examines the evolving malaria landscape in Borneo, highlighting the shift from human malaria elimination towards the persistent challenge of zoonotic malaria, particularly Plasmodium knowlesi. While Malaysia has achieved elimination of human malaria, Sabah and Sarawak continue to experience transmission driven by ecological factors at the human-animal-environment interface. The discussion situates malaria within changing land use patterns, deforestation, and increased human interaction with forest ecosystems, which facilitate transmission through macaque reservoirs and mosquito vectors. It underscores diagnostic limitations, especially misclassification in routine microscopy, and the need for improved access to timely and accurate testing in rural settings. Clinical implications, including rapid disease progression and the necessity for early treatment, are emphasised alongside preventive strategies such as vector control and behavioural risk reduction. The article argues for a strengthened One Health approach that integrates environmental, veterinary, and public health systems, alongside sustained investment and adaptive policy responses. Malaria in Borneo is framed not as a resolved issue, but as a complex, evolving public health challenge requiring context-sensitive and coordinated action. KeywordsMalaria; Plasmodium knowlesi; Sabah; Sarawak; Borneo; zoonotic disease; One Health; vector-borne disease; public health; Malaysia; forest ecology; disease surveillance