By 2050, nearly 7 out of 10 people globally will live in cities and other urban settings. While urbanization, overall, is expected to reduce malaria transmission, unplanned urbanization will likely result in a malaria disease burden that is disproportionately high among the urban poor. Cities are uniquely positioned to understand local needs and respond rapidly to changing conditions to safeguard health. These changes require strong city leadership to implement multisectoral, health-relevant policies and public services that engage communities. The response to malaria must be an integral part of such policies and processes. This framework supports the control and elimination of malaria in urban environments. It provides guidance for city leaders, health programmes and urban planners as they respond to the challenges of rapid urbanization in a targeted way. For each urban context, the strategic use of data can inform effective, tailored responses and help build resilience against the threat of malaria and other vector-borne diseases.