African leaders have warned that the world is facing the “biggest malaria emergency” of the past two decades.
Heads of state and experts came together in a show of unity to call for urgent action on malaria at the UN general assembly on Friday, saying progress on eradicating the disease faced serious setbacks from mosquitoes’ growing resistance to insecticides, and the decreased effectiveness of antimalarial drugs and diagnostic tests.
“We are at a critical juncture,” Guinea-Bissau’s president, Umaro Sissoco Embaló, said on the sidelines of the assembly. “If we don’t act swiftly … we will undoubtedly see malaria upsurges and epidemics.”
The number of people living with malaria in Africa has decreased steadily for nearly two decades, but funding for the disease plateaued in 2015 amid donor fatigue and the later redirection of funding to other health priorities, such as Covid-19.
“Now is the time to fully finance the malaria fight to ensure that we eliminate the disease once and for all,” said Embaló.
Progress on malaria had been reversed in at least 13 countries and had stalled in others, the World Health Organization said last month. Leaders have warned that funding shortfalls were placing lifesaving malaria treatments out of reach of many people at risk, threatening plans to eradicate the disease by 2030.
Julio Rakotonirina, the director of health and humanitarian affairs at the African Union Commission, said: “We need to ensure that we sustain our political commitment and continue to translate these commitments into concrete action. With most AU member states off-track to achieve the goal of eliminating malaria by 2030, much still needs to be done.”
Africa bears the highest burden of malaria cases globally, and accounts for 96% of deaths from the disease, according to 2021 data. Nearly 80% of those deaths are in children under the age of five.
As attention paid to the disease has waned, threats such as the climate crisis have added to the problem, experts say. Higher temperatures and rainfall create perfect breeding conditions for mosquitoes.
The increasing frequency of extreme weather events, such as flooding and cyclones, across the continent in recent years further raises the likelihood of mosquito-borne diseases.
Mozambique, for instance, witnessed spikes in malaria after Cyclone Freddy earlier this year, and such disasters make it harder for medication and services to reach affected areas.
“It’s a vicious cycle that we have to overcome,” said Dr Michael Adekunle Charles, the head of the RBM Partnership to End Malaria, a global platform for coordinated action against the disease.
“If we don’t continue making the connection [on climate-related risks to health], then we are going to lose a lot of ground in the fight against malaria.”
Malaria vaccines such as RTS,S/AS01 are being gradually rolled out across the continent. Experts have warned that while the vaccines were a significant breakthrough, they were not a “silver bullet” that would end malaria and there should be no letup in other measures to curb the disease.
Treated bednets, for instance, have been the most effective malaria prevention strategy since their introduction in the early 90s, preventing about 68% of cases in sub-Saharan Africa. However, their effectiveness can wane over time due to growing mosquito resistance.
“The mosquito is always evolving, so we need to get ahead of it. If we don’t, it will outsmart us,” said Charles.
The group of leaders at the UN called for the establishment of national malaria councils to keep the disease on countries’ development priorities, and for extra funding from the World Bank to tackle malaria.
