Resurgence of malaria and artemisinin resistance in Africa requires a concerted response

Abstract

Malaria is one of the leading causes of morbidity and mortality globally, with an estimated 249 million cases and 608,000 deaths in 2022, of which 94% and 95% occurred in Africa, respectively¹. As a result of innovative public health measures, malaria-related mortality in Africa has decreased dramatically, from 808,000 deaths in 2000 to 580,000 in 2022 (ref. ¹). Nine African countries have already eradicated malaria including five North African countries (Egypt, Libya, Tunisia, Algeria and Morocco) and a few sub-Saharan countries (Lesotho, Mauritius, Seychelles and Cabo Verde)². The introduction and scale-up of malaria vaccines could enhance global malaria elimination efforts.

However, in recent years, the continent has faced a resurgence of malaria, alongside the alarming emergence of artemisinin resistance, which threatens to undermine decades of progress. The effectiveness of ongoing malaria prevention programs is threatened by climate change, the emergence of insecticide and drug-resistant strains, and new variants of mosquitos. Emerging and reemerging public health emergencies (such as mpox and Marburg virus outbreaks) and armed conflicts in Africa have worsened malaria program effectiveness by interrupting the continuity of essential health services, distracting political and public health leadership, and requiring the diversion of limited public health resources.