The Independent Uganda: You get the Truth we Pay the Price
More than 260 million malaria cases and nearly 600,000 deaths were reported in 2023 alone globally
ANALYSIS | PATRICIA AKANKWATSA | Over the past two decades, Africa has made tremendous strides in the fight against malaria. Through the widespread use of insecticide-treated, bed nets (ITNs), rapid diagnostic tests (RDTs), preventive medicines, and, most critically, artemisinin-based combination therapies (ACTs), malaria cases and deaths have been dramatically reduced. These life-saving interventions have transformed communities, saving millions of lives.
Yet today, that progress stands on uncertain ground. In 2023 alone, more than 260 million malaria cases and nearly 600,000 deaths were reported globally—a sharp reminder that gains in malaria control are not only stalling but at risk of slipping into reverse.
At the heart of malaria treatment in Africa lies ACT, introduced in the early 2000s as a game-changer in combating Plasmodium falciparum, the deadliest malaria parasite. Its success has been profound. However, a new and ominous threat is emerging: antimicrobial resistance (AMR).
Antimicrobial resistance is a natural evolutionary process where microorganisms adapt to resist the effects of medicines. In the case of malaria, it is gradually undermining the efficacy of ACTs—Africa’s most relied-upon treatment option.
According to the World Health Organization (WHO), the use of ACTs, which combine two drugs to prevent the development of resistance, has been a cornerstone of malaria control. However, reports of partial resistance to artemisinin—the key component of ACTs—have surfaced in Southeast Asia and are now confirmed in several African countries, including Rwanda, Uganda, Tanzania, and Ethiopia. While this does not yet indicate complete treatment failure, it signals that the drug takes longer to clear the parasite—a worrisome trend.
Higher doses for treatment
Even more troubling are sporadic cases of resistance to the partner drugs in ACTs, requiring higher doses for effective treatment. If these forms of resistance become widespread, they could severely limit treatment options, particularly in Africa, which bears the heaviest malaria burden globally.
While ACTs such as artemether-lumefantrine remain effective for now, the rise in resistance-associated mutations is a clear warning. Data gaps mean that resistance may already be spreading unnoticed in other regions. Some recent studies also show conflicting results regarding the continued effectiveness of artemether-lumefantrine, which is used in 80–90% of malaria cases in Africa—adding urgency to ongoing assessments.
With the pipeline for new malaria drugs often taking years to deliver results, preserving the effectiveness of existing treatments is of paramount importance. Researchers from Imperial College London estimate that widespread artemisinin resistance, coupled with high partner drug resistance, could lead to 16 million additional malaria cases, 360,000 more severe cases, and 80,000 extra deaths each year. The economic toll? An estimated US$1 billion annually.
Amid growing concern, a landmark side event took place on May 20, during the 78th World Health Assembly. Convened by the Government of Rwanda and co-hosted by Eritrea, Ethiopia, Namibia, South Sudan, Uganda, the United Republic of Tanzania, and Zambia, the event underscored Africa’s leadership in confronting this threat head-on.
The gathering also brought together influential global health stakeholders, including the WHO, Medicines for Malaria Venture (MMV), the RBM Partnership to End Malaria, and the Africa Centres for Disease Control and Prevention (Africa CDC). The meeting signaled a unified and proactive commitment from Africa—the region most affected by malaria—to tackle drug resistance with urgency and resolve.
“This coordinated, committed and united call against antimalarial drug resistance comes directly from African leadership,” emphasised Dr. Martin Fitchet, Chief Executive Officer of MMV.
“As a long-standing partner in malaria research and development, MMV is committed to contributing our scientific expertise and access capabilities to this crucial effort.”
This collective stance is a major step forward in localising and implementing the WHO’s global strategy against antimalarial drug resistance. It also highlights the importance of transforming global commitments into concrete regional action plans.
Innovation remains key
The battle against drug-resistant malaria is, at its core, a race against time. Innovation must remain at the forefront of the response.
“Innovation is critical in the fight against drug resistance,” Dr. Fitchet noted. “With our partners, we’re developing next-generation antimalarials that could reach patients by 2027, while acting now to preserve the power of today’s treatments. Both are vital to outpace resistance and keep saving lives.”
MMV, as a leading product development partnership, is playing a vital role in bringing forward new treatments that align with WHO’s four-pillar strategy, including tracking resistance, safeguarding existing therapies, developing next-generation medicines, and strengthening access.
Dr. Daniel Ngamije, Director of the WHO Global Malaria Programme, echoed the urgency:
“Drug resistance is a growing threat that demands urgent, collective action. We must act decisively and in solidarity to preserve the tools we have—and to ensure access to effective malaria treatments for all in need.”
