Millions of Lives at Risk as Malaria Resistance Spreads in Africa

A new paper published in the journal Science has sounded the alarm on the rapid spread of drug-resistant malaria in several east African countries, warning that millions of lives could be at risk unless urgent action is taken.

The report reveals that the parasite that causes malaria is showing signs of resistance to artemisinin, the main drug used to fight the disease, in countries such as Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania. In fact, mutations indicating artemisinin-resistance have been found in over 10% of malaria-infected individuals in these countries.

Artemisinin Combination Therapies (ACTs) have been the cornerstone of malaria treatment in recent years, but the report’s authors say that there are worrying signs that they are becoming less effective. “We have increasing reports from eastern Africa saying that they have documented resistance against the first line treatments against malaria,” says report co-author Lorenz von Seidlein of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok.

The consequences of inaction are stark. It’s estimated that over one thousand children die every day from malaria in Africa, and the World Health Organization estimates that the global death toll from malaria in 2022 was 608,000.

The report’s authors are urging policymakers and global funding bodies to act now to prevent artemisinin resistance taking hold. Their recommendations include combining artemisinin drugs with other medicines, rolling out new, more effective insecticides and mosquito nets, better training of community health workers, the rapid deployment of new malaria vaccines, and better monitoring of parasite mutations.

The authors point to the success of similar efforts in Southeast Asia, where a concerted push to halt the spread of artemisinin resistance has been effective. “Ultimately, there was an understanding that this could be a major health emergency globally and so there were a lot of investments from funders for the from high-income countries towards these countries in the Greater Mekong sub-region to stop the spread of artemisinin resistant parasites,” says von Seidlein.

The report’s co-author, Ntuli Kapologwe, the director of preventive services at Tanzania’s Ministry of Health, is calling on funders to step up their support for malaria control and elimination programs in Africa. “We ask funders, specifically the Global Fund to Fight AIDS, Tuberculosis and Malaria [GFATM] and the U.S. Government’s President’s Malaria Initiative, to be visionary and to step up funding for malaria control and elimination programs to contain the spread of artemisinin resistance in Africa — as they have done effectively in Southeast Asia since 2014.”