Malaria control in Africa: progress, challenges and prospects, in-depth analysis of the African Union 2023 Progress Report

Author:

Christian Djoko

Article Type:

Article Number: 8

This article summarizes the key points of the African Union Malaria Progress Report 2023, produced by the African Union Commission, the African Leaders Malaria Alliance (ALMA) and the RBM Partnership for Malaria Elimination. Despite the progress made, much remains to be done to reverse the trend significantly and sustainably in the fight against malaria and neglected tropical diseases (NTDs).

Introduction

The latest World Malaria Report from the World Health Organization (WHO) reveals a worrying situation. Globally, malaria cases have increased in 2022 compared to the 2019 pre-pandemic period, reaching nearly 249 million cases. Malaria-related deaths have also surpassed 2019 levels, with 608,000 deaths in 2022, which is 32,000 more than in 2019. Although global malaria incidence remains slightly higher compared to 2019, global malaria mortality remains slightly higher (for a detailed exploration of this report, see our article at this address).

 

The situation has particularly deteriorated in sub-Saharan Africa, with a significant increase in the number of malaria cases between 2019 and 2022, reaching 233 million. The African region as a whole is not progressing favorably towards the Global Technical Strategy 2025 targets, showing respective deviations of 52% and 50% from established targets. Service interruptions during the COVID-19 pandemic and other humanitarian emergencies are identified as contributing factors to this deterioration.

 

Figure 1: Malaria data and trends in the Africa region

Source : Regional data and trends briefing kit. World Malaria Report 2023

 

The African Union (AU) has made the fight against malaria a priority and publishes an annual progress report. The 2023 report, the sixth in this series, is distinguished by an in-depth analysis that takes a close look at the current situation while also considering future prospects.

 

Progress and obstacles in the battle against malaria: a tango

 

According to the AU report, although significant progress has been made in the fight against malaria in Africa, the persistence of challenges such as the high burden of the disease, the emergence of new vectors and the need to strengthen health systems underline the importance of continuous, coordinated and innovative action to make progress towards eliminating malaria on the continent.

 

Progress made:

The main progress or gains achieved lie in the integration of new products in the fight against malaria, which broaden the options available to countries:

1. Vector control: In 2023, WHO approved the preferential use of pyrethroid-chlorfenapyr-impregnated mosquito nets, which are 43% more effective than pyrethroids alone, and retain 40% efficacy after three years. Member States have considerably extended the use of PBO and pyrethroid-chlorfenapyr-impregnated nets to protect vulnerable populations.
2. New malaria treatments: By the end of 2022, WHO has approved the use of artesunate-pyronaridine for the treatment of uncomplicated malaria. Countries are acquiring and deploying it as a complement to existing combination therapies.
3. Vaccine rescue: In October 2023, WHO recommended a second vaccine, R21/Matrix-M, for the prevention of malaria in children. Both vaccines, R21 and RTS,S, are safe and effective in children. Limited resources require strategic vaccine selection based on product characteristics, programmatic needs, ability to scale up, and long-term accessibility. To date, Gavi has approved deployment support for the RTS,S vaccine in 18 of the 28 member states that have requested it.

 

Ongoing challenges:

The report highlights several major challenges in the fight against malaria in Africa. Firstly, it highlights growing resistance to insecticides (35 member states face resistance to three or four classes of insecticide) and antimalarial drugs, compromising the effectiveness of vector control methods and delaying the elimination of parasites from patients. In addition, it highlights the lack of adequate funding to combat malaria, with significant budget deficits in many African countries. The financial crisis and the rising cost of essential products and interventions contribute to these funding shortfalls.” In 2022, domestic funding for malaria increased by $300 million USD amongst Member States. However, Member States continue to rely on donor funding with 70% of malaria resources coming from external funders.” (page 2).

 

The report also highlights the impact of climate change on the fight against malaria, with the African population disproportionately exposed to the effects of climate change. In 2022, 110 million of the continent’s inhabitants were affected, representing 60% of the global total, even though Africa contributes just 10% of global carbon emissions. A hotter, more humid climate favors the development of parasites and mosquitoes, increasing the risk of malaria for millions of people. Finally, the report highlights human resource constraints and the impact of humanitarian crises (between 2019 and 2022, 41 countries experienced humanitarian crises, affecting 169 million Africans) on the fight against malaria. Shortages of skilled personnel limit the scale-up of interventions and surveillance, while humanitarian crises disrupt access to health services and vector control campaigns.

 

The growing use of digital data: a game changer

 

The report highlights advances in the use of digital data to step up the fight against malaria in Africa. By improving data management, digitization fosters more effective action, greater accountability and an integrated approach, thus contributing to the elimination of malaria and the improvement of public health on the continent. The increasing digitization of health data provides greater access to real-time information, essential for monitoring the effectiveness of interventions and making informed decisions. This data facilitates the resolution of malaria-related operational challenges, the prioritization of actions, and strengthens the accountability of malaria control programs. The use of real-time data and mapping tools enables targeted action, promoting significant progress in reducing the disease burden. The digitization of data is part of a broader framework aimed at strengthening the resilience of health systems, promoting universal health coverage, and fostering an integrated approach within the Humanitarian – Development – Peace Nexus, details of which will be announced at the AU 2024 Summit, aimed at harmonizing digitization efforts to improve the coordination and implementation of malaria control interventions.

 

A symphony of initiatives

 

Finally, the AU report highlights the importance of political advocacy, concerted action and resource mobilization in strengthening the fight against malaria in Africa. Initiatives such as the “Zero Malaria Starts with Me” campaign launched in 2018 aim to mainstream the fight against malaria across all sectors, with a focus on keeping it among national priorities, increasing domestic funding, and community engagement. High-level advocacy events in 2023 sought to raise awareness among political leaders and mobilize crucial financial support. National councils for the elimination of malaria and neglected tropical diseases (NTDs) were set up in several countries to foster advocacy, action and resource mobilization. Regional coordination, notably through meetings of African Leaders Malaria Alliance (ALMA) and other partners, assesses country progress and provides a platform for advocating increased domestic resources. Cross-border cooperation strengthens planning, shares best practice, solves common challenges and improves access for vulnerable populations. In short, these initiatives would contribute to a more integrated and effective approach to achieving the goals of eliminating malaria and reducing the burden of NTDs on the continent.

 

Outlook and recommendations for accelerating progress

 

In reviewing this report, many suggestions emerge for stepping up progress in the fight against malaria, including:

• Increase domestic funding for malaria control. By way of illustration, the budget allocated by Cameroon’s Ministry of Health to the fight against malaria represented 2% for the years 2019 and 2020, and decreased to 1% in 2021. This reduction has resulted in the inability to carry out certain activities;
• Invest in research and development of new malaria control tools;
• Strengthen health systems to better diagnose and treat malaria;
• Strengthen the commitment of communities and civil society organizations. (Read our article on this subject);
• Implement a global registration system for vector control products, integrating WHO collaborative procedures and a harmonized regional approach, while building the capacity of national regulatory authorities;
• Integrate the fight against malaria into efforts to combat climate change;
• Ratify the Treaty establishing the African Medicines Agency (AMA), thereby improving access to safe, effective, quality medical products on the continent.
• Significantly increase local production of medicines and vaccines to ensure their accessibility and affordability, and boost the continent’s economic development and sustainability.

 

Is there cause for optimism?

 

This report, while instructive, raises the question of whether it will really spur African states to realize the urgency of the situation and act accordingly. Would this mean a significant increase in national investment in health in general, and in the fight against malaria in particular? What happens to the commitments made in the Abuja Declaration (2001), the ALM Declaration (2019) and the Parliamentarians’ Working Group on Domestic Resource Mobilization for Health in Africa, discussed at the African Union summit in 2023?