Year after year, hundreds of thousands of lives in Africa are lost to malaria--a preventable and treatable disease.
As the region hardest hit by malaria, the stakes are high. In March, ministers of health from 11 countries with the highest malaria burden on the continent met in Yaoundé, Cameroon, and committed to accelerating malaria mortality reduction.
They made a declaration-- "No-one shall die from malaria". Such a declaration requires new thinking about the best way to drive down the malaria burden.
Despite tremendous strides made in the fight against malaria over the past two decades, progress has stalled. Africa saw a rise in cases, with numbers climbing from 218 million in 2019 to 233 million in 2022.
"Blanket approaches spread precious resources too thin, leaving high-risk areas vulnerable and low-risk areas with tools that could be better used in other locations. "Cynthia Mwase, Director Health, Africa, at the Bill & Melinda Gates Foundation
In the face of threats including insecticide resistance, along with plateauing funding for the malaria fight, we must be more strategic in our use of current and future tools.
Now, countries across the continent are embracing a new approach--one that uses high-quality data to select the optimal combination of tools for a local setting. These strategies help countries maximize the impact of limited resources to put Africa on an accelerated path to ending malaria for good.
Malaria transmission varies considerably across the continent and within countries. Consider Mozambique, a country ranked among the top four globally for malaria cases and deaths. In the northern provinces, malaria prevalence soars up to 57 per cent. Conversely, the southern part of the country is on a path to malaria elimination, with only one per cent prevalence.
This striking contrast within a single nation underscores the critical need to tailor interventions based on the local setting. Blanket approaches spread precious resources too thin, leaving high-risk areas vulnerable and low-risk areas with tools that could be better used in other locations.
Tailored strategies use timely, accurate data on everything from malaria incidence to rainfall to mosquito populations to pinpoint the most effective combination of tools based on local conditions. This is the spirit of the Yaoundé Declaration's call for "strategic use of information for action."
Kenya, Mozambique, Tanzania, and Nigeria are the four countries leading this charge. These countries are employing sophisticated, data-driven strategies to determine the most suitable mix of tools such as treated bed nets, insecticide spraying, and vaccines for each district, rapidly driving down the malaria burden in their respective countries.
Notably, Kenya was an early innovator in utilizing subnational data to tailor interventions effectively.
Tanzania's National Malaria Control Programme was an early adopter of an approach that uses data, including mathematical models to tailor the mix of tools for local contexts, which has informed its country-wide malaria strategy.
Mozambique has adopted the use of integrated surveillance technology. Through the Malaria Atlas Project, which uses genomics data, the country is blending routine malaria case data from the health system with point-in-time prevalence surveys to create granular maps of malaria risk and account for seasonal variability. The results speak for themselves--due to scaling data-driven approaches, malaria prevalence in young children in Mozambique fell by 17 per cent over five years.
Nigeria is currently working to develop a dashboard that simulates the use of a combination of different tools to prevent malaria in different areas of the country. These scenarios are helping the Ministry of Health to make decisions about where the malaria vaccine can have the most impact and regions that should be targeted for rollout.
African science--and African scientists--are at the heart of this transformative approach. Institutions like the International Center for Research and Training in Applied Genomics and Health Surveillance (CIGASS) in Senegal and the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) in Nigeria are using cutting-edge genomic sequencing to identify and understand the patterns of resistance to anti-malarial drugs and insecticides used to control mosquitoes. National malaria control programs then adapt their strategies to respond with the right mix of solutions that will have the highest impact based on those resistance patterns.
Researchers like Susan Rumisha, co-lead of the Malaria Atlas Project in Tanzania, Isabella Oyier Research Scientist at KEMRI - Welcome Trust in Kenya and Ify Aniebo, a senior research scientist focusing on genomic surveillance in Nigeria, are at the helm of developing, deploying, and building capacity for these tailored approaches to combat malaria.
Their leadership and expertise are crucial for Africa's fight against malaria and inspire future generations of scientists--especially female scientists--across the continent.
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Scaling up tailored solutions can put the world on a fast track to malaria eradication, but only if we make eradicating malaria a top priority. The cost of inaction is too high.
Delay breeds resistance, which could cost millions more lives and billions of dollars in economic losses. Drugs and insecticides that once worked may fail, potentially leading to backsliding of progress we've worked hard to achieve over the last 20 years.
Governments in the hardest-hit countries must therefore prioritise localised strategies and invest in the next generation of tools to combat malaria. Donors need to back these solutions financially and the private sector's entrepreneurial solutions must be embraced through innovative partnerships.
From Yaoundé came a bold promise--no more needless malaria deaths. Africa has the ingenuity to fulfil that promise and finally usher in a world where no life is lost to malaria ever again--but we must act fast.
Cynthia Mwase is the Director Health, Africa, at the Bill & Melinda Gates Foundation. She has over 28 years' experience in health delivery, working with both community and global organisations.
This piece was produced by SciDev.Net's Sub-Saharan Africa English desk.
