How do you solve a serious problem like the malaria scourge in Africa?
A production plant for malaria and HIV test kits in Nigeria’s Ogun State, which aims to fill the gap left by US funding cuts. PHOTO | FILE
By Olivias Ndubuisi
In the 38th week of Adaugo Adebimpe’s pregnancy, she went to the hospital feeling ill. Her delivery was in two weeks and she thought her blood pressure was acting up again. Instead, doctors told her she had malaria, the fourth diagnosis during her pregnancy.
“I took the prophylaxis twice and yet I had malaria four times during my pregnancy,” she told The New Humanitarian. “I know I live in Africa and malaria is endemic, but four times in one pregnancy is a lot.”
Her family and doctors in the Nigerian city of Ibadan worried throughout her pregnancy – with good reason. Pregnant women are three to five times more likely to die from severe malaria than non-pregnant women, and 80 percent of all malaria deaths globally happen to children under five.
Adebimpe’s experience reflects a broader reality across much of Africa, where malaria remains one of the continent’s deadliest diseases.
World Malaria Day on 25 April aims to flag the progress that has been made against the disease. Between 2000 and 2024, the number of malaria-endemic countries fell from 108 to 80, and an estimated 14 million deaths were averted.
But these gains are extremely fragile. According to the World Health Organization’s World Malaria Report 2025, there were 282 million cases worldwide in 2025 – an 11 million increase from the previous year – and 627,000 deaths.
Africa accounted for 94 percent of cases and 95 percent of all deaths. The Democratic Republic of the Congo, Mozambique, Niger, Nigeria, and Uganda contributed to more than half of the global cases. Nigeria carries the world’s highest infection burden.
The WHO has set an ambitious target of eliminating malaria in at least 35 endemic countries by 2030 and reducing mortality rates by 90 percent. The African Leaders Malaria Alliance (ALMA) has also endorsed those goals.
But owing to aid funding cuts, growing mosquito resistance to treatments and insecticides, and the impact of conflict in some of the worst-affected countries, these look increasingly like over-ambitious goals.
The 2025 malaria report points out that the financing gap for malaria action has nearly doubled. US funding cuts have hit African public health systems especially hard, with the dismantling of USAID – a key global health financier – undoing decades of progress, potentially causing hundreds of thousands of avoidable deaths.
A slowdown isn’t like a break that can be un-paused when funding becomes available again – it has long-term effects on health systems. The burden of malaria also has a tremendous economic impact across the continent.
Lack of money is only part of the malaria struggle. Scientists have warned for years that malaria parasites and mosquitoes – the vectors of the disease – were adapting to standard interventions. Partial resistance to artemisinin-based combination therapies, or ACTs – a frontline treatment – has been confirmed in four African countries (Eritrea, Rwanda, Tanzania, and Uganda) and is spreading.
Partial resistance does not mean the drugs have stopped working altogether, as happened with chloroquine. But it does mean treatment is taking longer – a worrying development in places where patients may already struggle to complete a full course of medication, which in itself is a significant driver of resistance.
The last time Osato Edokpayi had malaria, he thought he might die. He spent the night in an Abuja hospital gripped by violent shivering, sweating – and fear. He was so certain he might not survive that he texted his best friend his bank details and passwords.
“ I’d never felt anything like that in my life. It genuinely felt like I wasn’t going to make it to morning,” he explained. “ That was a new dimension in my getting malaria and it was an incredibly scary dimension.”
Although no formal confirmation of ACT resistance has been made where Edokpayi lives, he says many people around him believe their experiences are worsening: Symptoms feel more severe, recovery takes longer, and some cases now lead to hospitalisation in situations where earlier treatment might once have worked.
Even basic mosquito repellants don’t seem to work as before.
Olivia Ndubuisi is a science journalist based in New York
“I was buying insecticide the other day and I asked the shop attendant which one would work best, and they pointed to one they said was pretty harsh and would get the job done,” recounted Edokpayi.
“I sprayed it around the house, took a walk, came back, and there were still mosquitoes,” he said. “This isn’t my experience alone. Everyone says the same thing. It feels like something is wrong.”
“The current tools we have are not effective. They have done their best, but the mosquitoes have evolved mechanisms to evade them.”
Martin Lukindu, a post-doctoral research entomologist on the Target Malaria project in the Ugandan Virus Research Institute studies resistance. “The current tools we have are not effective,” he told The New Humanitarian. “They have done their best, but the mosquitoes have evolved mechanisms to evade them.”
The Target Malaria project is working on new approaches, including gene technology, which researchers hope could help suppress mosquito populations or reduce their ability to transmit malaria.
The WHO also points to the rollout of new malaria vaccines in 25 countries – which could save millions of children’s lives – and a new generation of insecticide-treated bed nets.
But such work is costly and depends on steady investment. “If you look at the Western world, they have really invested a lot of money in just gaining that knowledge,” said Lukindu. “But when it comes to our countries, probably we have not, and as you know research is expensive.”
Access to populations in need is also key. Conflict and social upheaval blocks prevention, control, and treatment programmes.
In South Sudan, where fighting and displacement is a barrier to care, malaria remains one of the leading causes of illness and death. According to the WHO, it accounts for around 67 percent of all reported disease cases and half of all deaths in the country.
The stakes are incredibly high. If resistance spreads, the African continent could face 16 million more cases annually and 80,000 additional deaths, notes the WHO. Yet with the current assault on funding, coupled with a plateau in progress, it seems a perfect storm is brewing in malaria eradication efforts.
African governments need to be part of the solution
For Christian Happi, adjunct professor of infectious diseases at Harvard University, and director of the Institute of Genomics and Public Health at Redeemers University in Nigeria, part of the problem is that African countries are not pulling their weight.
“ It’s not just the responsibility of outside donors. I think our governments need to take full responsibility,” he told The New Humanitarian. “Countries used to make their healthcare plan and budget taking into account that aid was coming, but they never took responsibility a hundred percent.”
Kayode Tolulope, a malaria researcher at the University of Notre Dame in the US, agrees. He believes that Nigeria, for example, should be taking far more of a lead given that it carries the world’s heaviest malaria burden. Domestic financing for malaria research should be a national priority, he noted.
But climate change is also shifting the disease burden. Tolulope’s research is finding that mosquitoes are becoming present in cold, high-altitude regions and people are testing positive for malaria where it was previously assumed to not be possible, such as the Horn of Africa.
It could also re-emerge in areas where malaria has been beaten. “Right now malaria is not a thing for the US, but I think it might be very soon with climate change and global warming,” he noted.
Yet with the tools and resources available today, WHO believes nobody should be dying from malaria.
Tolulope agrees – but with reservations. “The problem of malaria is solvable, but a lot of the moving parts need to come together,” he said. “It will be difficult, but the countries that have got there are proof of concept. It can be solved, but not without heightened local funding and collaboration.”
The WHO’s goal of eliminating malaria in at least 35 countries by 2030 was set in 2015. What seemed potentially feasible then has not worn well.
“What we require right now is holistic, high-level funding to support and sustain all those efforts,” said Happi.
Even then, he estimates such an endeavour would take 25 years – another generation at least – before the threat of malaria ceases to be a present danger.
Olivia Ndubuisi is a science journalist based in New York
