Health ministers and senior officials from malaria-endemic African countries called today for intensified action to counter antimalarial drug resistance – a growing challenge that threatens to undermine hard-won progress against one of Africa's deadliest diseases.
Meeting on the margins of the Seventy-eighth World Health Assembly, the high-level gathering turned a spotlight on the urgent need for coordinated action to contain the spread of resistance to frontline malaria medicines.
"Antimalarial drug resistance is a threat to every community on this continent, noted Dr Sabin Nsanzimana, Minister of Health of Rwanda. "It demands a shared response, rooted in science, solidarity and speed."
Led by the Government of Rwanda, the side event brought together a powerful coalition of co-hosts, including Eritrea, Ethiopia, Namibia, South Sudan, Uganda, the United Republic of Tanzania and Zambia. Supporting partners included World Health Organization (WHO), Medicines for Malaria Venture (MMV), the RBM Partnership to End Malaria and Africa Centres for Disease Control and Prevention (Africa CDC).
A race against time to preserve life-saving malaria treatments
Containing antimalarial drug resistance is a critical public health priority – particularly in the African Region, which shoulders 95% of the global malaria burden. According to WHO's latest World malaria report , 4 East African countries – Eritrea, Rwanda, Uganda and the United Republic of Tanzania – have confirmed the presence of partial resistance to artemisinin, the core compound of the most effective treatments for P. falciparum malaria. Resistance is also suspected in other countries, including Ethiopia, Namibia, Sudan and Zambia.
Drug resistance has been driven by several factors, such as the use of substandard or counterfeit medicines and treatment regimens that are not followed to completion. Protecting the efficacy of artemisinin-based antimalarial drugs is now a race against time. With heavy dependence on artemisinin-based combination therapies (ACTs) in Africa, full-blown treatment failure could have very serious consequences.
In 2022, WHO released a dedicated strategy to confront antimalarial drug resistance in Africa. It reinforces the critical need for close collaboration with National Malaria Programmes, research institutions, and other partners to map the presence of antimalarial drug resistance, monitor drug efficacy and ensure patient access to effective treatments.
"Drug resistance is a growing threat that demands urgent, collective action," said Dr Daniel Ngamije, Director of the WHO Global Malaria Programme. "We must act decisively and in solidarity to preserve the tools we have and to ensure access to effective – treatments for all in need."
Urgent need to diversify malaria treatment options
In most malaria-endemic countries in Africa, artemether-lumefantrine (AL) accounts for more than 80% of the malaria treatment market in the public sector. To protect efficacy of AL and other artemisinin-based therapies, WHO has called for diversification of currently used ACTs (see box below). One approach is the use of multiple first-line therapies , which could reduce drug pressure and delay resistance. Next-generation therapies may include triple ACT combinations or non-artemisinin-based drugs.
However, some alternative ACTs with favorable safety and efficacy profiles are more expensive than AL, placing them out of reach for many endemic countries. Innovation must not only deliver next-generation treatments but also ensure they are accessible and affordable.
"Innovation is critical in the fight against drug resistance," said Dr Martin Fitchet, CEO of MMV. "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."
Together with countries and other partners, global funders are working to expand access to alternative treatments and bolster efforts to detect and mitigate resistance. In a joint donor statement issued in September 2024, the Gates Foundation, the Global Fund, UNITAID and the U.S. President's Malaria Initiative noted that time is of the essence:
"It's all too easy with a sweeping problem like resistance to only wake up to the scale of it too late," notes Peter Sands, Executive Director of the Global Fund and a panelist in today's discussion.
WHO-recommended artemisinin-based combination therapies ACTs combine an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a partner drug. The role of the artemisinin compound is to reduce the number of parasites during the first 3 days of treatment, while the role of the partner drug is to eliminate the remaining parasites and cure the infection. WHO currently recommends 6 ACTs as first and second-line treatment for uncomplicated P. falciparum malaria: ● artemether-lumefantrine (AL) ● artesunate-amodiaquine (AS-AQ) ● artesunate-mefloquine (AS-MQ) ● artesunate-pyronaridine (AS-PY) ● artesunate+sulfadoxine-pyrimethamine (AS+SP) ● dihydroartemisinin-piperaquine (DHA-PPQ) |
Momentum builds for national action on antimalarial drug resistance
Panelists in today's discussion echoed the commitments of the 2024 Yaoundé Declaration for strong leadership in malaria-endemic countries, greater regional collaboration and sustained support from global partners. These actions will not only help to accelerate reductions in malaria mortality, but also contribute towards curbing drug resistance.
Many speakers recognized the urgent need for robust surveillance systems and timely sharing of data on drug-resistant malaria. As Professor Dyann Wirth, Chair of the WHO Malaria Advisory Policy Group, noted:
"Data needs to be shared in a timely way so that researchers share it with policymakers – and then policymakers are able to use that data to make decisions."
Health leaders also called for more predictable, sustainable financing to close critical gaps in health services and surveillance – including through increased domestic resource mobilization and continued support from international partners.
Stepping up collective action, aligned with country priorities
To bolster country-driven efforts, coordinated support from global partners is vital. The "Big Push" initiative is bringing together governments, communities and other partners in a shared effort to revitalize malaria control.
"The Big Push represents a new era of partnership – one that is country-driven and community-led," said Dr Michael Charles, CEO of the RBM Partnership to End Malaria.
The Big Push calls for a clear accountability mechanism and increased investment in malaria responses. It further highlights the critical role of data-driven decision-making, resilient primary health care systems and meaningful community engagement.
