Malaria Burden Remains High in Sub-Saharan Africa Amidst Progress in Vaccination and New Tools
Introduction
Malaria continues to impose a severe health and economic burden globally, with sub-Saharan Africa accounting for approximately 95% of cases and deaths. According to the World Malaria Report 2025, an estimated 282 million cases and 610,000 deaths occurred in 2024 across 80 countries. Children under five represent about three-quarters of malaria fatalities in Africa, and over half of all deaths in the region are concentrated in Nigeria, the Democratic Republic of Congo, and Niger. Despite notable advances in vaccines and paediatric treatments, the overall trend of rising cases and deaths indicates that progress is stalling.
Main Body
The current epidemiological situation reflects a combination of persistent and emerging pressures. Funding for malaria control has plateaued, while the efficacy of key interventions—such as artemisinin-based combination therapies and insecticide-treated nets—is diminishing due to resistance in parasites and vectors. Climate change is expected to exacerbate transmission, with a study in Nature projecting an additional 123 million cases and up to half a million deaths in Africa by 2050 if adaptation measures are insufficient. Floods, in particular, create standing water that facilitates mosquito breeding and disrupts control programmes, as noted by researchers Tiaan de Jager and Taneshka Kruger. Conflict and mass displacement in the Sahel region further complicate delivery of preventive and curative services. Positive developments have occurred concurrently. In July 2025, Swissmedic approved the first malaria treatment specifically formulated for infants and young children aged two months to five years, addressing a critical gap in paediatric care. Seventeen endemic countries, representing roughly 70% of the global malaria burden, introduced malaria vaccines into routine childhood immunisation programmes in 2024. Two vaccines are currently available: RTS,S, first deployed in a routine programme in Cameroon in January 2024, and R21/Matrix-M, developed by Oxford University and approved by the World Health Organization in October 2023. Early data from Ghana showed an 86% reduction in malaria deaths among children under five following subnational rollout of RTS,S. Mali, which introduced the R21/Matrix-M vaccine in April 2025, adapted its delivery by administering booster doses alongside seasonal malaria chemoprevention campaigns to improve adherence. Dr. Ngozi Erondu, Technical Director at the Global Institute for Disease Elimination, emphasised that while innovation is promising, the primary challenge lies in scaling and sustaining these tools. She noted that cross-border data integration is essential because mosquito populations and transmission patterns do not respect national boundaries. Initiatives such as the Sahel Malaria Elimination Initiative (SaME) have established regional platforms for sharing epidemiological data and coordinating responses. AI-based mosquito identification tools, such as VectorCam piloted in Uganda, can accelerate entomological surveillance by enabling non-specialists to classify species from images or sound recordings. However, Dr. Erondu cautioned that these technologies require local training data, integration into national systems, and investment in human capacity. She also stressed that data quality at the point of care remains a bottleneck, and that surveillance systems should be integrated rather than disease-specific to ensure sustainability. The reliance on external financing—nearly half of sub-Saharan African countries depended on external sources for more than a third of health expenditure in 2021—makes programmes vulnerable to donor fatigue and shifting global priorities. Researchers Taneshka Kruger and Tiaan de Jager argued that prevention is far more cost-effective than treatment, with long-lasting insecticidal nets costing US$4–7 each compared to hundreds of dollars for a single severe malaria case.
Conclusion
The malaria landscape in sub-Saharan Africa is characterised by a paradox: new vaccines, treatments, and digital tools offer unprecedented opportunities to reduce transmission, yet the disease burden is rising due to funding shortfalls, biological resistance, and climate-driven disruptions. Achieving the United Nations target of ending malaria epidemics by 2030 will require sustained investment in health systems, cross-border coordination, and the deliberate scaling of proven interventions alongside emerging innovations. Without such efforts, the current momentum may be insufficient to reverse the upward trend in cases and deaths.