HEALTH OPINION
With the fight against malaria back-sliding, and with mosquitoes adapting to existing tools, Uganda is leading the exploration of new technologies to regain ground.
Over 600,000 people die from malaria every year, with an estimated 76% under 5 years of age. Africa continues to shoulder the heaviest burden of the disease – accounting for an estimated 95% of all malaria cases (234 million) and 96% of all deaths (593,000). At an average of 200,000 new cases per week and 130 deaths per month, Uganda suffers the world’s third-highest malaria burden, which threatens 90% of the country’s population living in endemic areas.
Beyond the human tragedy, a new report details the economic burden on African countries and their people, totalling more than $150 billion up to 2030. In Uganda, the average economic loss due to malaria annually is over $500 million. Tackling malaria would boost the national economy by more than US$4 billion up to 2030.
In addition to lost workdays, decreased productivity and school attendance, a single episode of malaria costs a Ugandan family an average of UGX 33,500 (approx. $9), or 3% of their annual income. Given that many people are infected multiple times a year, this has substantial financial consequences to families. A family in a malaria-endemic area may spend up to 25% of the household income on malaria prevention and treatment. Industries and agricultural activities also suffer due to loss of person-hours and decreased worker productivity. Investors are wary of investing in countries where malaria rates are high, leading to a loss in investment opportunities.
After decades of progress, Uganda’s gains in the fight against malaria are being undermined by several factors. Cases have been on the rise since 2015. Mosquitoes are developing resistance to insecticides, and the malaria parasite is resisting antimalarial drugs. Climate change is adding uncertainty, and resilient mosquitoes are set to change disease prevalence.
Leading malaria scientists recently issued an urgent warning against the rising threat posed by rising drug-resistant malaria spreading across Africa, with millions of lives at risk. With the added threat of climate change, sustainable and resilient malaria responses are needed now more than ever.
As Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, states in the organization’s 2023 report, a changed approach with greater resourcing, data-driven strategies and new tools is needed to regain momentum in the fight against malaria.
In recognition of the importance and urgency of regaining the upper hand in the fight against this deadly disease, global innovators are working around the clock to broaden the malaria-fighting toolkit. New insecticides and drugs are being developed, and vaccines rolled out. In recent weeks, Cote d’Ivoire started rolling out the new R21 vaccine, which is poised to save thousands of lives.
To target disease-spreading mosquitoes, genetic technologies are now becoming a reality. These technologies turn the biology of mosquitoes against themselves and are designed to be highly targeted to the specific kinds of mosquitoes which transmit disease.
Genetic approaches such as this have garnered much attention over recent years, but at least one version is no longer experimental – it has entered the mainstream in the Americas. Friendly™ mosquitoes, developed by the company Oxitec, have been repeatedly tried-and-tested against the dengue-causing mosquito Aedes aegypti in Brazil. This has resulted in a reduction of populations of the mosquito by more than 95% in urban communities, with no recorded harm to people or the environment.
These Friendly™ mosquitoes have now been deployed in Africa, directing the same technology at the urban malaria-causing mosquito, Anopheles stephensi. This invasive species arrived in Djibouti from Asia in 2012 and caused a steep rise in malaria cases, setting the country several years back in the fight against malaria. The Djiboutian government has partnered with Oxitec to conduct pilots against this urban invader in local communities, with the first Friendly™ fliers being released for the first time in May 2024.
In the face of escalating malaria cases, Uganda is embracing the new tools being developed to prevent infections, and to combat the malaria parasite and the mosquitoes that spread it.
Initiatives such as the Uganda Parliamentary Forum on Malaria and the private-public partnership, Malaria Free Uganda, are working to drive engagement and action towards a Uganda free of malaria. Uganda, like Cote d’Ivoire, will be among the first countries to deploy the Malaria Vaccine which, according to the Health Ministry, is set to be rolled out in April 2025.
The Uganda Virus Research Institute is leading, globally, in pioneering new solutions for the country’s most dangerous malaria-spreading mosquito species, through the Target Malaria consortium, and soon through a new partnership with Oxitec. In the latter partnership, UVRI scientists will co-develop a solution from scratch in Uganda to combat Anopheles funestus mosquito – which is spreading malaria even during the dry season and exhibiting resistance to insecticides.
Uganda’s Minister of Health, Dr Jane Ruth Aceng, has previously stated, “We need to bolster investment in research and development, innovation and manufacturing of health tools to address the wide spectrum of diseases that threaten us.” As the numbers testify, new tools are urgently needed to make malaria history and Uganda is leading the way.
The Author Dr. Banoba Florence is a Medical Doctor and Medical Policy Consultant