A test of Africa’s Health Security and Sovereignty – Africa CDC

By H.E. Dr. Jean Kaseya, Director General, Africa CDC

As Africa marks World Malaria Day 2026, one fact remains inescapable: malaria continues to impose one of the heaviest and most avoidable burdens on the continent. In 2024, Africa accounted for an estimated 270.8 million malaria cases and nearly 600 000 deaths, representing 96% of global cases and 97% of global malaria deaths. ¹ Children under 5 years of age and pregnant women remain the most affected. ¹ Malaria is therefore not only a health problem. It is a direct constraint on Africa’s development, weakening human capital, reducing productivity, deepening poverty, and slowing progress towards attainment of Agenda 2063 and universal health coverage. ¹^,²

Over the past two decades, the scale-up of insecticide-treated nets, indoor residual spraying, rapid diagnostic testing, artemisinin-based combination therapy, seasonal malaria chemoprevention, malaria vaccine, and stronger community-level delivery has saved millions of lives.¹ A small number of African Union (AU) member states have successfully achieved malaria-free certification, while others have shown that transmission can be pushed to very low levels through strong surveillance, vector control, targeted strategies, and sustained political commitment.¹ These examples confirm an essential point: malaria outcomes are not determined by geography alone. They are rather shaped by leadership, implementation quality, accountability, and investment.

Despite some progress observed in AU member states, progress remains fragile. Recent epidemiologic reports from Africa CDC indicate that malaria is upsurging and progress towards meeting global malaria elimination targets remains an unfinished agenda, underscoring the need for sustained, innovative actions.¹ Artemisinin partial resistance has now been documented in several African settings, raising concern for the long-term effectiveness of first-line treatment.⁴ Insecticide resistance continues to erode the impact of the continent’s principal vector control tools, requiring stronger monitoring and more adaptive deployment of next-generation interventions.⁵ Climate change is further compounding the challenge by altering vector habitats, extending transmission seasons, and increasing the frequency of floods, droughts, and other environmental shocks that amplify outbreaks.⁶ These pressures are interacting with humanitarian crises, population movement, and financing gaps. Malaria is becoming more complex, not less.

This changing epidemiology exposes the weakness in the current response. The principal challenge is no longer the availability of commodities only, it is the strength of the systems through which those commodities are delivered. The relevant question is whether countries can deploy prevention, diagnosis, treatment, surveillance, and response rapidly, precisely, and equitably enough to match the resurgent epidemiology of malaria in Africa. This is why malaria must now be treated as a defining test of Africa’s Health Security and Sovereignty (AHSS) agenda. A continent cannot claim health sovereignty while a preventable and treatable disease continues to kill hundreds of thousands of its people every year. Malaria control and elimination are inseparable from stronger public health institutions, resilient and digitally enabled primary health care (PHC) systems, effective surveillance systems powered by stronger laboratory systems, commodity security at the last mile enabled by local manufacturing and pooled procurement, and more predictable, domestic, and innovative financing. ³

Africa CDC aims to further strengthen its leadership on malaria control across the continent as it moves toward the 2030 malaria elimination goals through five key actions. First, mobilizing high-level political commitment from African leaders is essential. Africa CDC is uniquely positioned to serve as a convening and coordinating body, rallying political leaders to support this effort. Advocating for high-level political support to help countries turn continental and global strategies into consistent, locally adapted actions under African leadership is crucial.

Second, strengthening evidence generation on the determinants of malaria resurgence and the underlying drivers of stagnation in the malaria response across Africa is essential. This includes deepening understanding of emerging threats such as artemisinin partial resistance, shifting transmission patterns linked to climate variability and change, the effects of conflict and insecurity on service delivery, and the broader implications of health system constraints, including workforce capacity, supply chain reliability, and surveillance performance. Such evidence should be generated through coordinated, multidisciplinary approaches that combine routine programme data, research, and advanced analytics. Equally important is ensuring that this knowledge is translated into actionable insights that are tailored to diverse epidemiological and health system contexts across countries and subnational settings. By grounding decision-making in robust, context-specific evidence, countries and partners will be better positioned to design differentiated strategies, prioritize interventions more effectively, and adapt responses in a timely manner, ultimately strengthening the impact and sustainability of malaria control and elimination efforts across the continent.

Third, coordination of malaria response efforts across the continent is critical. Africa already has a model to learn from. In response to mpox, Africa CDC and WHO co-led an Incident Management Support Team (IMST) that aligned countries and partners under a single framework. The value of that model was not merely technical coordination. It was the discipline it brought to execution, accountability, and adaptation across multiple countries. The same approach is now being applied in the continental cholera response, which builds on the mpox IMST under the “4-One” principle: one team, one plan, one budget, and one monitoring and evaluation framework. This model has enabled stronger coherence, faster decision-making, and clearer accountability across Member States and partners. Leveraging IMST’s experience, Africa CDC is establishing the African Malaria Response Acceleration Taskforce (AMRAT) to speed up implementation, strengthen accountability, and improve results. AMRAT will review epidemiological and operational performance data, identify persistent bottlenecks, support stratified deployment of interventions, monitor drug and insecticide resistance, strengthen cross-border coordination, and elevate priority implementation issues that require technical or political action. Its value lies precisely in its complementarity; AMRAT will add value by accelerating strategy implementation under country leadership and partners’ support.

Fourth, Africa CDC plans to further bridge the gap between strategy and the implementation of proven malaria prevention and control interventions by mobilizing community-based systems. Harnessing the deployment of the remaining 1 million community health workers (CHWs), out of the 2 million target set by the African Union, Africa CDC will guide Member States to specifically leverage polyvalent CHWs to improve malaria prevention and control program efficiency, timely course correction, coherent use of data, strengthened district-level performance management, and the effective translation of technical guidance into measurable outcomes. Digitally enabled, epidemic ready, and climate resilient PHC systems that empowers CHWs will form the backbone of accelerated malaria control and elimination, by anchored delivery of integrated package of malaria prevention, quality case management and surveillance tailored to local epidemiology and using a One Health approach. A transformed PHC system also provides the most practical platform for integrating effective malaria interventions with maternal and child health, nutrition, immunization, water and sanitation, environmental and community health systems. ⁷^,⁸

Fifth, the availability and accessibility of malaria prevention and control commodities through the Africa Pooled Procurement Mechanism (APPM) is indispensable. The expansion of local manufacturing and the establishment of reliable markets for malaria commodities through the APPM are pivotal. This initiative to advocate for the local manufacturing of malaria prevention and control commodities has begun to bear fruit, as demonstrated by the production of bed nets in Angola. Africa CDC is also partnering with Medicines for Malaria Venture (MMV) to promote access to antimalarial drugs.

Malaria elimination by 2030 cannot be achieved through aspiration alone. It requires African political ownership, evidence-informed decisions, stronger community-based systems, coordinated efforts, and investments in local manufacturing and ensuring access to malaria commodities. Africa has reached a point at which malaria can no longer be managed as routine business. It must be confronted as a continental priority, with the urgency, discipline, and political seriousness that health security demands. If Africa is to lead its own public health future, then ending malaria must be part of that leadership. What is required now is concerted action. Malaria has taken enough from Africa. It is time for Africa to end malaria.

References

1. World Health Organization. World malaria report 2025. Geneva: WHO, 2025.
2. African Union Commission. Agenda 2063: The Africa We Want. Addis Ababa: AUC, 2015.
3. Africa Centres for Disease Control and Prevention. Africa’s Health Security and Sovereignty Agenda. Addis Ababa: Africa CDC, 2025.
4. Rosenthal PJ, Asua V, Bailey JA, et al. The emergence of artemisinin partial resistance in Africa: how do we respond? Lancet Infect Dis 2024; 24:590-600.
5. Oxborough RM, Chilito KLF, Tokponnon F, et al. Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance. Lancet Planet Health 2024;8: e610-e620.
6. Kaseya J, Dereje N, Tajudeen R, Ngongo AN, Ndembi N, Fallah MP. Climate change and malaria, dengue and cholera outbreaks in Africa: a call for concerted actions. BMJ Glob Health 2024;9: e015370.
7. World Health Organization, UNICEF. Declaration of Astana. Geneva: WHO and UNICEF, 2018.
8. World Health Organization. Primary health care on the road to universal health coverage: 2023 monitoring report. Geneva: WHO, 2023.