Increasing challenges of malaria control in sub-Saharan Africa: Priorities for public health research and policymakers

TLDR

Malaria remains a leading public health threat in sub‑Saharan Africa, accounting for about 95 % of global cases and 96 % of deaths, most of which occur in children under five. This review examines the obstacles to malaria control in sub‑Saharan Africa despite ongoing public health interventions. The review identifies rising resistance to artemisinin‑based combination therapies and vector insecticides, a decline in RTS,S vaccine efficacy to 60–70 % after 18 months, and calls for renewed research priorities and increased political and financial investment in vaccine production and distribution.

Abstract

The ever-increasing cases and mortality due to malaria remains one of the most important public health threats, especially in sub-Saharan Africa-where this burden is considerably high. In 2020, sub-Saharan Africa accounted for about 95% of all cases and 96% of all malaria deaths with about 80% of these deaths reported in children under the age of 5. This review, adopting a public health focus, aimed to understand the challenges of malaria control in sub-Saharan Africa despite ongoing public health interventions. Our review highlights two important findings. First, the increasing resistance of malaria parasites to artemisinin-based combination therapy (ACT) and its partner drugs coupled with increased vector resistance to pyrethroids and insecticides is reversing the progress of public health interventions in keeping malaria under control. Second, the wanning for the efficacy of the WHO-approved vaccine i.e. RTS,S from 60 to 70% following 18 months of observation, and its short-term availability remains an impediment to achieving the WHO target of producing malaria vaccines with more than 75% efficacy by 2030. Our findings underline the need to reassess research priorities with a focus on vaccine production in sub-Saharan Africa. Furthermore, African governments and policymakers must be committed to invest both the political and financial capital in vaccine production and distribution.