Robust health systems could stem climate-related rising cases of malaria

Over the past few decades, remarkable strides have been made to end Africa’s malaria burden. Frontline tools, including insecticide-treated bed nets (ITNs) and artemisinin-based combination therapies (ACTs), have played significant roles in saving countless lives by reducing deaths and curbing the spread of the disease over the past two decades.

Between 2000 and 2021, over 11 million deaths and two billion malaria cases were averted, mostly in the African region, through concerted efforts and the implementation of these frontline tools. However, decreased effectiveness of tools, the challenge of climate change, and poor health systems continue to make malaria a threat to the lives of millions of people in Africa, the region that bears the brunt of a gendered disease.

Pregnant women and children under five are the most at risk.Science has proven that rising temperatures create favourable conditions for the increase in malaria-carrying mosquitoes, which thrive in warm environments.

As temperatures increase, their reproduction rates accelerate. Thus, extended seasons of warmth prolong the breeding period, allowing mosquitoes to multiply rapidly, leading to a surge in malaria transmission.

Additionally, higher temperatures accelerate the development of the malaria parasite within mosquitoes. This results in the expanded geographic range of malaria, and regions that were once considered low-risk are now more susceptible.

Altered rainfall patterns resulting from climate change contribute to increased mosquito breeding sites. Areas experiencing increased rainfall may witness the creation of stagnant water bodies, which serve as breeding grounds for mosquitoes.

Conversely, areas affected by prolonged droughts may see a decline in mosquito populations. However, when rain falls after a drought, the sudden availability of water can trigger a rapid increase in mosquito populations, leading to malaria outbreaks.

These unpredictable shifts in rainfall patterns disrupt traditional malaria control measures, necessitating adaptive strategies to mitigate the disease’s impact.
At a webinar on Ending Malaria series hosted by the African Institute of Development Policy (AFIDEP)’s Platform for Dialogue and Action on Health Technologies in Africa (Health Tech Platform), recently, Dr James Chirombo, Biostatistician at the Malawi Liverpool Wellcome Programme, argued that it is important for countries to understand local climate patterns and variations, as well as the aftermath of extreme weather events and incorporate climate data in malaria control and elimination efforts.

The Platform for Dialogue and Action on Health Technologies in Africa (Health Tech Platform) is an initiative of the African Institute for Development Policy (AFIDEP) established to facilitate informed, objective, transparent, open and balanced discussions on the development and use of emerging tools and technologies to address key health challenges in Sub-Saharan Africa.

Since the World Malaria Day in April, AFIDEP has through the Health Tech Platform been facilitating a series of Webinars on various aspects of malaria and have roped in experts from across Africa who have provided insights into the topic.

According to the experts, the growing resistance of both the Anopheles mosquito and Plasmodium parasite to insecticides and drugs, respectively, is among several threats impeding the achievement of the global goal of a 90% reduction in malaria incidence and deaths by 2030, as noted by Mr Balla Jatta, Neglected Tropical Diseases Programme Manager, Epidemiological and Disease Control Unit at the Ministry of Health-The Gambia in his keynote address. While governments continue to use treated bed nets and indoor residual spraying as primary tools for combating malaria-causing mosquitoes, these mosquitoes can now survive exposure to insecticides, allowing them to continue transmitting malaria.
Further, growing Plasmodium parasite resistance to the effects of drugs used for treatment is leading to treatment failures, necessitating the discovery and development of new chemotherapeutic agents.

This growing resistance has led to the declining effectiveness of insecticides and ACTs. Consequently, countries are 48% off track to eliminating malaria by 2030, according to WHO figures highlighted by Dr Michael Okal, Director of Research and Development at Vector Health International Ltd, as he delved into mosquito and parasite facets of resistance and their implications for elimination efforts.

The challenge towards meeting the global goal in Africa has been compounded by the invasion of the resistant mosquito species, Anopheles stephensi, which is native to Asia.

While speaking on lessons from India on controlling the species, Professor Arti Prasad, Professor and Head of the Department of Zoology at Mohanlal Sukhadia University, noted that key to India’s elimination strategy is a robust case-based surveillance system and early diagnosis and complete treatment.

Case-based surveillance involves actively monitoring and tracking malaria cases at the community level and responding promptly to prevent further transmission.
Effective malaria interventions are dependent on robust health systems. The burden of malaria weighs heavily on Africa’s fragile healthcare systems. Limited access to quality healthcare services, inadequate infrastructure, and insufficient human resources derail timely malaria diagnosis, treatment, and surveillance efforts.

As Dr Chris Barasa, Chief of Party at Amref Health in Kenya, noted, African countries must streamline public health functions, especially primary healthcare, to build resilience in efforts to improve, promote, protect and restore the health of all people.
Resilience, in this context, refers to the capacity of actors, health institutions, and populations to prepare for, respond to, and recover from crises while maintaining core functions.

It involves proactive measures, crisis management, and post-crisis learning to enhance future preparedness. Given the uncertainty of future health threats, resilience becomes a crucial aspect of healthcare planning.

Some measures that countries can put in place include: identifying potential threats and developing strategic health information systems; diversifying primary healthcare services to manage a broad range of health challenges; instituting effective data collection and use to support evidence-based decision-making; and facilitating collaboration and coordination between various healthcare entities to allow for a more comprehensive and effective response to health threats.

The threats faced from drug and insecticide resistance, climate change and fragile healthcare systems highlight the complex web of challenges to address if we are to end malaria in Africa.