As malaria cases nudge their way upwards on the continent, and while the cunning parasite evolves to evade detection and conquer drugs used to treat it, at the same time, the region is taking action, boosting efforts to ward off drug-resistance to the disease, write Dr Stephanie van Wyk and Dr Donnie Mategela for Health-e News.
Van Wyk and Mategela write:
Malaria outbreaks are rising again in parts of southern Africa. Across the SADC (Southern African Development Community) region, there is a convergence of pressures: climate-driven outbreaks, funding shortfalls, and the early signs of emerging resistance, which combined, threaten the most vulnerable communities.
Of SADC’s 420m people, roughly 365m are at risk. Most rely on effective treatment as their last line of defence. At the same time, the malaria parasite is evolving to evade detection and, increasingly, to overcome the medicines used to treat it.
But what sets this moment apart from past antimalarial drug failures is that the region is beginning to act early, combining forces and leveraging its strengths before drug-resistant malaria resistance becomes widespread and entrenched. For SADC, drug resistance is not yet a crisis.
Yet it is a stark warning of the potential dire consequences if responses are delayed.
Neighbouring regions offer a glimpse of what could come next. In East Africa and the Horn of Africa, malaria that’s partially resistant to the artemisinin component of the most common and effective treatment has already been confirmed in Rwanda, Uganda and Eritrea.
Within SADC, mainland Tanzania has confirmed resistance to a key component of the first-line treatment, while Zambia and Namibia are showing concerning early signals of suspected resistance.
Current score of malaria in SADC
Malaria already places a heavy burden on the region. There are an estimated 78.9m cases and nearly 39 000 deaths across SADC per year. For 2026, this burden is expected to increase dramatically.
Recent malaria outbreaks, including those in Madagascar, Namibia and Zambia, show how quickly transmission can surge under the right conditions.
This is particularly concerning for countries that have been hoping to move towards complete malaria elimination by 2030. Instead, Botswana, eSwatini and South Africa are now reporting renewed risk of transmission and outbreaks.
Southern Africa is showing early signs of a deeper shift: case numbers are rising, surveillance is detecting emerging resistance across multiple countries, and the effectiveness of first-line treatments may soon come under pressure.
For now, the antimalarial treatment is thought to remain effective in most areas. But that could change quickly if these warning signs are ignored.
Stakes are rising
Drug resistance raises the stakes significantly. Current treatment relies on artemisinin-based combination therapies, pairing artemisinin, a fast-acting class of drugs, with a longer-acting partner drug. If the fast-acting component weakens, pressure shifts to the partner drug. If both fail, treatment options become severely limited.
There are no available replacement therapies yet. New antimalarial drugs are undergoing lengthy clinical development and are therefore unlikely to be available for routine use across the region in the near future.
If resistance spreads, the consequences will fall hardest on those already most at risk: young children, pregnant women, and communities with limited access to timely, effective care. Health systems will also come under increasing strain. That makes prevention of resistance as important as the treatment itself.
SADC building on its strengths for targeted response
SADC countries are moving away from isolated national responses towards a co-ordinated regional strategy.
For the first time, drug resistance is rising to the top of the regional health agenda. Indeed, a pre-emptive agenda and targeted response may be the region’s greatest advantage in the fight against drug-resistant malaria.
Recent regional reviews and stakeholder engagements, bringing together ministries of health and technical experts, have identified key knowledge gaps and vulnerabilities and helped align responses. This marks a shift from fragmented efforts to co-ordinated action.
Now efforts are under way to:
- strengthen real-time surveillance and monitoring systems;
- expand investigation into the therapeutic efficacy of currently available (and potential future) treatments;
- improve evidence and skills sharing across borders; and
- align national responses through regional co-ordination.
The region is leaning into its existing strengths to combat this threat: world-class scientific institutions, globally recognised academic expertise, and powerful pathogen surveillance systems that became refined during the Covid-19 pandemic.
These include fast laboratory, genomic, analytical and bioinformatics capacities that are already in place, and now need to be mobilised to combat malaria.
Academia playing a key role
Researchers are central to this transition from data to action. My colleagues and I are already seeing early warning signs across the region. Through the Mitigating Anti-malaria Resistance Consortium for Southern and Eastern Africa (MARC SE-Africa) consortium and our collaborations with national malaria programmes, we are tracking resistance-conferring genetic changes in the parasite, analysing treatment outcomes, and developing predictive tools to support public health decision-making.
This work is not theoretical; it directly informs policy and helps ensure treatment guidelines remain effective. In line with the SADC’s 2022-2030 Malaria Strategic Plan and broader global frameworks, this growing evidence base continues to guide decision-making across the region.
Narrow window of opportunity
Southern Africa is not starting from scratch. Unlike regions where resistance became entrenched before co-ordinated action could be taken, SADC still has a narrow window to respond early. The detection of resistance markers is not a sign of failure: it is a signal to act.
The region’s leadership appears to be doing just that. By bringing together governments, partners and researchers, and placing data at the centre of decision-making, southern Africa is building a more proactive response to drug-resistant malaria.
The challenge now is speed.
Data must move quickly: from detection to decision, and from decision to action. Our work shows that malaria parasites adapt quickly. The question is whether our response can move even faster.
Dr Stephanie van Wyk, Mitigating Antimalaria Resistance Consortium for Southern and Eastern Africa (MARC SE-Africa), University of Cape Town.
Dr Donnie Mategela, Malawi, Liverpool Wellcome Research Programme and Liverpool School of Tropical Medicine.
See more from MedicalBrief archives:
International partnership to combat drug resistant malaria in Africa
Africa needs to reassess fight against malaria