Rwanda is confronting an unexpected resurgence in malaria infections and signs of treatment resistance that have forced alarmed officials to revisit vaccine intervention the country once declined – this after years of progress in slashing cases, reports Scidev.Net.
Steady declines in malaria infections have been recorded for nearly a decade, with cases falling from almost 5m in 2016 to just 430 000 in 2023 – about a 90% reduction – according to figures from the Rwanda Biomedical Centre (RBC).
But these gains are now under threat, said Aimable Mbituyumuremyi, division manager for malaria and other parasitic diseases at the RBC, Rwanda’s health implementation agency, who said that in 2024, malaria cases rose by more than 45% in just the one year, reaching 620 000.
Rwanda had previously opted out of receiving malaria shots during the first phase of distribution by the World Health Organisation (WHO) and Gavi in 2023, confident in its consistent progress in reducing malaria over the past decade.
“But now, we’re experiencing a surge,” Mbituyumuremyi told Scidev.Net, “and are considering using the vaccines since all other measures have yet to work and infections are increasing.”
The rise in cases began unexpectedly in January 2024, a time when malaria incidence usually declines, according to Mbituyumuremyi.
“It’s the first time we have seen an increase in cases in Rwanda since 2016,” he noted, “and we’re alarmed that it’s not just a slight increment, but a significant one.”
The number of annual deaths fell from 650 in 2016 to 67 in 2023, and more than two dozen districts entered the malaria pre-elimination phase.
But, he said, between January and October 2024, the country recorded 620 000 malaria cases, an increase of nearly 200 000 compared with the same period in 2023.
October alone accounted for 112 000 of those cases, with almost 90% of them (about 100 000) concentrated in just 15 of Rwanda’s 30 districts.
“At this time, we never expected such a burden because we were in the pre-elimination phase,” Mbituyumuremyi said. “We anticipated a progressive decrease, not even a slight increase.”
So far 17 African countries have rolled out the malaria vaccine with support from the WHO and Gavi.
"Now, we would like that consideration [vaccine distribution] to be extended to us as well,” he added.
The malaria resurgence comes despite investments in most malaria-prone districts.
Mbituyumuremyi said the country had poured money into existing control strategies, such as indoor residual spraying and mosquito net distribution, and spent more than US$1.5m per district on indoor spraying in a dozen districts.
Drug resistance
The RBC says several factors have contributed to the new surge in cases, including rising mosquito resistance to drugs, shifting mosquito behaviour, and environmental changes that increase breeding sites.
Mbituyumuremyi also expressed concerns over the possible spread of the disease between countries.
“Preliminary investigations indicate that nearly all of the most affected sectors are in the cross-border communities of Nyagatare, Gisagara, and Bugesera,” he said.
To combat drug resistance, Rwanda has started using alternative treatments, and since the end of last year, has been receiving new anti-malaria drugs.
“While Coartem is being used less frequently, it has not been completely phased out. We are implementing a multiple first-line treatment strategy,” Mbituyumuremyi said.
Despite the setback, Rwanda still aims to be malaria-free by 2030, he added.
Scidev.Net article – Rwanda Reconsiders Malaria Vaccines Amid Surprise Surge (Open access)
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