Published: 12 December 2021

Ahead of the African Union Summit in February 2022, the bloc did not achieve its target of reducing malaria incidence and mortality by 40% by 2020 as set out in the continent’s Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030. 6 Member States did achieve at least one of the targets and the continent is not on track to eliminate malaria by 2030. There were an estimated 232 million malaria cases (96% of global total) and 611,802 malaria deaths (98% of global total) in Africa in 2020. This includes 69,000 additional malaria deaths in 2020 (two-thirds because of COVID-19 disruptions to malaria programmes and broader health services). The estimated number of malaria deaths is significantly higher than previously understood (19% more estimated malaria deaths since 2000, including a 35% more since 2015), increasing the urgency of controlling and eliminating malaria.

“Malaria remains a significant threat to health and social and economic development of the continent. For us to achieve the Africa that we want we need to ensure that we eliminate malaria. Eliminating malaria is achievable and will ensure that we have free hospital beds, that we transform our health systems and that we have more time for socio-economic development and structural transformation” said Joy Phumaphi, ALMA Executive Secretary.

There were 232 million estimated malaria cases (96% of total) and 611,802 estimated malaria deaths (98% of total), including 16 million additional cases and 69,000 deaths compared to 2019. 80% of malaria deaths were children under the age of 5. The burden of malaria is more significant than previously understood, renewing the urgency of controlling and eliminating malaria. Revisions to how WHO estimates malaria deaths resulted in a significant increase in the number of estimated deaths since 2000. 2.1 million additional estimated malaria deaths in Africa since 2000 (19% increase compared to the previous methodology). There were 693,617 additional estimated malaria deaths between 2015-2019 (35% increase).

Progress towards the African Union’s goal of eliminating malaria in Africa by 2030

The African Union is not on track to achieve its ambitious goal of eliminating malaria in Africa by 2030. To achieve its objective, the AU set a 2020 target of reducing malaria incidence and mortality by 40% (compared to 2015). According to WHO’s estimates, malaria incidence only declined by 1% between 2015-2020 and malaria mortality increased by 1%. Six Member States did achieve the 2020 targets for either malaria incidence or mortality. Achieved incidence target: The Federal Republic of Ethiopia (-60%) and the Republics of Cabo Verde (-100%), The Gambia (-60%), Ghana (-41%), and Mauritania (-51%).

An additional eight Member States reduced either malaria incidence or mortality by at least 25% since 2015: the Kingdom of Eswatini and the Republics of Equatorial Guinea, Kenya, Niger, Rwanda, Senegal, Sierra Leonne, and Togo. Cabo Verde and Sao Tome & Principe have reported zero malaria deaths since 2018.

Ongoing impact of the COVID-19

WHO estimates that disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic contributed to 49,000 additional malaria deaths (roughly two-thirds of 69,000 additional estimated deaths in 2020).

The 10% increase in malaria deaths in 2020 reflects that the continent took action to sustain malaria interventions and avoided the worst-case scenario. At the outset of the COVID-19 pandemic, WHO projected that malaria deaths could increase between 7% (best case scenario) and 99% (worst case scenario) because of interruptions to access to antimalarial medicines and disruptions to ITN campaigns. Member States, however, took decisive action and adopted innovative approaches to sustain malaria and broader health services and enabled indoor residual spraying (IRS), insecticide-treated nets (ITNs), and seasonal malaria chemoprevention (SMC) campaigns to move forward as planned.

In Q3 2020, 25 Member States reported concerns about having adequate stock of rapid-diagnostic tests (RDTs) and 27 reported similar concerns about antimalaria medicines (ACTs). By Q3 2021, this had declined to 8 and 14, respectively. By the end of 2020, 24 Member State’s ITN and IRS campaigns had been completed or were on track to be completed (75% of planned campaigns) and the remaining 8 were making progress.  As of Q3 2021, 80% of planned ITN and IRS campaigns were on track or had been completed and only one was not on track (Republic of Sudan). 31 million children under the age of 5 received SMC in 2021 (a record). Malaria can be defeated in our generation, a renewed call for action is needed to step up action against this preventable and treatable disease.