DUMA BOKO | Africa must take ownership of the fight against malaria 

As African leaders gather this week for the African Union Summit, we face a stark and urgent public-health moment that demands clarity and action. Malaria ― a disease that has plagued our continent for generations ― is once again on the rise after decades of hard-fought progress. It makes clear that legacy approaches built on external dependency are no longer sufficient nor sustainable.

In 2024, malaria claimed more than 600,000 lives globally ― nearly all in Africa. We know how to prevent and treat malaria. The challenge today is financing and implementation at scale.

New tools are measurably better. Vaccines have moved beyond pilot programmes and are now operating across 25 African countries. Next-generation dual-insecticide mosquito nets are outperforming their precursors, while surveillance systems are becoming faster and more precise.

However, these tools have arrived in a tougher operating environment. Official development assistance for health in Africa has contracted sharply ― falling by nearly 70%. Climate shocks are driving sudden case spikes by rapidly increasing mosquito breeding and extending transmission seasons. In my country of Botswana, heavy rains last year led to increased malaria incidence, including in districts that had previously eliminated the disease. At the same time, insecticide and drug resistance is rising, making increasingly precise surveillance essential to stay ahead of the disease.

Too often, malaria programmes are disrupted by unpredictable funding cycles, fragmented procurement, and uneven delivery systems across districts and communities. Clinics experience stock-outs, community health workers lack consistent support, and data arrives too late to guide action.

The result is a widening gap between what is scientifically possible and what is operationally achieved. This is why Africa must take greater ownership of malaria financing and delivery. We welcome partnerships, but we must build systems that stand when financing shifts.

The question is not whether the continent can afford to end malaria. We cannot afford not to. Without sustained prevention, a resurgence could cost Africa $83bn in GDP by 2030.

Through the African Leaders Malaria Alliance (Alma), heads of state have committed to closing this gap by focusing on three priorities.

If we can design the surveillance and detection system, increase the capacity of national laboratories, improve supply chains and logistics for medicines and equipment, and expand community health worker programmes, we create the machinery to beat the next outbreak when it comes ― all the while strengthening primary healthcare.

1. Domestic resource mobilisation. Across the continent, End Malaria Councils and Funds are now established in 11 countries, bringing together government, the private sector and civil society, and mobilising more than $166m in domestic public and private commitments to support country-owned malaria strategies.
2. Accelerated scaling of innovation. Vaccines, next-generation nets, improved diagnostics and digital surveillance must be rapidly integrated into national health systems. This requires investment in laboratory capacity, procurement systems, delivery, and community health workers ― the practical infrastructure that turns innovations into outcomes.
3. Political accountability. Alma scorecards tracking coverage, financing and performance are already helping leaders identify bottlenecks. Commitments must translate into budget outlays, procurement orders and operational plans. Progress must be reviewed regularly at the highest political level.

This agenda is larger than malaria alone: it is a pathway to build out healthcare systems, bolster health sovereignty and boost local manufacturing. If we can design the surveillance and detection system, increase the capacity of national laboratories, improve supply chains and logistics for medicines and equipment, and expand community health worker programmes, we create the machinery to beat the next outbreak when it comes ― all the while strengthening primary healthcare.

We cannot wait. With international aid retreating and climate change accelerating transmission, each delay in financing deepens malaria’s toll on our communities. Yet the resurgence is not inevitable. It is the result of financing gaps and uneven execution ― all of which can be addressed with decisive leadership.

With predictable investment, stronger institutions and political accountability at the highest level, Africa can regain momentum and protect the next generation from a disease that has long constrained our continent. Africa now has an opportunity ― and a responsibility ― to beat malaria.

Duma Gideon Boko, the president of Botswana, serves as chair of the African Leaders Malaria Alliance (Alma), an AU–linked coalition of African heads of state and government working to eliminate malaria across the continent.