Climate-proof Uganda’s malaria eradication plan

Malaria remains Uganda’s leading cause of death, claiming tens of thousands of lives a year, mostly of children under five. As torrential rains continue to pound a swathe of the country, it is imperative that we become alive to the danger signs that are there in profusion.

Standing water is an ideal breeding ground for disease-carrying mosquitoes. With resistance to medicines, including artemisinin, not in question, statistics of outpatient department attendances keep telling a disturbing story.

The 2021/22 Annual Health Sector Performance Report, for one, shows that malaria accounted for 32.1 percent of such attendances. Coughs or colds placed a distant second behind an attendance rate of 20.4 percent.

Besides the growing resistance to insecticides, an invasive mosquito, Anopheles stephensi, has—per the 2023 WHO world malaria report—spread beyond its native Asian and Arabian habitats to Africa. The WHO warned in the same report that the species, which thrive in urban settings, have the potential of wreaking intolerable damage.

These revelations should not be taken lightly by Uganda, not least because its development partners recently indicated that their support of the country’s fight against malaria has levelled off.

Uganda is estimated to lose just under Shs2.5 trillion annually thanks to its malaria burden.

The country’s Health ministry recently revealed that it has reached out to China to help it plug the gaps occasioned by the retreat of development partners from the Global North.

Conventional wisdom suggests that this is a stopgap measure. The government has to start thinking deeply about how to get ahead of the major threat that extreme weather poses to the fight against malaria.

It is instructive to note that extreme weather is not about, as is currently the case, the wets becoming wetter. No. It is also about, as was previously the case, the hots becoming hotter. Mosquitoes thrive in warm, damp and humid conditions. When either of the two conditions become extreme, the consequences can be dire.

The question to be posed to the government then is: if climate-proofing is a malaria eradication strategy, what has it got to show?

Already, rainstorms are knocking down the rickety brick-and-mortar of the country’s health services. Roads that are used to gain access to health services are being cut off. Absenteeism of health workers can also be traced back to extreme weather episodes.

To be clear, it has not entirely been a story of doom and gloom. The development of new insecticides and antimalarial drugs as well as the highly effective malaria vaccine—R21/Matrix-M—the WHO recommended for widespread use last year have produced a ray of hope. We believe the Ugandan government can build on this by using a climate-sensitive approach to nip a growing problem in the bud.