Our collective share of the blame for malaria

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OPINION

By John Musinguzi

Every April 25, we mark World Malaria Day. We print posters, repeat slogans, mourn dead children and promise action. Then we return to routine: clearing forests for charcoal, draining wetlands, building in flood-prone areas without proper drainage and leaving stagnant water around our homes. Then we act surprised when malaria returns.

It is time to say what we often avoid: in Uganda, malaria is not just a parasite problem. It is also an environmental problem, and we are helping to create it.

The scale of the crisis should shame us into honesty. In 2023, Uganda recorded more than 16 million malaria cases and 2,793 deaths, most of them among children under five. That is not just a public health challenge. It is a national failure repeating itself year after year.

Mosquitoes do not ask for much. Give them stagnant water, warmth, humidity and a dark place to rest, and they will do the rest. Our patterns of settlement, farming, waste disposal and land degradation provide these conditions generously.

In Oyam district, an outbreak investigation linked malaria transmission to human activity near swamps, rice irrigation and water collecting around homes after rainfall. In other words, the outbreak was not simply an accident of nature. It was enabled by the way people interacted with the land.

That is the harder truth: We are creating breeding sites faster than the health system can spray, test or treat.

Wetland destruction is not only an environmental issue. It is mosquito engineering. When swamp edges are dug up for brickmaking, converted into gardens, overgrazed or settled, they leave behind pits and waterlogged depressions, perfect mosquito nurseries. What we call “land use” has quickly become a conveyor belt for malaria.

Deforestation tells the same story. We often discuss forest loss in the language of carbon footprint offsetting, rainfall and biodiversity.

But forest loss is also a malaria issue. As climate pressures and poverty push communities into deforestation, land degradation and poorly-managed irrigation, malaria vectors gain new ground. The pattern is clear. We degrade ecosystems, alter water flow, increase stagnant pools, and then spend billions treating the disease that follows.

Malaria is climate sensitive. A warmer climate can speed up mosquito breeding and parasite development. Irregular rainfall can create new breeding sites or shift malaria into new areas. This means malaria control is no longer solely the Ministry of Health’s burden. Agriculture, housing, energy, water, local government and environmental policy are now part of malaria policy.

There is something morally disturbing about the economics of it all. The global malaria therapeutics market is projected to grow sharply, not because prevention is winning, but because the disease burden remains stubbornly high. That should alarm us. It means the world is preparing to profit from a crisis we are still helping to sustain.

So what must change?

We should start with what is practical and immediate: drain pooled water, fill pits, unblock drainage channels, cover water containers and dispose of plastic waste properly.

However, that is not enough. Uganda must protect wetlands as public health infrastructure, not treat them as empty land waiting to be exploited. We must reduce deforestation by expanding affordable clean energy and regulating charcoal supply chains. New settlements must be planned with drainage, sanitation and waste management in mind. Environmental and climate data should sit at the centre of malaria planning, not at the margins.

This World Malaria Day, let us drop the comforting fiction that malaria is only a medical problem. We cannot spray our way out of environmental destruction. We cannot ‘sleep under a mosquito net’ our way out of bad land use. If malaria ends with us, as the World Health Organisation says, then it also spreads with us, through the forests we clear, the wetlands we destroy, the drainage we ignore and the waste we tolerate. In Uganda, environmental protection is not just conservation. It is malaria prevention.

The writer is a marketing communications professional and behavioural science enthusiast