African countries seek anti-malarial drug resistance solutions

Uganda has joined other African countries in demanding solutions to end resistance to antimalarial drugs such as artemisinin-based combination therapies (ACTs).

The resistance is being experienced not only in Uganda but also in neighbouring countries such as Rwanda, Tanzania, Eritrea and Ethiopia.

For Uganda, partial resistance to antimalarial drugs like artesunate, especially among children with severe malaria, was reported by the health ministry in 2024, and since then, they have been monitoring the situation by implementing strategies to address drug resistance and improve malaria treatment outcomes.

The danger with the drug resistance, according to health practitioners on the continent, is that it increases malaria cases, high cost of treatment for rural households, but also leads to death in some cases.

The joint call was made on Tuesday, May 20, 2025, on the sidelines of the 78th World Health Assembly (WHA) organised by Medicines for Malaria Venture (MMV), Antimalarial, with support from the World Health Organisation in Geneva, Switzerland.

According to a press statement from the Medicines for Malaria Venture released on Tuesday, Antimalarial drug resistance is rapidly gaining ground across the African continent, with evidence of partial resistance reported in Rwanda, Uganda, Tanzania, Eritrea and Ethiopia.

Currently, artemisinin-based combination therapies remain the WHO-recommended first-line treatment for malaria, with the most commonly used ACT, artemether-lumefantrine, used in 80-90% of all malaria cases across Africa.

In that regard, researchers from Imperial College London warned that if not addressed, the artemisinin partial resistance and partner drug resistance being experienced across Africa today will lead to an increase in malaria cases by 16 million people and 80,000 additional deaths annually.

"This co-ordinated, committed and united call against antimalarial drug resistance comes directly from African leadership. As a long-standing partner in malaria research and development, MMV is committed to contributing our scientific expertise and access capabilities to this crucial effort,” MMV chief executive officer Dr Martin Fitchet said during the meeting.

Fitchet explained further that in the meantime, affected countries should look out for innovations to counter drug resistance. 

“Innovation is critical in the fight against drug resistance. With our partners, we’re developing next-generation antimalarials that could reach patients by 2027—while acting now to preserve the power of today’s treatments. Both are vital to outpace resistance and keep saving lives”.

He explained further his organisation has, over time, supported innovations that are addressing antimalaria drug resistance, including multiple first-line treatments (MFT): where they are supporting pilot studies in Kenya and Burkina Faso, which have demonstrated the operational feasibility of this intervention in diversifying ACT use to reduce dependence on a single treatment. The study has so far shown that with strong systems and local engagement, MFT can be scaled successfully. 

Triple ACT combinations (TACTs): MMV, the Mahidol-Oxford Tropical Medicine Research Unit, Fosun Pharma and Marubeni Corporation are collaborating to develop the first fixed-dose TACT, artemether-lumefantrine-amodiaquine. This formulation combines artemisinin with two partner drugs rather than one, creating a highly efficacious drug even in areas with high resistance.

Novel non-artemisinin antimalarials: MMV's R&D pipeline includes promising non-artemisinin-based treatments and compounds developed in partnership with Novartis, such as ganaplacide-lumefantrine (currently in Phase 3 trials) and cipargamin, which has shown the fastest parasite clearance rate of any non-artemisinin antimalarial.

Prevention and transmission blocking: Adding a low dose of primaquine, an antimalarial medicine with activity against gametocytes, to an existing ACT has been proven to reduce the transmission of Plasmodium falciparum malaria.

This approach is recommended by WHO in areas threatened by antimalarial resistance, among others.