10 country-specific insights from Africa's fight against malaria

10 country-specific insights from Africa’s fight against malaria

By Ollie Sayeed, PhD

1Day Sooner has compiled a tracker for each African country, collecting important information such as:

the size of the population at risk of malaria
the number of malaria cases and deaths in 2023
which vaccine (R21 vs. RTS,S) is planned for rollout in that country
the status of that rollout, including the number of doses ordered and delivered
Gavi income group each country falls into

From a bird’s eye view of the continent’s malaria statistics, we can draw a number of conclusions:

Nine countries in Africa have already eradicated malaria. The five countries of North Africa – Egypt, Libya, Tunisia, Algeria, and Morocco – along with several small sub-Saharan countries – Lesotho, Mauritius, Seychelles, and Cabo Verde – are malaria-free. Cabo Verde is the most recent entry on this list, announcing a successful eradication program in January 2024. ¹
The bulk of Africa’s malaria burden is in Nigeria and the DRC. The distribution of malaria cases in Africa is heavily skewed to the most populous countries, with 28% of the continent’s malaria burden in Nigeria and another 13% in the Democratic Republic of Congo (DRC). Along with Uganda (5%) and Mozambique (4%), the top four countries comprise half of Africa’s malaria cases.
Nigeria has not announced any vaccine orders. Despite having nearly a third of the continent’s total malaria burden, there are currently no publicly available details of vaccine deliveries to Nigeria. The country has announced its intention to begin rolling out R21 in Bayelsa and Kebbi, two states with high malaria transmission, once it has started receiving dose shipments.² Confirming and accelerating the delivery of R21 doses to Nigeria should be a priority for global health advocates.
The countries worst hit by malaria are in West Africa. The highest malaria rates per capita are seen in Benin (38k), Burkina Faso (35k), Mali (35k) and Liberia (35k). Burkina Faso was involved in trials for both RTS,S,³ and R21⁴ and is currently rolling out RTS,S. In West Africa, Mali strongly stands out in currently having no vaccine financing or roll-out plan despite its high malaria burden.
The Democratic Republic of Congo has ordered the most vaccines so far. In early 2024, the DRC requested 3.5 million doses over three years, the single biggest number ordered by any country. Although there are currently no details from Gavi about confirmed dose numbers for the DRC, its combination of a large population and one of the highest case rates outside West Africa make the DRC a clear candidate for a large dose allocation.
Angola needs international financing. Although it has the fifth-highest malaria burden in Africa, it is not deemed eligible for vaccine financing from Gavi⁵ and currently has no public vaccine roll-out plan. Although Angola is wealthier than most countries in sub-Saharan Africa, comparably wealthy countries like Kenya and Ghana have been allocated financing, and Angola’s high malaria burden should make it a focus for extending Gavi’s eligibility conditions.
Ethiopia has low rates of malaria but a big population. Ethiopia’s status as the second most populous country in Africa is enough to outweigh the relatively low malaria rates characteristic of the Horn of Africa, giving it a total malaria burden bigger than those of Kenya, Guinea, Malawi, or Chad. There are currently no malaria vaccine financing plans for Ethiopia, but rolling out the vaccine is likely to save a large number of lives even if potential victims of malaria are spread out over the population, as in neighbouring Kenya.
Sudan’s progress has stalled after Gavi’s approval. Sudan is the only country that has successfully been approved by Gavi for malaria vaccine introduction,⁶ but hasn’t been assigned either vaccine. Global health and development initiatives have likely been disrupted by the country’s ongoing civil war, but international funders should work to send vaccines to Sudan if they can be safely distributed.
Southern Africa has generally low rates of malaria. Although South Africa, Botswana, Namibia, and Eswatini have not strictly eradicated malaria, they have very low case numbers, at 31 per 100,000 people at risk in Botswana and 34 in South Africa. Within Southern Africa, the most important focus should be on Angola and Mozambique, which have among the largest malaria burdens on the continent.
The smallest countries should be less of a focus. Several of the smallest countries in Africa, like Seychelles, Mauritius, and Cabo Verde, have already eradicated malaria. In the rest, like Djibouti, Comoros, and São Tomé and Príncipe, total malaria case numbers are hundreds of times smaller than in Nigeria or the DRC. The allocation of malaria vaccines should focus on saving the most lives rather than distributing vaccines to the biggest number of countries.