Michael Adekunle Charles

On the morning that I visited Al-Sabbah Children’s Hospital in Juba, South Sudan, in December last year, almost all the children we found receiving treatment had malaria. The health workers reported that about 80 percent of the cases they see are malaria-related. The strain was visible as health workers used the limited resources they had to save lives in a country that has suffered prolonged conflict.

When a country is experiencing conflict, the government’s only choice is to wear the strong and crucial hat of resilience and hope. As the RBM Partnership joined South Sudan to launch the High Burden High Impact Initiative (HBHI) at the beginning of December, the government of South Sudan emphasized its commitment to rewriting its story and that of its people — beginning with rebuilding the health sector so that the human capital needed to rebuild the country remains alive and healthy.

An important part of rewriting this health story is strengthening the malaria response. The HBHI initiative is a significant step in countries recognizing that they carry a disproportionate burden of malaria — and that this burden stands in the way of health and development. HBHI is also an important first step in addressing the specific impact of malaria on multiple aspects of life and the economy.

A report by RBM partners, Malaria No More UK and the African Leaders Alliance Against Malaria, indicates that if the world stays on track to meet its 2030 targets, it can save 1.86 million lives and boost Africa’s GDP by US$231 billion. Conversely, the report warns that a worst-case scenario — where the world turns its back on the fight against malaria and countries fail to implement preventative interventions — would cost Africa US$402 billion.

Without doubt, countries affected by conflict, where health commodity supply chains are fragile or even non-existent during active conflict and where resources are already scarce, would be hit hardest by any reductions in malaria funding. Already, while the Global Fund replenishment has shown some promise, with over US$11 billion raised, the world remains far from achieving the US$18 billion required for malaria efforts.

Further, the funding gap in health remains a stark reality. The 2024 World Malaria Report indicates that total malaria funding reached US$3.9 billion. This is lower than the US$4 billion invested in 2023 and far below the US$9.3 billion needed in 2024 to meet global targets. The US$3.9 billion invested represented only 44 percent of the required funding, leaving a shortfall of US$5.4 billion. In 2023, the target investment was US$8.3 billion, but the US$4 billion invested left a funding gap of US$4.3 billion, meaning malaria received only 48 percent of the necessary funding. The increase in the funding gap from US$2.6 billion in 2019 to US$5.4 billion in 2024 reflects a worrying shift in donor priorities away from malaria and global health.

During the launch of the HBHI initiative, South Sudan’s Vice President in charge of the Service Cluster, H.E. Josephine Lagu, echoed RBM’s call for strong collaboration and unity to turn commitment into action. Aware of the realities of the global health funding landscape, she pledged to intensify domestic resource mobilization to build a more sustainable health response. She also announced that the government would work toward establishing an End Malaria Council in South Sudan, joining a growing number of African leaders who have demonstrated political will and mobilized domestic resources toward malaria elimination.

In South Sudan, donors such as the World Bank, the European Union and others remain committed to prioritizing malaria. Sustaining this commitment and collaborating with the South Sudanese government to mobilize domestic resources is essential for achieving success against malaria. The latest World Malaria Report shows that 610,000 people died from malaria in 2024. The report also recorded 282 million malaria cases worldwide — nine million more than in 2023.

As was the case in 2023, 94 percent of malaria cases and 95 percent of malaria deaths occurred on the African continent, which also ranks low on the development index. Five countries — the Democratic Republic of Congo, Ethiopia, Mozambique, Nigeria and Uganda — accounted for more than half of all global cases. Nigeria, with nearly 700,000 deaths, registered the highest malaria burden globally, followed by the Democratic Republic of Congo and Uganda.

The World Health Organization recognizes growing threats of antimalarial drug resistance and insecticide resistance as major obstacles to progress in the fight against malaria in South Sudan. Malaria remains the leading cause of patient morbidity in South Sudan, accounting for around 67 percent of all cases and 50 percent of deaths in the country. In the context of conflict — where some areas are inaccessible and many deaths occur silently in homes without being officially recorded — the true scale of malaria-related deaths is likely far greater than official statistics suggest.

The destabilization caused by conflict creates the perfect environment for malaria and other diseases to thrive, making the health system one of the major casualties of conflict. In South Sudan, the dangerous combination of conflict, biological threats and limited funding is painfully evident, underscoring the urgent need to combine resources and respond quickly to prevent further deaths. Climate change further worsens the crisis, with some parts of South Sudan experiencing severe flooding and increased malaria cases, while others endure extreme temperatures that create ideal breeding conditions for mosquitoes. In complex emergencies, malaria spreads in unique and dangerous ways.

This is why our approach to malaria in complex situations must be deliberate and responsive to these unique realities. As we move toward implementing Unity 30, RBM’s new framework aimed at bringing countries together to end malaria within the next five years, we must mobilize greater resources to intensify the fight against malaria in complex settings and strengthen partnerships to accelerate progress toward malaria elimination goals.

Dr. Michael Adekunle Charles is the CEO of the RBM Partnership to End Malaria.