University of Cape Town leads regional action plan against drug-resistant malaria in East Africa
UCT is part of a research consortium that has played a pivotal role in developing the first regional action plan to combat drug-resistant malaria in East Africa.
Image: Pexels/Jimmy Chan
A research consortium led by the University of Cape Town (UCT) has played a pivotal role in developing the first regional action plan to combat drug-resistant malaria in East Africa. Endorsed by health ministers from across the region, the plan represents a major step forward in preserving the efficacy of life-saving antimalarial treatments.
The Regional Detailed Action Plan for Responding to Antimalarial Drug Resistance in East Africa was officially endorsed in May 2025 at the 25th Ordinary Meeting of the East African Community (EAC) Sectoral Council of Ministers of Health. Developed through a partnership between UCT's Mitigating Antimalarial Resistance Consortium in South-East Africa (MARC SE-Africa) and the EAC Roll Back Malaria Secretariat, the plan unites national malaria programmes and global health stakeholders behind a common goal: safeguarding effective malaria treatment amid growing resistance and tightening global funding.
Senior researcher at UCT and technical advisor within the consortium, Dr Stephanie van Wyk, said: 'This is a landmark achievement. This endorsement reflects the potential realised when scientific evidence, political will and regional solidarity converge. UCT remains committed to fostering solutions that not only assist our East African neighbours but also provide a template for responses to drug resistant malaria in other African regions. By enhancing case management and proactively addressing resistance challenges through regional collaboration, we contribute to safeguarding the effectiveness of antimalarial treatments throughout the endemic regions of Southern Africa.'
The action plan targets drug-resistant Plasmodium falciparum, especially resistance to artemisinin-based combination therapies (ACTs) – the frontline treatment for malaria.– the frontline treatment for malaria. The plan outlines a roadmap for optimised treatment protocols, improved supply chain management and strengthened regional cooperation by integrating the latest research and surveillance data. It also identifies evidence-based short- and medium-term interventions to address resistance before it undermines decades of progress in malaria control.
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The plan's development involved intensive collaboration with leading national and international health partners, including the Global Fund, the President's Malaria Initiative, the Clinton Health Access Initiative, the African Leaders Malaria Alliance and Medicines for Malaria Venture. The EAC Roll Back Malaria Secretariat, led by Dr Michael Katende, played a central coordinating role in aligning partner countries and institutions behind a shared vision.
'Malaria knows no borders, and neither should our response. This consensus-based regional action plan demonstrates the power of multinational collaboration in tackling drug-resistant malaria. Now is the critical moment for East African nations and international partners to commit to sustained action and ensure effective malaria treatment remains available for millions at risk,' said Professor Karen Barnes, lead of MARC SE-Africa and coordinator of the initiative at UCT.
With more than 300 million people – over 80% of the EAC population – living at risk of malaria, the plan arrives at a critical juncture. Resistance is rising, and funding shortfalls threaten to reverse hard-won gains. The coordinated approach signals a shift toward African-led, research-driven and politically unified responses to one of the continent's most pressing public health threats.
Through this regional initiative, East Africa sets a new precedent for protecting the impact of ACTs, reinforcing its commitment to collective action, and demonstrating leadership in global health innovation.
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These include regimens that were bitter tasting, or pills meant for adults that had to be crushed and were difficult to dose correctly, side-effects, and at times 'insufficient market incentives' for child-friendly formulations. Today, a child-friendly formulation that contains the drug dolutegravir is recommended as part of the preferred first line treatment for children from four weeks of age. Results from a recent Cape Town study, reported on by Spotlight, showed that two new formulations of dolutegravir were also safe to use in newborns. Anderson describes the introduction of cheap, child-friendly dolutegravir as a significant breakthrough that could transform paediatric outcomes. 'It is hoped that transitioning all children on ART to dolutegravir-based regimens may significantly improve paediatric viral suppression rates.' This is because dolutegravir-based regimens, she says, have several advantages, including better palatability and once-daily dosing and fewer side-effects. 'We don't have much recent data yet to show if these expected improvements are being realised… but watch this space!' What needs to be done? Despite the progress, Archary says there is still a long way to go. One priority is providing better support for mothers or caregivers. A lot of the counselling he and his team provide to caregivers of children living with HIV is to help them get a strong support structure around themselves and the child. This, he says, serves as a type of safety net to ensure the child is always given their treatment, no matter what happens. Anderson also weighed in on this. 'Family-centred approaches and better attention to broader social support for the most vulnerable mothers are needed for more successful HIV prevention and treatment,' she says. Family-centred approaches include 'structuring the healthcare services/visits so that mothers and children are seen together at the same visit, ideally by the same provider'. 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Important research derailed Long-acting HIV treatments for children could potentially help them stick to treatment better because caregivers wouldn't have to give medicine every day. However, some research efforts along these lines have been derailed by the funding cuts and new funding policies for research grants from the US government. 'I am hopeful that long-acting injectables could be the game changer we've long awaited, both in further reducing vertical transmission, and in improving viral suppression rates among mothers and children,' Anderson says. 'At the same time, I am worried that cuts to future HIV research funding could undermine the hard-won progress we have made.' This is a reality for Archary. He was involved in a study set to look at the use of long-acting cabotegravir and rilpivirine injections for HIV treatment in adolescents, paired with peer support interventions. But this was halted because funding through a grant from the US National Institutes of Health, which is the largest public funder of biomedical research globally, was cancelled. 'I think it's a wake-up call for research in South Africa because we've been quite highly dependent on external funding… [M]uch of the innovative research that's happened in HIV, TB and other infectious diseases has happened from South Africa, so we've got the intellectual capital, but we do need to now find the money in order to cover that gap,' he says. DM
