This week across Africa, health warnings are mounting due to several intersecting factors. We are seeing a sharp rise in malaria cases continent-wide, which is further exacerbated by persistent underfunding that continues to slow the overall response. Compounding this challenge, growing resistance to current antimalarial treatments is also gaining ground, making effective intervention more difficult. Despite these struggles, the continent is witnessing significant forward momentum in other public health arenas. There is an advance in HIV prevention thanks to a new, trial-stage injectable PrEP (pre-exposure prophylaxis), offering a promising alternative for at-risk populations. Similarly, the battle against deadly hemorrhagic fevers is progressing: the fight against Lassa fever is moving forward with the launch of a dedicated vaccine trial, and Ethiopia is currently pursuing an experimental vaccine against the Marburg virus. In regional news, Nigeria is facing a "silent crisis" in oral health, a significant public health issue that often goes overlooked. On a more positive note, the Democratic Republic of Congo (DRC) has officially declared the end of its latest Ebola outbreak.

The world recorded 282 million malaria cases in 2024, 9 million more than in 2023, and about 610,000 deaths, according to the World Malaria Report 2025. Africa accounted for 265 million cases, or 94 percent of the global total.

Three countries drove more than half of the global increase: Ethiopia (up 2.9 million cases), Madagascar (up 1.9 million) and Yemen (up 378,000). The five most affected countries are Nigeria (25.8 percent of African cases), the Democratic Republic of Congo (13.3 percent), Uganda (5 percent), Ethiopia (4.7 percent) and Mozambique (3.9 percent).

With the tools we have today, no one should die from #malaria.

But cases are rising again. In 2024, 282 million people were infected and 610 000 died, mostly young children in Africa.

⚠️ Drug resistance
⚠️ Conflict
⚠️ Climate shocks
⚠️ Funding gaps
are stalling progress to… pic.twitter.com/WYrEuALY8F

— World Health Organization (WHO) (@WHO) December 4, 2025

Since 2015, malaria cases in Africa have risen by nearly 24 percent, driven by conflict, climate change, interruptions in bed net distribution, and weak health systems. In some countries, such as Madagascar, estimates have more than doubled since 2022 because of extreme climate events.

Partial resistance to artemisinin is spreading, with four African countries now reporting confirmed resistance and four others reporting suspected resistance, posing a threat to current treatments. The expansion of the Anopheles stephensi mosquito into several countries is also increasing the risk of urban transmission.

Chronic underfunding and new risks in Africa

Global funding totaled 3.9 billion dollars in 2024, only 42 percent of the annual 9.3 billion dollar target set for 2025. The resulting 5.3 billion dollar shortfall has been growing steadily since 2019 and threatens programs at a time when needs continue to rise.

According to the World Health Organization (WHO), without greater investment, recent warning signs in Africa could lead to a sustained increase in malaria cases in already fragile settings.

HIV: Southern Africa tests a solution that could prevent infection

In Eswatini and Zambia, health authorities have recently begun administering lenacapavir, a new long-acting injectable PrEP (pre-exposure prophylaxis) given twice a year, Africa 24 reports. This option targets people who have difficulty adhering to a daily pill regimen. In Eswatini, where adult HIV prevalence is around 27 percent, initial doses are being directed to the highest-risk groups.

In Zambia, priority is being given to young people and vulnerable communities. Clinical trials show that the treatment offers near-complete protection against infection.

Across Africa, 26.3 million people are living with HIV, and sub-Saharan Africa accounts for more than 60 percent of new infections. Lenacapavir could expand prevention options on the continent.

Experts caution, however, that its impact will depend on the ability of health systems to ensure follow-up, maintain supplies and train staff.

Lassa Fever: First volunteer vaccinated at Oxford, West Africa central to strategy

The first volunteer has received a dose of the experimental ChAdOx1 Lassa vaccine at the Oxford Vaccine Group, in a trial funded by the Coalition for Epidemic Preparedness Innovations (CEPI). Thirty-one adults will take part in this Phase 1 trial in the United Kingdom, ahead of a second trial planned in Ghana.

?The first volunteer has received a dose of @UniofOxford's Lassa fever vaccine candidate in a Phase I trial funded by CEPI | @OxfordVacGroup

?https://t.co/Fv6DlYy8M1 pic.twitter.com/EmNKgjygiW

— CEPI (@CEPIvaccines) December 4, 2025

Lassa fever, which is endemic in West Africa, is spread by rodents and can cause severe hemorrhage, permanent deafness and death. The WHO classifies it among priority pathogens with high epidemic potential, with as many as 700 million people possibly living in at-risk areas by 2070.

The vaccine candidate uses the same viral vector platform as the Oxford AstraZeneca Covid-19 vaccine.

Separately, the Lassa Fever Coalition, led by the West African Health Organization (WAHO) with CEPI, is preparing scenarios for equitable rollout in affected countries, including regulatory pathways and distribution planning for high-risk areas.

HIV, Tuberculosis, Malaria: Global Fund weakened, Africa called to step up

A 6.6 billion dollar shortfall threatens the eighth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, finalized in Johannesburg. Compared with a target of 18 billion dollars, major donors including the United States, France and Germany have reduced their commitments.

According to researcher Fred Eboko, 23 million people could be at immediate risk of dying if treatment supplies were to run out. Nearly two thirds of people living with HIV are in sub-Saharan Africa.

Eboko calls on African governments to match the financial efforts they made during the Covid-19 pandemic, when they mobilized multibillion-euro emergency packages with support from regional central banks and international financial institutions. He argues that countries must invest more in their own health systems to reduce dependence on donor nations.

Nigeria: Offensive against the "silent pandemic" of bad teeth and noma

In Nigeria, authorities are warning of a silent epidemic of poor oral health. According to the health minister, millions of people, especially children and older adults, suffer from preventable oral diseases that undermine nutrition, schooling and employment. Noma, a fast-moving infection that begins as simple gingivitis and can kill a child within days, remains widespread in the northwest.

Our surgical team has performed 1,400 surgeries for people with noma in Sokoto, Nigeria, in 10 years. Noma is a neglected disease that affects people living in poverty and causes disfigurement.

Come along with Dr Elma Wong and Professor Jacob Legbo for a surgical intervention ⬇️ pic.twitter.com/XkPTcXRTjW

— MSF International (@MSF) February 8, 2025

The inclusion of noma on the WHO list of neglected tropical diseases gives new momentum to national action. The government has announced plans to integrate basic dental care into primary health centers, extend health-financing schemes to cover oral care, modernize technical facilities and recruit more dentists.

Doctors Without Borders reports having carried out more than 1,600 reconstructive surgeries and detected 666 early cases in 2025.

Marburg in Ethiopia: An experimental vaccine deployed urgently

As it continues to face its first outbreak of Marburg virus disease, Ethiopia this week received more than 640 doses of the experimental cAd3-Marburg vaccine, developed by the Sabin Vaccine Institute.

The vaccine, now in Phase 2 trials in Africa and the United States, will be tested in a rapid-response study to assess its safety and immunogenicity in healthcare workers and high-risk contacts. The protocol involves two cohorts receiving immediate or delayed vaccination after 22 days.

Marburg, a close relative of Ebola, has a fatality rate that can reach 88 percent. Ethiopia has reported 13 cases and eight deaths since mid-November. The absence of approved treatments or vaccines makes this trial especially important.

DRC: End of 16th Ebola outbreak in Kasai, but vigilance maintained

In the Democratic Republic of Congo, authorities have declared the end of the sixteenth Ebola outbreak in Kasai province after 42 days without new cases since the last patient was discharged on October 19, 2025.

The outbreak involved 64 cases, including 53 confirmed and 11 probable, and 45 deaths. More than 47,500 people were vaccinated, first among contacts and then in surrounding communities.

For the first time, an infectious-disease treatment module designed by the WHO and the World Food Programme was used to ensure safe care while improving patient comfort. The response also relied on safe and dignified burials.

The country has now entered a 90-day period of heightened surveillance and is shifting to an integrated disease-surveillance system to detect any resurgence quickly.

Ayi Renaud Dossavi