Africa is confronting a potential catastrophic resurgence of malaria that could reverse two decades of progress, with dire implications for Kenya and the broader East African region. A recent report by the African Leaders Malaria Alliance (ALMA) and Malaria No More UK warns that without sustained investment, the continent could face 525 million new malaria cases and 990,000 deaths by 2030. The majority of these deaths, an estimated 750,000, would be among children under five.

This health crisis carries a staggering economic cost, projected at Sh10.7 trillion (approximately $83 billion) in lost GDP for the continent by the end of the decade. For developing economies, malaria imposes a significant 'growth penalty,' estimated to be up to 1.3% per year in some African nations, constraining development and deepening poverty. In countries with a high malaria burden, the disease can account for as much as 40% of public health spending and up to 50% of outpatient visits.

A Perfect Storm of Threats

The progress made against malaria since 2000, which has averted an estimated 2.2 billion cases and 12.7 million deaths globally, is now in jeopardy. A combination of factors is creating a 'perfect storm' for a resurgence. Insufficient funding is a primary concern, with more than half of the activities in national malaria strategies currently unfunded. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which provides nearly 60% of all international financing for malaria programs, faces significant funding challenges that could lead to a collapse in prevention efforts if not addressed.

Compounding the financial pressures are growing biological threats. Mosquitoes are developing widespread resistance to pyrethroids, the primary insecticide used in long-lasting insecticidal nets (LLINs). Additionally, partial resistance to artemisinin, the core compound in the most effective malaria treatments, has been confirmed in several African countries, including Uganda and Tanzania, raising fears of untreatable infections. The arrival of the invasive Asian mosquito species, *Anopheles stephensi*, which thrives in urban environments, further complicates control efforts.

Climate change is another major driver, altering weather patterns and expanding mosquito habitats. Rising temperatures are allowing malaria-carrying mosquitoes to reach higher altitudes, bringing the disease to highland areas in East Africa, including parts of Kenya and Uganda, that were previously too cold for transmission. Prolonged rainy seasons and flooding also create more breeding sites for mosquitoes.

Implications for Kenya

While Kenya has made significant strides, reducing malaria prevalence from 8.2% in 2015 to 6% in 2023, these gains are fragile. The country remains heavily reliant on international aid, having recently signed a KSh 59.7 billion grant from the Global Fund for HIV, TB, and malaria for the 2024-2027 period. A portion of this funding, approximately KSh 9.4 billion ($72.9 million), is specifically for malaria, with a goal to reduce incidence and mortality by 75% by 2027.

The threat of resurgence puts these national targets at risk. Increased cases would further strain a health system already contending with other infectious and non-communicable diseases. Economically, a malaria comeback would impact key sectors like agriculture and tourism and increase household healthcare costs, perpetuating a cycle of poverty.

A Glimmer of Hope: New Tools in the Fight

Despite the grim outlook, new tools offer hope. The rollout of two WHO-recommended malaria vaccines, RTS,S/AS01 and R21/Matrix-M, is a landmark development. As of early April 2025, 19 African countries, including Kenya, have begun integrating these vaccines into their routine childhood immunization programs. The RTS,S vaccine was piloted in Kenya, Ghana, and Malawi between 2019 and 2023, reaching over two million children and resulting in a 13% drop in mortality among those eligible for the vaccine. The wider rollout is expected to save tens of thousands of young lives annually.

These vaccines are intended to complement, not replace, existing interventions like insecticide-treated nets and timely diagnosis and treatment. The fight against malaria in Kenya and across Africa is at a critical juncture. Sustained domestic and international funding, coupled with the strategic deployment of new and existing tools, will be essential to prevent a devastating resurgence and protect a generation from this preventable disease.