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The 2024–25 Uganda Malaria Indicator Survey, released earlier in March by the Uganda Bureau of Statistics, contains both encouraging news and a stark warning.
As a data scientist working on innovative malaria control approaches, the picture it paints is clear: despite decades of effort and billions of shillings invested, malaria is adapting faster than our existing tools can keep up.
After years of steady decline — from 42 per cent parasite prevalence in 2009 to just 9 per cent in 2018/19 — national prevalence has more than doubled to 21 per cent among children under five.
In Lango subregion, 59 per cent of children tested positive. In Acholi, 46 per cent. In Teso, 44 per cent. These aren’t just statistics. They represent children running fevers in the night, families sick with worry, mothers missing work for clinic queues, and families trapped in a cycle of sickness and poverty.
WHAT’S WORKING — AND WHAT ISN’T
Our current interventions have achieved real gains. Household bed net ownership stands at 86 per cent, and 83 per cent of pregnant women with access slept under one the previous night.
These are genuine victories that have saved countless lives. But bed net ownership alone is no longer enough. The mosquitoes are evolving: they are biting earlier in the evening before people are under bed nets; they are resting outdoors beyond the reach of indoor spraying, and they are developing resistance to the insecticides our tools depend on. Our arsenal is struggling to keep up with the ever-adapting mosquitoes.
WHY WE MUST LOOK FURTHER
This is why Uganda must seriously consider supporting research into new tools and transformative approaches, such as genetically modified mosquitoes and gene drive technologies.
Gene drive is a potential strategy to modify mosquitoes, so they cannot transmit the parasite, or to reduce their populations to stop transmission of the disease. It is not a magic bullet because it would complement existing and new interventions.
It is also not ready for release tomorrow, but the survey data convinces me that we cannot afford to dismiss potential new tools. Malaria is highest in the poorest households — 38 per cent in the lowest wealth quintile against 3 per cent in the highest — and in rural areas where health infrastructure is thin.
Current interventions require constant, expensive, logistically complex repetition: bed nets every three years, indoor spraying annually; health workers intervening constantly to test and treat, communities mobilised again and again.
These programmes are vital but are no longer able to take us to elimination. Yet, I believe that malaria elimination could be within reach. Gene drive, if proven safe and effective through rigorous research, offers something different: a self-sustaining intervention on the vector – not requiring any changes from humans – that complements existing tools rather than replacing them.
The survey’s findings on refugee settlements — where malaria persists despite net distribution — illustrate exactly the contexts where additional tools could matter most.
THE PATH FORWARD
Responsible research must be transparent, community-centred, and safety-first. Target Malaria has been conducting stakeholder engagements across Uganda precisely for this reason.
But let’s also be honest about the alternative: we are losing ground, and the mosquitoes are not waiting. Uganda’s malaria elimination strategic plan aims for zero deaths by 2030. Achieving it requires everything we have — stronger health systems, continued net distribution, better treatments, and bold new science.
The evidence from this survey is clear: we need more tools in our toolbox if we are to ever defeat this number one killer in Africa.
The writer is a data scientist, Target Malaria Uganda, Uganda Virus Research Institute (UVRI)
