Where the cure is failing
Every endemic country shaded by its artemisinin partial resistance status: confirmed, suspected, under surveillance, or no data. Hover or rotate to inspect a country; the panel shows which K13 markers were found and when. The story is a spread from South-East Asia to Africa.
Antimalarial drug resistance, global status
Artemisinin partial resistance and partner-drug failure · drag the globe to rotate
Confirmed resistance
Suspected resistance
Under surveillance
No data or non-endemic
The unfolding crisis
For now, artemisinin combination therapies still cure most infections across Africa. But the warning signs are unmistakable. Modelling suggests that if African resistance reached the levels once seen in Cambodia, the continent could see 78 million extra cases over just 5 years, and treatment failure could climb to about 31% by 2060. The Greater Mekong proved resistance can be contained when it is caught early. The question for Africa is reach.
The spread, from Mekong origins to African soil
How a South-East Asian problem became a continental one
1957Chloroquine resistance first detected on the Cambodia to Thailand border and in Colombia, later sweeping across Africa.
2008Artemisinin resistance confirmed in western Cambodia, the start of the modern crisis.
2010K13 C580Y emerges independently in Guyana, proving resistance can arise anywhere, not just spread from Asia.
2014The R561H mutation appears in Rwanda samples, the first clear evidence of artemisinin partial resistance in Africa.
2016 onIndependent foci ignite across the Horn of Africa and East Africa: Eritrea, Ethiopia, Uganda, the Sudan, Tanzania.
2024Four African countries now have confirmed resistance and four more are suspected, even as the Mekong nears elimination.
The molecular fingerprints
Resistance is tracked through PfKelch13 (K13) mutations and therapeutic efficacy studies. When cure rates fall below the 90% threshold, treatment guidelines must be reviewed. Here is the African watchlist, the markers detected, and where treatment is already faltering.
African watchlist: confirmed and suspected countries
Validated K13 markers and the year resistance was documented
| Country | Status | K13 marker | Documented | Notes |
|---|---|---|---|---|
| Rwanda | Confirmed | R561H | 2013 to 2015 | First African focus; ring-stage assays confirm reduced DHA susceptibility |
| Uganda | Confirmed | A675V, C469Y | 2016 to 2022 | Multiple independent origins; delayed parasite clearance documented |
| Tanzania | Confirmed | R561H | Kagera, north-west | Spread in the Lake region bordering Rwanda and Uganda |
| Eritrea | Confirmed | R622I | 2016 onward | Resistance paired with HRP2-negative parasites that evade rapid tests |
| Ethiopia | Suspected | R622I | Horn of Africa | Resistance plus diagnostic escape; over 5% marker prevalence at sites |
| The Sudan | Suspected | R622I | South-east | High prevalence of artemisinin-resistant parasites reported in 2025 |
| Namibia | Suspected | candidate K13 | recent surveys | Sites reporting over 5% prevalence of validated or candidate mutations |
| Zambia | Suspected | candidate K13 | recent surveys | Sites reporting over 5% prevalence of validated or candidate mutations |
Beyond Africa: the Greater Mekong (Cambodia, Myanmar, Thailand, Viet Nam, Lao PDR) remains the historic epicentre with the C580Y marker. The Guianas (Guyana, Suriname, French Guiana) carry piperaquine partner-drug resistance, and Papua New Guinea shows C580Y at low frequency.
WHO World Malaria Report 2025, Chapter 7, Fig. 7.2; Malaria Threats Map
The partner drugs are under pressure too
Share of recent African efficacy studies exceeding the 10% treatment-failure threshold
WHO global database on antimalarial drug efficacy; since 2019, AL failure over 10% at sites in Angola, Uganda and Tanzania
What unchecked spread would cost
Modelled P. falciparum treatment-failure rate in Africa if resistance is not contained
Modelled projection, Watson et al.; up to about 31% treatment failure by 2060, over 50 million failures in that year alone
The second front: insecticide resistance
The drugs are only half the story. The mosquitoes that carry malaria are themselves evolving past the insecticides on our nets and sprays. Resistance to at least one insecticide is now confirmed in 83% of reporting countries, and an invasive urban vector is spreading across the Horn of Africa.
Insecticide resistance by class
Share of monitored countries with confirmed resistance at one or more sites (2020 to 2024)
WHO World Malaria Report 2025, Chapter 6.3; pyrethroids are the insecticide on every prequalified net
An. stephensi: the invasive city mosquito
An efficient urban vector, resistant to multiple insecticide classes, marching across Africa
2012First detected in Africa, in Djibouti.
2016Ethiopia and the Sudan report the vector.
2019 to 21Spreads to Somalia, Nigeria, Eritrea and Yemen.
2022Reaches Ghana and Kenya.
2024Detected in the Niger, returning to West Africa.
Why this matters
Insecticide-treated nets drove a 70% fall in African malaria cases between 2000 and 2015, and pyrethroids coat every prequalified net. As pyrethroid resistance becomes near-universal, programmes are switching to costlier dual active ingredient nets, which rose from 8% of deliveries in 2022 to 47% in 2024. The tools still work, but only if the right ones reach the right places before resistance outruns them.
Kenya: encircled, watching, not yet confirmed
Kenya has no confirmed artemisinin partial resistance, and artemether-lumefantrine remains its first-line cure. But it sits inside a ring of trouble: Uganda and Tanzania to its borders are confirmed, Ethiopia and the Sudan to the north are suspected, and the invasive An. stephensi mosquito arrived in 2022.
The neighbourhood
Resistance status of the countries around Kenya
| Country | Direction | Status | Marker |
|---|---|---|---|
| Uganda | West border | Confirmed | A675V, C469Y |
| Tanzania | South border | Confirmed | R561H |
| Ethiopia | North | Suspected | R622I |
| The Sudan | North-west | Suspected | R622I |
| Rwanda | Regional | Confirmed | R561H |
The exposure: validated resistance markers now sit on three of Kenya's borders. Cross-border movement and shared parasite populations mean a confirmed focus next door is a standing risk at home.
Kenya's standing
Status, tools and the watch ahead
Western Kenya TES 2016 to 2017 found AL and DHA-PPQ treatment failure under 10%; An. stephensi confirmed in Kenya in 2022
The Willow read
Kenya is doing the right things: artemisinin combinations still cure, surveillance is active and net coverage is high. But three of its neighbours carry confirmed or suspected resistance, and a drug-and-diagnosis-evading mosquito has already crossed the border. The window to invest in genomic surveillance and frontline efficacy testing is now, while the cure still works.