Can you stop malaria crossing borders? One nation’s bid to wipe out the disease

Eswatini, a landlocked African nation of 1.2 million people, is intensifying efforts to eradicate malaria amid rising challenges such as climate change, insecticide resistance, and economic migration. After four years without any reported cases, the country recorded 362 confirmed malaria cases in 2024. This resurgence is particularly concerning given Eswatini’s proximity to Mozambique, which reported 11.6 million cases, and South Africa, with 4,639 cases, highlighting the difficulty of controlling malaria across porous borders where informal migration facilitates the parasite’s spread. At the heart of Eswatini’s malaria control strategy is the national insectary in Siphofaneni, where scientists like Nombuso Princess Bhembe rear mosquitoes to monitor species distribution and test insecticide effectiveness. Changing climate conditions have extended the malaria season and created favorable breeding environments, especially during the sugarcane harvest when people are more exposed in the fields. Surveillance teams operate “sentinel sites” to trap and analyze mosquitoes, noting shifts in species that may be linked to rising temperatures and expanding malaria risk zones. The recent detection of malaria in the northern Hhohho region triggered an immediate public health response. After a local woman tested positive, malaria prevention teams quickly mobilized to conduct house-to-house visits, distributing insecticide sprays, tests, and educational materials. Nomcebo Dlamini, chief malaria surveillance officer, emphasized the importance of rapid intervention to prevent wider outbreaks. This proactive approach reflects Eswatini’s commitment to malaria elimination despite the complex interplay of environmental, economic, and social factors that threaten progress. Eswatini’s experience underscores the broader challenge faced by countries aiming to eliminate malaria in regions with high cross-border movement and shifting ecological conditions. The combination of climate change, migration, and resistance to current control methods complicates eradication efforts, requiring coordinated regional strategies and sustained investment. As malaria continues to adapt and spread, Eswatini’s efforts highlight the critical need for vigilance, innovation, and collaboration in the fight against this deadly disease.