Seeing the Invisible: How African Science Is Helping Us Stay One Step Ahead of Malaria

Why genomic surveillance and therapeutic efficacy studies have become essential tools for protecting the effectiveness of antimalarial treatments

When I began my career in parasitology, I spent hours looking through a microscope. Each slide told the story of a patient with malaria—a drop of blood, a moment in a life suspended between uncertainty and diagnosis. But over time, I came to understand that some of the most important information remained invisible to the naked eye. It was written into the parasite’s very DNA.

This realization gradually led me from the laboratory bench to genomics: to understanding not only whether the parasite is present, but also how it changes and what it might become tomorrow if no one is monitoring it.

Seeing What the Microscope Cannot Reveal

A microscope shows us that the parasite is there. Genomics helps us understand how it evolves and, sometimes, what it might become tomorrow.

Malaria parasites are constantly evolving. Drug resistance never emerges overnight: it develops gradually, mutation by mutation, long before treatment failure becomes apparent in a clinical setting. Waiting until that point to respond often means acting too late.

Today, we have the ability to detect the earliest warning signs before they become a public health threat.

From Research to Decision-Making: Science Does Not Stop at the Laboratory

This conviction guides my work within the REACH programme. Together with our team at the International Centre for Research and Training in Applied Genomics and Health Surveillance (CIGASS), we support several National Malaria Control Programmes across Africa in strengthening their capacity to monitor the effectiveness of antimalarial treatments.

Our support covers the entire scientific process: designing therapeutic efficacy studies (TES), training national teams, ensuring the quality of microscopy, monitoring patients, conducting molecular analyses of parasites, and interpreting results for health authorities.

TES help determine whether recommended treatments are still effectively curing patients. Molecular analyses add another layer of insight: they help distinguish true treatment failures from new infections and enable researchers to identify the earliest genetic markers of resistance before they spread.

Building African Capacity, Not Just Generating Data

Beyond generating scientific data, our goal is to strengthen African capacity for the long term. Every mission is also an opportunity to train biologists, microscopists, laboratory technicians and national programme teams so that they can conduct these activities independently in their own countries, year after year.

This support now extends to several countries—Senegal, Sierra Leone, Liberia, Burkina Faso, Burundi, Guinea and Ethiopia—reflecting a distinctly regional approach. The aim is not to bring in expertise from outside, but to build it together with and for the countries concerned.

Genomic surveillance should do more than give Africa access to technologies developed elsewhere. It should empower African scientists to generate, analyse and use their own data to inform public health decisions and strengthen countries’ ability to shape their own responses to health threats.

When a Discovery Changes How We Monitor Malaria

Recently, our work led to the identification in Senegal of a rare genetic marker associated with artemisinin resistance: Pfkelch13 C469Y. Yet the patient concerned had responded perfectly well to treatment. Clinically, everything appeared normal. Without genomic surveillance, this signal would have remained invisible.

This experience perfectly illustrates why molecular data complement clinical observations: they enable us to anticipate threats before they become visible on a large scale—and therefore before they cost lives.

It is precisely this combination of clinical surveillance, molecular data and scientific expertise that enables national programmes to better understand emerging threats and adapt their malaria control strategies. This approach is essential for making the best use of available resources and directing them where they are most needed, particularly at a time when funding is becoming increasingly constrained.

Why Africa Must Invest in These Approaches

African scientists are now generating high-quality scientific data. Laboratories are in place. Sequencing platforms are available. The expertise is there.

What is needed now is sustained investment, better integration of these approaches into national health policies, predictable long-term funding and stronger regional collaboration. These are essential to ensure that this expertise continues to grow across the continent rather than remaining dependent on external resources.

My Message

I remain deeply optimistic. Across Africa, I meet researchers, biologists, clinicians and programme leaders who are committed to generating high-quality data to better protect their populations. Today, we have the scientific knowledge, expertise and partnerships needed to anticipate threats rather than simply react to them.

Our collective responsibility is now to ensure that every piece of data generated in our laboratories can inform a public health decision and help bring our continent closer to the goal of Zero Malaria.

To achieve this, we must learn to see threats before they become visible. This is one of the strengths of African science: turning invisible signals into decisions that can save lives.