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[KIGALI, SciDev.Net] After years of progress in reducing malaria cases, Rwanda is confronting a surprising resurgence and signs of treatment resistance that have forced officials to revisit vaccine intervention the country once declined.

Rwanda had recorded steady declines in malaria infections for nearly a decade, with cases falling from nearly five million in 2016, to just 430,000 in 2023 — about a 90 per cent reduction — according to figures from the Rwanda Biomedical Centre (RBC).

But these gains are now under threat, says Aimable Mbituyumuremyi, division manager for malaria and other parasitic diseases at the RBC, Rwanda’s health implementation agency.

In 2024, malaria cases rose by more than 45 per cent in one year, reaching 620,000.

Rwanda had previously opted out of receiving malaria vaccines during the first phase of distribution by the World Health Organization (WHO) and GAVI in 2023, confident in its consistent progress in reducing malaria over the last decade.

“But now, we’re experiencing a surge in the disease,” Mbituyumuremyi said in an interview with SciDev.Net.

“We’re considering using vaccines since all other measures have yet to work and malaria cases are increasing.”

The rise in cases began unexpectedly in January 2024, a time when malaria incidence usually declines, according to Mbituyumuremyi.

“It’s the first time we have experienced an increase in malaria cases in Rwanda since 2016,” he said.

“We’re alarmed that it’s not just a slight increment, but a significant one.”

According to Mbituyumuremyi, the number of annual deaths fell from 650 in 2016 to 67 in 2023, and more than two dozen districts entered the malaria pre-elimination phase.

He said between January and October 2024, the country recorded 620,000 malaria cases, an increase of nearly 200,000 compared to the same period in 2023.

October alone accounted for 112,000 of those cases, with almost 90 per cent of them (about 100,000) concentrated in just 15 of Rwanda’s 30 districts.

“At this time, we never expected such a burden because we were in the pre-elimination phase,” Mbituyumuremyi explained.

“We anticipated a progressive decrease, not even a slight increase.”

So far 17 African countries have rolled out the malaria vaccine with support from the World Health Organization and Gavi, the Vaccine Alliance.

“Now, we would like that consideration to be extended to us as well,” Mbituyumuremyi  added, referring to the distribution of vaccines.

Rwanda’s malaria resurgence comes despite investments in most malaria-prone districts.

Mbituyumuremyi tells SciDev.Net that Rwanda has invested heavily in existing control strategies, such as indoor residual spraying and mosquito net distribution.

He says the country has spent more than US$1.5 million per district on indoor spraying in a dozen districts.

Drug resistance

The RBC says several factors have contributed to the new surge in cases. These include growing mosquito resistance to drugs, shifting mosquito behaviour, and environmental changes that increase breeding sites.

Preliminary data shown to SciDev.Net by the RBC indicates that the effectiveness of the artemisinin drug is diminishing due to resistance.

Additionally, Mbituyumuremyi says mosquitoes are increasingly biting outdoors rather than indoors, raising the risk for people spending time outside at night.

Mbituyumuremyi also expressed concerns over the possible spread of the disease between countries.

“Preliminary investigations indicate that nearly all the most affected sectors are in the cross-border communities of Nyagatare, Gisagara, and Bugesera,” he said.

To combat drug resistance, Rwanda has started using alternative treatments.

“Since the end of last year, we have been receiving new anti-malaria drugs. While Coartem is being used less frequently, it has not been completely phased out. We are implementing a multiple first-line treatment strategy,” he explained.

Despite the setback, Rwanda still aims to be malaria-free by 2030.

Health officials are re-evaluating the country’s strategy, including the possible adoption of vaccines as part of a broader response.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

Here’s some shocking truth: The science showing how poisonous the chemicals in our consumer products are is as strong as the science that led the government to ban lead from gasoline and place warnings about cancer on cigarette packs. Study after study from top-tier journals showcases how phthalates and BPA (both of which are found in cosmetics and personal care products, plus toys and food packaging) disrupt the normal functioning of hormone systems and are linked to cancer, asthma, birth defects, immune system damage, and infertility.

It’s overwhelming to think about how these toxic chemicals plague our lives. But that doesn’t mean we can’t do something about it. Wherever you are in your clean living journey is the perfect starting point. Even I started as a skeptic, so you don’t have to get into full-on activist mode (though I would love that).

None of these suggestions provide a full solution, but I encourage you to pick something to commit to doing regularly. Let’s aim for progress, not perfection. We are all worth the effort. Here are manageable ways to safely shop the market and suss out the greenwashers.

Buy half of what you typically consume.

This is the best and highest-impact way you can help reduce the demand for and use of toxic chemicals. It’s also the simplest. We (including myself) buy too much shit, and every product has impacts on human and planetary health. With the commodification of wellness and health, even of sustainability, we all need to reassess our consumption instead of buying into (literally) the idea that we need every product the market introduces to us.

Buy secondhand.

Repair products (like we used to). Maybe skip an iPhone model or two or three before you purchase your next one. And before you pop that next item into your cart, ask yourself: Do I really need this? If not, what’s the environmental impact if I click “purchase”?

Shop brands and retailers leading the way.

The Mind the Store campaign, created by the grassroots advocacy organization Toxic Free Future, ranks retailers annually based on the strength of their policies to remove toxic chemicals from their shelves. Although a top ranking doesn’t ensure that all of a retailer’s products are toxin-free, you’re voting with your dollar to support those retailers who are stepping up and taking this issue seriously. (Some of the top retailers from 2024 are Apple, Walmart, and Sephora.) Visit retailerreportcard.org for the full list. You can also shop some of my brand and product recommendations by following the frequently updated list at heyhilde.com.

Look for specific certifications.

These certifications—while imperfect—are the strongest for assessing ingredient safety and contaminants: EWG VERIFIED for beauty and personal care products (there is also an app version); MADE SAFE for other product categories like children’s toys and cleaners; EPA Safer Choice for cleaners and other household products; Clean Label Project, which tests supplements and protein powder for over two hundred common contaminants; Cradle to Cradle Certified Gold Material Health (for furniture and building materials); and GreenScreen Certified (for various product categories)

If a brand says its products are “clean” or “sustainable” or uses related marketing language, see if it defines these terms.

One of the best confirmations that a brand is legit is the presence of a dedicated page on its site that defines terms like “clean,” “sustainable,” etc., in detail. Any clean standard should go beyond retailer certifications and include explicit language about how they screen ingredients for safety, as well as details about testing programs (many “clean” brands are not actively screening their own ingredients or testing for things like heavy metals). If the brand sets public goals (such as reducing plastic or working toward climate goals around carbon reduction), it should also have details on how it’s going to hit those goals and transparently track progress. Anything short of sharing these important details is greenwashing.

Be wary of apps that claim to screen products.

Clearya and EWG Skin Deep are the two strongest, science-based apps that assess product and chemical safety. Some others, like Yuka and Think Dirty, are well-intentioned but fail to give you complete and accurate safety ratings. Although most of the consumer apps that cover a variety of product categories (with a heavy emphasis on beauty) were developed by individuals aiming to offer real guidance, their developers have limited, if any, experience in the science of environmental health, product formulation, or accurate assessment of risk.

I’ll give you an example: Yuka and Think Dirty give a “poor” ranking to any product that includes the preservative phenoxyethanol (a compound that EU regulations show can be safely used at concentrations under 1 percent, which is how most brands use it). Most personal care products need a preservative to prevent the growth of mold, yeast, and bacteria to protect the integrity of the formula while also protecting your health. But a few misguided studies about phenoxyethanol that were neither conducted scientifically nor applicable to its use in beauty products have stirred up the internet and led Yuka and Think Dirty to inappropriately ding products that contain the chemical.

Know what to prioritize.

Focus on products that are larger sources of exposure to the most toxic chemicals, items such as couches, mattresses, and cookware. If your budget can cover only some clean beauty products, prioritize the ones that stay on your skin all day (lotion, makeup) and worry less about those that rinse off, such as shampoo and conditioner. And know that safer does not always mean expensive; good old-fashioned white distilled vinegar (acidic, antimicrobial) is an effective way to clean your countertops, floors, and toilets. Perfection and total control are illusions—and it’s better to do something than nothing at all.

Cleaning House: The Fight to Rid Our Homes of Toxic Chemicals by Lindsay Dahl

Adapted from the book Cleaning House: The Fight to Rid Our Homes of Toxic Chemicals by Lindsay Dahl. Copyright © 2025 by Lindsay Dahl. Reprinted by permission of Dey Street Books, an imprint of HarperCollins Publishers.