Mitigating Resistance to Malaria Treatments in Sub-Saharan Africa Requires More than New Drugs.

In September 2024, the US President's Malaria Initiative; the Global Fund for AIDS, Tuberculosis, and Malaria; the Gates Foundation; and Unitaid called for malaria partners to increase the availability and lower the cost of alternative artemisinin-based combination therapies (ACTs) for countries with growing evidence of resistance to artemisinin and current ACT partner drugs, particularly in sub-Saharan Africa. Although these global leaders should be applauded for raising this challenge to the highest levels, they missed the opportunity to highlight a major driver of resistance to malaria treatments: the limited access to high-quality health services for malaria. Progress has been made in scaling up integrated community case management and clinical and laboratory quality improvement programs, but few malaria-affected countries have achieved national scale. If affected countries and their partners do not want to confront resistance to these newer alternative ACTs in the near future, they must take more decisive action now to expand access and improve the quality of malaria services.