Even in winter, we continue to see transmission.
Across southern Africa, a disease as old as human civilization is finding new strength in a warming world. Driven by shifting rainfall, rising temperatures, and the compounding force of La Niña, malaria is surging through communities that once believed they had begun to outpace it — threatening not only lives, but the carefully constructed ambition of regional elimination by 2029. In villages like Calcutta in Mpumalanga, and across Mozambique and Namibia, the question is no longer whether climate change reshapes public health, but how quickly health systems can adapt to a threat that no longer follows the seasons.
- Malaria cases in Mpumalanga quadrupled in a single month, while Mozambique recorded 1.35 million cases in just six weeks — numbers that signal a system under acute strain.
- Warmer temperatures and heavy flooding are not merely spreading mosquitoes but accelerating the parasite's development inside them, collapsing the seasonal boundaries that once gave health workers a predictable window to act.
- Even Gauteng — South Africa's urban economic core, historically free of endemic malaria — recorded over 400 cases and 11 deaths in early 2026, signaling the disease is breaching its traditional frontiers.
- Flooded roads cut off remote communities from spray teams and medicine, extreme heat breaks vaccine cold chains, and community skepticism about insecticide safety leaves some households unprotected despite the mounting toll.
- South Africa's 2029 malaria elimination target, once an ambitious but plausible goal, is now in serious jeopardy as climate volatility rewrites the conditions under which every intervention was designed.
In Calcutta, a small village in Mpumalanga, 63-year-old retiree Paulina Mhlongo watched health workers move through her home with insecticide sprayers — the first real protection her household had ever received beyond a rattling fan. Her grandson nearly died from malaria the previous year, and she understands what is at stake. Across southern Africa, the disease is surging in ways that are beginning to overwhelm health systems and unravel years of progress toward elimination.
Mpumalanga sits at the core of South Africa's malaria belt, where heavier rains create breeding pools and rising temperatures shorten the time mosquitoes and parasites need to mature. Cases in the province jumped fourfold in January alone. The crisis reaches beyond South Africa: Namibia saw a 68 percent year-on-year rise in early 2026, while Mozambique — battered by flooding — recorded over 1.35 million cases in six weeks, up 55 percent, with dozens of deaths. A combination of human-driven climate change and a La Niña weather pattern intensified both the rains and the transmission that followed.
Professor Jantjie Taljaard of Stellenbosch University cautions that malaria is not so much spreading to new territories as being supercharged where it already exists — with longer transmission windows and more intense outbreaks. The old assumption that malaria was a summer disease, confined to known seasons and zones, no longer holds. Mpumalanga's malaria programme manager describes a reality in which even winter now carries risk.
At a clinic in the region, laboratory technicians process an ever-growing volume of blood slides, staining each one to reveal the parasite beneath the microscope. The science is sound, but the logistics are fracturing. Flooding prevents health workers from reaching isolated communities. Heat disrupts the cold chains medicines depend on. And in some households, distrust of insecticide spraying means residents turn workers away, even as preventable deaths accumulate.
Back in Calcutta, after the spray team finished their work, Mhlongo offered them a homemade snack and listened as they pointed out empty beer cans nearby — potential breeding sites she had not considered. She grasped the lesson quietly. Her village stands at the intersection of climate volatility and disease, and the outcome of that collision remains unresolved. South Africa's health system is racing toward a 2029 deadline that grows harder to reach with every unpredictable season.
Paulina Mhlongo watched from her doorway as health workers in protective gear moved methodically through her nine-room house in Calcutta, a small village in Mpumalanga province, spraying insecticide across the walls. Until that day, her family's only shield against malaria-carrying mosquitoes had been a rattling fan. The 63-year-old retiree knows what the disease can do. Her teenage grandson nearly died from it last year, one of more than a quarter-million people who succumb to malaria annually worldwide. Now, as climate patterns shift across southern Africa, the disease is surging in ways that have begun to overwhelm the region's health systems and threaten carefully laid plans to eliminate it entirely.
Mpumalanga sits at the heart of South Africa's malaria belt, a zone where changing rainfall and rising temperatures have created conditions that mosquitoes find irresistible. Heavy rains pool into breeding grounds for eggs. Warmer air accelerates how quickly mosquitoes develop and shortens the time the malaria parasite needs to mature inside them. In January alone, cases in Mpumalanga jumped fourfold compared to the same month a year earlier, according to the National Institute for Communicable Diseases. The surge threatens South Africa's goal of eliminating malaria by 2029. Even Gauteng, the country's economic heartland where malaria has never been endemic, recorded more than 400 cases and 11 deaths in the first three months of 2026—a troubling sign that the disease is no longer confined to its traditional strongholds.
The crisis extends far beyond South Africa's borders. Namibia reported 8,760 cases in the first four weeks of 2026, a 68 percent jump from the previous year. Mozambique, battered by flooding, recorded more than 1.35 million cases in just six weeks, up 55 percent year-over-year, with dozens of deaths reported. The culprit is a combination of human-driven climate change, which has intensified extreme weather patterns, and a naturally occurring La Niña phenomenon that brought above-average rains to parts of southern Africa in early 2026. The flooding created vast new mosquito breeding sites, and the warmer temperatures that followed accelerated transmission.
Professor Jantjie Taljaard, head of infectious diseases at Stellenbosch University, explains that malaria is not migrating to new regions so much as being supercharged in the places where it already exists. Climate change is lengthening transmission windows and intensifying outbreaks in established hotspots. Rural areas and communities on the margins of known malaria zones face the highest risk. The old certainty—that malaria was a summer disease, confined to specific seasons—no longer applies. Sharon Lindiwe Nyoni, the malaria programme manager at Mpumalanga's health department, describes the challenge plainly: with climate change, everything unfolds unpredictably. Even in winter, transmission continues.
At Cunningmoore Clinic, technicians Nicholas Skhumbane and Armstrong Mgiba work in a threadbare laboratory, processing blood samples from surrounding villages with the same precision as facilities 50 kilometers away. They add drops of Giemsa stain—a purplish-blue dye that reveals malaria parasites—and examine each slide under a microscope. The results come back quickly, but the volume keeps climbing. For health officials, the shifting weather patterns demand a complete rethinking of malaria strategy. The old playbook no longer works.
The practical challenges are mounting. Flooding makes it impossible for health workers to reach remote communities to deliver control measures. Extreme heat can break the cold chain that vaccines require, preventing them from reaching clinics in isolated areas. And then there is the problem of community trust. Some residents remain skeptical about the safety of insecticide spraying and refuse to allow health workers into their homes, even as preventable and curable cases mount. Virologist Edina Amponsah-Dacosta notes the painful irony: watching someone die from a disease that can be stopped.
Back in Calcutta, as the sharp scent of insecticide drifted from her freshly sprayed house, Mhlongo expressed quiet relief. She served the spray team a homemade snack of maize meal, sugar, and groundnuts. The workers had warned her about empty beer cans stacked in the back of a nearby pickup truck—another place mosquitoes could breed. She understood the stakes. Her village sits at the intersection of climate volatility and disease, and the outcome remains uncertain. South Africa's health system is racing against a deadline that grows more difficult to meet with each passing season.
Notable Quotes
Climate change is supercharging existing hotspots and lengthening transmission windows, fuelling far more intense outbreaks.— Professor Jantjie Taljaard, Stellenbosch University
With climate change everything is just unfolding. The old assumption that malaria is confined to summer no longer holds.— Sharon Lindiwe Nyoni, Mpumalanga health department
The Hearth Conversation Another angle on the story
Why is malaria suddenly appearing in places like Gauteng where it was never a problem before?
It's not really appearing there—it's being imported. Most of those cases came from people traveling from known hotspots. But the fact that even imported cases are taking hold in a province that has no endemic transmission is a warning sign. It means the climate is shifting in ways that could eventually make transmission possible there too.
So climate change isn't creating malaria, it's just making the existing problem worse?
Exactly. The disease has always been in southern Africa. What's changed is the intensity and the timing. Warmer temperatures and heavier rains are creating ideal breeding conditions and extending the season when mosquitoes can transmit the parasite. It's like turning up the volume on something that was already playing.
The article mentions people refusing to let health workers spray their homes. Why would someone reject help when the disease is so dangerous?
There's skepticism about the safety of the insecticide itself, and also a broader trust issue. When you live in a remote area and health systems have been underfunded for years, you develop a certain wariness. But it's heartbreaking for the health workers—they know these interventions work, and they're watching preventable deaths happen.
What does the flooding have to do with it?
Flooding creates standing water, which is where mosquitoes lay eggs. But it also makes it harder for health workers to reach communities to spray homes or distribute nets. And if it's extreme heat, it can destroy vaccines in transit because they need to stay cold. So climate change creates the problem and simultaneously makes it harder to fight.
Is South Africa going to meet its 2029 elimination goal?
Not at this pace. The surge in cases, the unpredictability of climate patterns, the logistical challenges—it all points toward a much longer fight than anyone planned for. The health officials are essentially trying to hit a moving target.