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  • NAPHS Development, 2025.

    NAPHS Development, 2025.

    NAPHS 2025.

    Lilongwe, Malawi – May 28th, 2025.
    by
    Moses Nyambalo Phiri in collaboration withGrace Choo and Settie Kanyanda.

    On 26th May, a crucial workshop kicked off in Mponera, Dowa district, marking a significant step forward in Malawi’s health security. The Public Health Institute of Malawi (PHIM), with support from the World Bank and the Tackling Deadly Diseases in Africa Program (TDDAP), hosted a fundamental workshop focused on developing the nation’s National Action Plan for Health Security (NAPHS).

    A Unified Approach to Public Health, The NAPHS is a strategic framework that ensures a unified and comprehensive approach to public health, directly aligning with the International Health Regulations (IHR 2005). This current workshop built upon insights gained from a Joint External Evaluation (JEE) conducted in December 2024, which assessed Malawi’s health security across 19 technical areas, including prevention, detection, response, and other hazard management. Dr. Wilfred Chalamira on behalf of the Director for PHIM welcomed the participants and emphasised the importance of the event as it will have overall impact of the nations health.

    Multi-Sectoral Collaboration for “One Health”
    A diverse group of representatives from key government ministries and departments participated in the four-day orientation. Officials from the Ministries of Justice, Agriculture, Natural Resources and Climate Change, Gender, Community Development and Social Welfare, Treasury, and the Malawi Police Service, among others, highlighted the essential multisectoral nature of health security. This wide-ranging engagement directly addresses the identified need to strengthen coordination structures across different sectors at national and sub-national levels to implement a “One Health” framework.

    Deep Dive into Health Security
    On the first day, participants were introduced to the NAPHS processes, tools, and overall context. Dr. Gertrude Chapotera from WHO provided an introduction to the NAPHS, while Dr. Herbert Bakiika from the Infectious Diseases Institute (IDI), Uganda, demonstrated the application of NAPHS development templates. The afternoon was dedicated to the critical task of selecting and identifying priority activities, informed by various assessment reports, including the JEE and COVID-19 reports.
    The JEE from December 2024 praised Malawi’s strengths, such as the establishment of PHIM and the operationalization of Public Health Emergency Operations Centers (PHEOCs). Strong capacities in disease surveillance, laboratory services, and multi-sectoral collaboration were also noted. However, the JEE also pinpointed critical areas needing immediate attention, including strengthening legal and regulatory frameworks, ensuring sustainable financing, and expanding training and capacity-building. This workshop directly aimed to address the recommendation to develop a costed NAPHS to outline national IHR gaps and priorities and facilitate resource mobilization.

    Addressing Climate Change and Prioritizing Actions
    The second day saw participants continue to identify and prioritize activities based on comprehensive assessment reports. A significant session integrated Climate Change and Health into the National Action Plan for Health Security, led by Halcycon from Uganda. This integration acknowledges Malawi’s high vulnerability to climate threats, being ranked 5th on the Global Climate Risk Index (2021) and having faced numerous climate-related disasters in recent years. The majority of the day was spent in group work, prioritizing NAPHS activities by technical area, taking into account recommendations from the JEE. For instance, the need to develop and implement a national multi-sectoral strategic plan for Points of Entry (PoEs) was discussed, and efforts to fast-track the enactment of the Public Health Act were highlighted as crucial for strengthening legal instruments.

    Synergies, Coordination, and Costing
    The third day was primarily dedicated to extensive group work, where participants aligned priority actions to identify synergies, prevent duplication, and efficiently compile detailed NAPHS activities. This is especially relevant given the JEE’s findings on fragmented legal instruments for biosafety and biosecurity and the need for a consolidated inventory of high-consequence pathogens. Strengthening multi-sectoral coordination mechanisms was identified as a key priority to promote effective collaboration across different sectors, including developing and formalizing a One Health platform structure.

    On the final day, participants compiled detailed cost assumptions per technical area for each detailed NAPHS activity. The workshop officially concluded with the submission of completed NAPHS templates to the NAPHS Secretariat. This directly addresses the urgent need for a costed NAPHS to facilitate resource mobilization and ensure various sectors mainstream and leverage their resources to address identified gaps. Looking ahead, strategic actions for “Legal Instruments” include engagement meetings with stakeholders and lobbying parliamentary committees for the enactment of the Public Health Act. Further plans include conducting Infection Prevention and Control (IPC), Vaccination & Risk Communication and Community Engagement (RCCE) trainings, extending training for early warning surveillance functions, and increasing national coverage for electronic laboratory information management systems (LIMS).

    Efforts in Biosafety and Biosecurity will focus on consolidating the inventory of high-consequence pathogens and finalizing legal frameworks, ultimately aiming to strengthen the linkage between public health and security authorities for a rapid multisectoral response to suspected or confirmed biological, chemical, or radiological events.

  • PHIM Enhances Chitipa and Karonga Preparedness and response capability for Cholera, Mpox, and Marburg.

    PHIM Enhances Chitipa and Karonga Preparedness and response capability for Cholera, Mpox, and Marburg.

    Cholera, Mpox, and Marburg Training.

    Chitipa, Malawi – March 7th, 2025.
    by
    Moses Nyambalo Phiri in collaboration with Chriswell Nkoloma and Settie Kanyanda.

    In a proactive approach to enhance the country’s response to public health emergencies, the Public Health Institute of Malawi (PHIM), with support from AMREF, conducted crucial training sessions in  Karonga and Chitipa districts. These sessions focused on cholera, Mpox, and Marburg.

    These activities aim to ensure that healthcare workers can effectively manage cases, strengthen surveillance and contact tracing, improve laboratory diagnostics, and educate communities on preventive measures for Mpox, Marburg, and Cholera.

    From May 6th to 7th, 2025, Public Health Emergency Management Committees and District Rapid Response Teams in the two districts were refreshed on their roles and responsibilities. Subsequently, from May 8th to 14th, frontline healthcare workers, including clinicians, nurses, health surveillance assistants, laboratory staff, and data clerks, received specialized training on sample collection, clinical case management, data reporting etc.

    Mr. Chriwell Nkoloma presenting on Mpox Global Overview and Malawi Situation to the Chitipa DRRT.

    Officers from the national level, comprising experts from various pillars such as Case Management, Surveillance, Laboratory, IPC, Vaccination, RCCE, and Points of Entry, facilitated the PHEMC and DRRT meetings. District-level staff then conducted further orientations for healthcare workers at the facility level, with participation from the Department of Animal Health and Livestock development personnel.

    The training of frontline health care workers was conducted in 5 sessions for Karonga and 4 sessions for Chitipa, with 181 and 125 participants, respectively.

    Hester Mkwinda Nyasulu, Amref Country Director – Malawi.

    “Karonga and Chitipa districts are the first ever districts to have their frontline health workers trained on Mpox and Marburg, so the future plan is to reach out to all the districts in Malawi with this training.” Remarks from Hester Mkwinda Nyasulu, Amref Country Director – Malawi.

  • Mpox Situation in Malawi.

    Mpox Situation in Malawi.

    Mpox Situation in Malawi – Comprehensive Analysis
    Mpox Issue 73 | Current Status

    Epidemiological
    Intelligence

    Surveillance Update: 20th January, 2026

    PUBLISHED BY

    Moses Nyambalo Phiri

    Executive Case Briefing

    On 18th January 2026, the Public Health Institute of Malawi confirmed a new case in Salima District involving an 18-year-old female. This diagnostic confirmation, occurring 12 days after the initial hospital presentation, underscores the vital importance of molecular validation in managing the current outbreak, which has now accumulated 148 confirmed cases.

    148

    National Total

    01

    New Salima Case

    Clinical presentation of suspected Mpox lesions
    Primary Symptom: Characteristic Cutaneous Lesions

    Fig A: Typical clinical presentation observed in recent Central Region cases.

    Operational Response & Data Insights

    District Sentinel Analysis

    The notification from Salima District hospital on January 6th, followed by PCR confirmation on the 18th, highlights a critical window for containment. The Salima District Rapid Response Team (DRRT) has prioritized contact tracing around this 18-year-old female, who represents a significant demographic shift as younger populations increasingly become points of entry for the virus in rural settings.

    Operationally, the focus is now on “Ring Surveillance.” By mapping the patient’s interactions within the 21-day incubation period, the DRRT is effectively creating a safety perimeter. This prevents the transition from a sporadic case to a localized cluster, which is essential given Salima’s role as a transit and tourism hub that could easily facilitate cross-district transmission.

    One Health Surveillance Matrix

    The activation of the Incident Management System (IMS) signifies a transition to high-alert status. This multisectoral One Health approach is critical because it integrates human clinical data with animal health monitoring. Understanding the zoonotic potential of Mpox in Malawi is key to identifying the environmental reservoirs that might be driving these persistent “sporadic” infections across different districts.

    Furthermore, the IMS structure allows for real-time resource reallocation. As shown in the surveillance matrix, deployment of functional Rapid Response Teams (RRTs) is not static; it follows the trajectory of new confirmations. The training of National Emergency Medical Teams ensures that the surge capacity is prepared for any sudden spikes in severity or volume that may arise as the virus moves through the lake-shore communities.

    Diagnostic Efficiency Trends

    Diagnostic integrity is the cornerstone of the Malawi Mpox response. The PCR-based testing of lesion swabs provides the definitive evidence needed to trigger public health interventions. While the turnaround time for the Salima case reflects the logistical challenges of sample transport from district to central labs, the successful confirmation demonstrates a robust end-to-end diagnostic pipeline that can handle highly infectious specimens.

    Looking forward, the focus is on reducing the “symptom-to-confirmation” latency. By empowering district-level human and animal health workers through advanced training, PHIM aims to improve early suspicion and immediate sample collection. This diagnostic intelligence ensures that clinical management, including isolation and symptomatic treatment, begins at the earliest possible stage, significantly improving patient outcomes and reducing secondary attack rates.

    Specialized Mpox Isolation Units

    Containment Strategy: Infrastructure & Resilience

    The strategic deployment of dedicated Mpox Isolation Units is a vital component of Malawi’s health system resilience. By physically separating Mpox management from general medical wards, PHIM effectively mitigates the risk of nosocomial transmission. These units are not merely physical structures; they represent a specialized clinical ecosystem equipped with advanced waste management protocols and high-frequency disinfection cycles, ensuring that healthcare workers remain protected while delivering intensive supportive care.

    Beyond the immediate benefit of containment, these facilities foster clinical excellence through specialization. Staff assigned to these units are trained in specific lesion care, pain management, and the identification of secondary bacterial infections. This concentrated expertise is particularly crucial for younger patients, such as the 18-year-old from Salima, ensuring they receive evidence-based care in a dignifying and safe environment that prioritizes both physical recovery and community protection.

    Macro-Level Data Analysis

    1. Cumulative Geographic Burden (n=148)

    The distribution of 148 laboratory-confirmed cases reveals a persistent, low-intensity spread that spans across multiple regions. While large urban centers initially dominated the statistics, the recent case in Salima demonstrates that the virus is successfully exploiting mobility corridors. This geographic burden analysis suggests that surveillance cannot be localized; rather, a nationwide “blanket” surveillance approach is necessary to capture infections in districts that may not have high healthcare-seeking behavior but are nonetheless at risk.

    Strategically, this data indicates that the 148 cases represent only the “tip of the iceberg.” For every confirmed case, there is a statistical likelihood of sub-clinical or asymptomatic cases within the community. Public health efforts are therefore prioritizing districts with high population density and frequent transit, using this geographic data to allocate diagnostic kits and protective equipment where they are most likely to encounter the next “sentinel” case.

    2. National Epicurve & Temporal Dynamics

    The national epicurve illustrates the temporal progression of the outbreak since April 2025. Unlike explosive outbreaks, Mpox in Malawi exhibits a “smoldering” pattern, with sporadic cases occurring regularly over several months. The confirmation of Case 148 in late January 2026 confirms that the transmission cycle has not been broken. This trend analysis is vital for predicting seasonal peaks and ensuring that the healthcare system is prepared for sustained engagement rather than a short-term emergency response.

    Mathematically, the presence of the Salima case on the tail end of this curve suggests that the virus remains endemic in certain reservoirs. The epicurve analysis informs our Risk Communication and Community Engagement (RCCE) strategies—shifting from high-volume general awareness to targeted, behavior-change messaging in districts showing new activity. Constant vigilance is required to ensure that this smoldering trend does not ignite into a large-scale resurgence as environmental and social conditions fluctuate.

    Preventative Clinical Directives

    Public Safety Protocols

    • Zero Contact: Avoid all skin-to-skin contact with individuals presenting unexplained rashes or blisters.
    • Sanitization: Mandatory hand hygiene with soap and water or alcohol-based sanitizers in all public transit hubs.
    • Immediate Reporting: Any individual with fever and rash must report to the nearest health facility within 24 hours.

    Surveillance Mandate

    Following the Salima case, PHIM has mandated enhanced surveillance for all district hospitals. Health workers are directed to treat all “Fever + Rash” presentations as suspected Mpox until PCR results prove otherwise. This high-index of suspicion is our primary defense against widespread community transmission.