The onset of the malaria season this month signals potential challenges for many regions across Africa, as it remains one of the most lethal diseases on the continent, particularly impacting children. This situation has been exacerbated by the recent decision of the U.S. administration to cut down 90% of USAID’s foreign aid contracts, prompting severe concerns among local health authorities that crucial communities in poverty-stricken areas face impending calamity.
In Uganda, Dr. Jimmy Opigo, the head of the malaria control program, emphasized the urgency of the issue, noting that USAID’s halt in contracts since late January has left them focusing on catastrophic preparedness. The United States has been a primary bilateral source of funding towards anti-malaria efforts in Africa.
Essential tools in the fight against malaria, such as antimalarial drugs and insecticide-treated bed nets, are likened to basic necessities by Dr. Opigo, who highlighted the need for uninterrupted supplies. As stock diminishes due to contract terminations, there is an expectation of surging cases of severe malaria, characterized by severe health issues such as organ failure, for which there is no definitive cure. Although vaccines are being rolled out in some regions, they are imperfect and will likely continue, sustained by a global vaccine alliance.
Research from Malaria No More suggests that disruptions in malaria control efforts might result in an additional 15 million malaria cases and 107,000 deaths globally within a year. The organization has called upon the U.S. administration to reinitiate these crucial programs to prevent potential outbreaks.
Africa comprises 95% of the global malaria mortality rate, with 597,000 deaths in 2023, as reported by the World Health Organization. In countries with the highest malaria burdens, such as Nigeria, Congo, and Uganda, health workers forecast a cascade of detrimental effects due to the termination of U.S. support.
The U.S. had provided significant financial aid, often through non-governmental organizations and philanthropic entities, making prevention and treatment of malaria accessible, particularly in rural areas. In 2023, Uganda experienced 12.6 million malaria cases resulting in nearly 16,000 deaths, affecting primarily children under five and pregnant women. Dr. Opigo stated that the annual financial aid from the U.S. for malaria control was between $30 million and $35 million. Although specific terminated contracts were undisclosed, he mentioned that field research operations were notably impacted.
In Uganda, some of the USAID funding covered mosquito-spraying campaigns designed to preemptively combat mosquito breeding ahead of the rainy season, operations which have been subsequently suspended.
Meanwhile, in Nigeria, which records a quarter of the global malaria cases, concerted efforts have managed to lower malaria-induced fatalities by 55% since the year 2000, thanks in part to U.S. support. In recent years, the U.S. provided approximately $600 million annually in health assistance to Nigeria, though the current status of this aid remains uncertain. Through the President’s Malaria Initiative, significant supplies, including fast-acting medicines and treated bed nets, have been disseminated across Nigeria.
In the Democratic Republic of Congo, U.S. support has amounted to $650 million since 2010, contributing to malaria control successes now under threat. This jeopardizes ongoing efforts to manage and track disease outbreaks in the vast country, which are further complicated by unrest in the eastern regions, leading to the evacuation of some health workers.
In response to the loss of significant U.S. support, it is recognized that many will face hardships, especially those unable to afford treatment. Dr. Yetunde Ayo-Oyalowo from Nigeria, who runs the Market Doctors nonprofit, pointed out that around 40% of the patients served by her organization are diagnosed with malaria.
There is optimism among African health professionals that, despite USAID’s scale-down, U.S. aid might continue through other channels like the Global Fund to Fight AIDS, Tuberculosis, and Malaria. However, this organization also depends heavily on U.S. funds and has yet to respond publicly to these funding cuts. In Uganda, potential assistance might come from institutions such as the U.S. Centers for Disease Control and Prevention and the National Institutes of Health, though Dr. Opigo stressed that managing relations with the U.S. will be crucial going forward.
