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Malaria is a pandemic disease that hits the voiceless hardest: most of those who fall ill and die are small children and pregnant women in Africa. It is the leading infectious killer of the continent, responsible for nearly 600,000 deaths a year. Cases are rising and there is an urgent need for more funding, yet western donor countries are instead cutting back on aid. We still hear brave talk about eliminating malaria. But an expert report now warns of a potential resurgence that could add almost a million more deaths to the annual toll by the end of the decade.
Most of the money to fight the mosquito-borne disease – 59% – comes through the Global Fund to Fight Aids, Tuberculosis and Malaria. Its executive director, Peter Sands, said last week at the World Health Summit in Berlin that of the three killers, the one that kept him awake at night was malaria.
This could be the canary in the coalmine. Malaria kills far more quickly than HIV or tuberculosis. The impact of funding cuts and aid diversions and the scrapping of USAID by Donald Trump, which housed so much global health expertise, will be seen in the malaria figures faster than in most other diseases. But mankind’s despoliation of the environment is also in play.
The climate crisis is altering rainfall patterns and enabling the spread of mosquitoes. The parasites they carry have developed some resistance in east Africa to the artemisinins, the best drugs we have against the disease. It happened with chloroquine and with every other malaria drug, and undermines the effectiveness of artemisinin-impregnated bed nets as well. There was a window of real opportunity while the drugs had full power, but it’s closing. The other hope is vaccines, and some have been developed and rolled out, but although they offer about 50% protection against death from malaria in the first year – for a child fortunate enough to get vaccinated – they do not stop transmission.
Cases surged in 2023, the latest for which we have figures, reaching 263m, which was 11m higher than in the previous year. The report, from a group of agencies including Malaria No More UK and the African Leaders Malaria Alliance, supports the call of the Global Fund for more money. Data analysis shows the damage that will be done if malaria control slips – and the hugely positive impact on African lives and economies if pressure on the parasite can be maintained. Reaching a 2030 annual funding target would save 1.86 million lives and boost African GDP by $231bn, as healthy children stay in school and become economically productive rather than a cost to society. But a 20% cut would lead to 82,000 more deaths and a drop in GDP of $5.14bn. A severe cut in funding would mean 990,000 more deaths as malaria prevention collapses, and a GDP drop of $83 billion.
Worryingly, the second scenario is already on the cards: Germany has promised €1bn to the Global Fund, which is a 23% cut on previous contributions. Malaria is a really hard disease to beat, but it can be done and it would surely be unthinkable to let the killing climb again. The UK, rumoured to be considering a 20% cut, and other countries, must find the funds however tight their budgets, to save voiceless children’s lives.
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