Malaria remains Africa's deadliest disease as US aid cuts hurt fight

Malaria season begins this month in a large part of Africa. No disease is deadlier on the continent, especially for children. But the Trump administration's decision to terminate 90 per cent of USAID's foreign aid contracts has local health officials warning of catastrophe in some of the world's poorest communities.

Dr. Jimmy Opigo, who runs Uganda's malaria control programme, told The Associated Press that USAID stop-work orders issued in late January left him and others focusing on disaster preparedness. The US is the top bilateral funder of anti-malaria efforts in Africa.

Anti-malarial medicines and insecticide-treated bed nets to help control the mosquito-borne disease are like our groceries, Opigo said. There's got to be continuous supply.

As those dwindle with the US-terminated contracts, he expects a rise in cases later this year of severe malaria, which includes problems like organ failure. There is no cure. Vaccines being rolled out in parts of Africa are imperfect but are expected to largely continue with the support of a global vaccine alliance.

The Washington-based Malaria No More says new modelling shows that just a year of disruption in the malaria-control supply chain would lead to nearly 15 million additional cases and 107,000 additional deaths globally. It has urged the Trump administration to restart these life-saving programmes before outbreaks get out of hand.

Africa's 1.5 billion people accounted for 95 per cent of an estimated 597,000 malaria deaths worldwide in 2023, according to the World Health Organisation.

Health workers in the three African nations most burdened by malaria Nigeria, Congo and Uganda described a cascade of effects with the end of most US government support.

The US has provided hundreds of millions of dollars every year to the three countries alone through the USAID-led President's Malaria Initiative.

The US funding has often been channelled through a web of non-governmental organisations, medical charities and faith-based organisations in projects that made malaria prevention and treatment more accessible, even free, especially for rural communities.

Uganda in 2023 had 12.6 million malaria cases and nearly 16,000 deaths, many of them children under 5 and pregnant women, according to WHO.

Opigo said the US has been giving between $30 million and $35 million annually for malaria control. He didn't say which contracts have been terminated but noted that field research was also affected.

Some of the USAID funding in Uganda paid for mosquito-spraying operations in remote areas. Those operations were supposed to begin in February ahead of the rainy season, when stagnant water becomes breeding ground for the wide-ranging anopheles mosquito. They have been suspended.

We have to spray the houses before the rains, when the mosquitoes come to multiply, Opigo said.

Already, long lines of malaria patients can be seen outside clinics in many areas every year. Malaria accounts for 30 per cent to 50 per cent of outpatient visits to health facilities across the country, according to Uganda National Institute of Public Health.

Nigeria and Congo

Nigeria records a quarter of the world's malaria cases. But authorities have reduced malaria-related deaths there by 55 per cent since 2000 with the support of the US and others.

That support is part of the $600 million in health assistance the west African country received from the US in 2023, according to US Embassy figures. It was not immediately clear whether all of that funding has stopped.

The President's Malaria Initiative has supported Nigeria's malaria response with nearly 164 million fast-acting medicines, 83 million insecticide-treated bed nets, over 100 million rapid diagnostic tests, 22 million preventive treatments in pregnancy and insecticide for 121,000 homes since 2011, the embassy says.

In Congo, US government funding has contributed about $650 million towards malaria control since 2010.

Now, some of the successes in fighting malaria in Congo are being threatened, which will complicate already difficult efforts to identify and track disease outbreaks across the vast country as supplies and expertise for malaria testing are affected.

Worsening conflict in Congo's east, where some health workers have fled, has raised the risk of infection, with little backup coming.

With the loss of substantial US support, a lot of people are going to be affected. Some people are really poor and cannot afford (malaria treatment), said Dr. Yetunde Ayo-Oyalowo, a Nigerian who runs the Market Doctors nonprofit providing affordable local healthcare services.

Up to 40 per cent of her organisation's clients are diagnosed with malaria, Ayo-Oyalowo said.

There is hope among health workers in Africa that, even after the dismantling of USAID, some US funding will continue flowing via other groups including the Global Fund to Fight AIDS, Tuberculosis and Malaria. But that group also received US support and has not issued a public statement on the dramatic cuts in US aid.

Opigo in Uganda said the US Centres for Disease Control and Prevention and the National Institutes of Health might be sources of help.

But he added: We need to manage the relationship with the US very carefully.