'Malaria thrives on chaos' — and the US aid freeze is creating it

The fight against malaria has always been a battle against time — mosquitoes do not wait for bureaucracy, and disease does not pause for policy debates. Now, as a sweeping U.S. aid freeze disrupts critical funding, the clock is ticking louder than ever, and experts warn that the cost of inaction grows with every passing day. Within hours of taking office, U.S. President Donald Trump announced a 90-day freeze on U.S. foreign assistance funding, which was quickly followed by a blanket stop-work order for all implementing partners. Though waivers for lifesaving humanitarian assistance were issued and a federal judge ordered the reversal of the aid freeze on existing programs, malaria advocates warn that the disruptions caused could have a critical impact on malaria programming. USAID’s global health waiver allows a limited set of lifesaving health programs to continue amid the ongoing freeze on U.S. foreign aid. For malaria, this includes diagnosis, treatment, distribution of nets, and indoor spraying in high-risk areas. However, restrictions and operational uncertainties remain. The existence of restrictions, confusion over what is included in the waiver and the disruptions caused by the funding freeze continue to raise concerns among malaria control stakeholders. “The waiver, issued by the State Department for Emergency Humanitarian Assistance, is an important step toward getting malaria medicines to millions of people who urgently need them— mostly young children and pregnant women — across sub-Saharan Africa,” Malaria No More CEO Martin Edlund said in a statement. While further urging the State Department to issue “a start-work order to all programs to begin indoor spraying, net distribution, as well as testing and treatment for malaria,” Edlund noted that “even short-term interruptions of malaria prevention and treatment lead to outbreaks and deaths.” Such disruptions are already being noticed on the front lines. ‘Every day lost makes the comeback harder’ Cameroon was on the eve of launching its seasonal malaria chemoprevention, or SMC, campaign when the funding freeze was announced. Local officials and their international partners, including the U.S. President’s Malaria Initiative, or PMI, had spent months planning the nationwide effort to distribute lifesaving preventive medication to millions of children under 5 — the age group most vulnerable to malaria. Then, suddenly, everything ground to a halt. “Malaria thrives on chaos. … Once you stop prevention, it takes years — and a lot more money — to regain control.” --— John Ameh, a Nigerian malaria control advocate SMC, a preventive treatment given at monthly intervals during peak transmission season to protect young children from malaria, is one of the most cost-effective interventions, reducing cases by 75% for just $1.50 per child per month. Yet, with the abrupt pause in U.S. foreign aid, the program was thrown into disarray just as peak transmission season loomed. “The worst part of it is that we have a timing issue. The rainy season is between July and October, so every single week from now counts. If we miss even one month—if the campaign starts in August instead of July—many children will have already died in July. Just one month’s delay could mean many lives lost,” said Olivia Ngou, executive director of Impact Santé Afrique, and global coordinator of civil society for malaria elimination. Ngou said there is still confusion on the ground about what activities should resume after the waiver was granted. “The waiver is not clear and has not been communicated to all implementers yet,” Ngou told Devex, adding that many activities including the SMC campaign are still on hold. History has shown that even short-term disruptions in malaria control can lead to devastating long-term consequences. In Ethiopia, where the health system was severely affected by conflict, malaria cases surged from less than 1 million cases to more than 7 million cases in a short period. A similar pattern emerged in Uganda when indoor residual spraying was paused for just 10 months — malaria cases increased fivefold. Similarly, during the 2014 Ebola outbreak in West Africa, overwhelmed health systems resulted in 3.5 million additional malaria cases and nearly 11,000 extra deaths. Experts warn that disruptions from the funding freeze, even for a short period, could trigger a similar ripple effect across Africa — overwhelming hospitals, undoing years of progress in malaria elimination, placing millions more at risk, and requiring exponentially greater resources to regain control. “Malaria thrives on chaos,” John Ameh, a Nigerian malaria control advocate, told Devex. “Once you stop prevention, it takes years — and a lot more money — to regain control.” Beyond the immediate health crisis, malaria advocates told Devex the funding freeze has shaken confidence in the U.S. as a reliable global health partner. Ameh noted that governments often allocate domestic resources based on the assumption of continued U.S. support, ensuring that programs such as SMC, bed net distribution, and vaccine rollouts remain fully funded. With U.S. commitments now in question, some governments may be forced to divert funds elsewhere, creating lasting gaps in prevention efforts. The financial disruptions caused by the funding freeze could also ripple into research and innovation efforts — delaying investments in new mosquito control technologies, resistance monitoring, and drug development, said Dr. William Moss, deputy director at the Johns Hopkins Malaria Research Institute. There is also growing concern that the 90-day review of U.S. foreign aid may extend beyond its deadline, which could deepen the crisis. “We have seen this before — these things don’t always restart as quickly as they stop,” a senior health official warned. “And every day lost makes the comeback harder.” “When we invest in fighting malaria, we’re investing in stability.” --— Olivia Ngou, executive director, Impact Santé Afrique The US malaria legacy For decades, the United States has played a pivotal role in the global fight against malaria. On July 1, 1946, the Centers for Disease Control and Prevention was established to fight malaria within the U.S. It stretched its roots through time, weathering seasons, decades, and government changes. During his confirmation hearing as the U.S. secretary of state, Marco Rubio underscored the economic and security benefits of the U.S. leading the global fight against malaria. According to him, malaria is not just a health crisis or humanitarian crisis, it has deep economic implications. He noted that malaria pulls kids out of school for long periods of time, literally setting people and communities back. “People are the greatest resource of any country. And the cost-benefit of an investment, leveraging private partnerships to deal with things like malaria, pays extraordinary dividends if appropriately done and channeled,” he said. Malaria funding has always been more than just aid — it is often regarded as an investment in global stability, economic growth, and security partnerships. “When we invest in fighting malaria, we’re investing in stability,” Ngou said. “A healthy workforce in Africa means stronger economies, fewer health emergencies, and better trade relationships for the U.S. in the long run.” She argued that pulling back now, after years of investment, could undermine decades of progress and open the door for more resilient, insecticide-resistant mosquitoes that are harder to control. “If we don’t finish the fight now, it will cost even more to regain lost ground in the future.” PMI has seen its budget evolve over the years to address the global challenge of malaria. In fiscal year 2023, U.S. funding for malaria control efforts and research activities was about $1 billion. For 2024, the appropriations bill included $795 million for PMI. “We must take control of our own malaria fight. This is the only way forward.” --— Olivia Ngou The push for domestic malaria funding For years, African nations have relied on donor-backed initiatives to drive malaria prevention and treatment. But with U.S. aid in limbo, experts say Africa needs to take greater ownership of malaria financing. In March 2024, months before Trump’s electoral victory, the Yaoundé Declaration was signed as several African health ministers committed to increasing domestic malaria funding. The declaration was heralded as marking a shift from dependency to self-reliance. In Nigeria, the government convened a national malaria roundtable, engaging state governors and private sector leaders to explore sustainable funding sources. “We cannot continue waiting for external funding,” one official remarked. “The lives of our people are our responsibility.” Similarly, Cameroon has adopted a multisectoral approach, bringing together ministries of health, finance, education, agriculture, and the environment to allocate malaria resources. In Uganda, the parliament is mandating that every government ministry contribute to malaria funding, ensuring that malaria interventions are woven into the national budget rather than treated as an externally driven initiative. One of the most ambitious shifts is the push for local manufacturing of malaria prevention tools. Traditionally, bed nets, diagnostic kits, and antimalarial drugs are imported, leaving African countries vulnerable to global supply chain disruptions. Now, local stakeholders are calling for the prioritization of local production, which will reduce costs and ensure uninterrupted access. They believe this move not only secures malaria commodities but also creates jobs and strengthens economic resilience. “We must take control of our own malaria fight. This is the only way forward,” Ngou stressed.