Despite the onslaught of headlines, we must not underestimate the detrimental impacts of recently announced global health funding cuts by several major donors. International aid contributions by many high-income countries are declining, despite increasing need among the most vulnerable. Historic leaders, including the UK and France, have dramatically scaled back their contributions and US cuts to USAID present a drastic and immediate freeze on billions of dollars.  Global malaria burden was already disastrously off track from the reduction targets set in 2021, and these new cuts will inevitably render such goals unachievable, bringing a harsh spotlight to the precarious nature of aid infrastructure.

This World Malaria Day, we reflect on the acute effects these cuts will have on millions of people worldwide.  Whilst there is still uncertainty about the extent of the changes to come, cessation of thousands of projects and funding for the President’s Malaria Initiative (PMI) has and will continue to cause significant disruptions to routine malaria control programmes - from decreased workforce capacity and disrupted supply chains to weakened outbreak preparedness and surveillance systems. Modelling from the Malaria Atlas Project suggests a 12-month PMI freeze could result in 15 million additional malaria cases and over 100,000 preventable deaths in 2025 alone. We know from experience that previous abandonment of malaria elimination programmes in the 1960s led quickly to decades of avoidable malaria resurgence

As national control programmes, NGOs and humanitarian actors work to collaborate and prioritise efforts to mitigate the impact of these cuts where possible, academia and malaria researchers must also consider their role in this new environment. Malaria research and development funding in 2023 remained below the long-term average, with significant reductions in US CDC contributions (a record low of 0.3 million USD down 93% from 4.2 million USD in 2023).  The two largest funders of research in 2023 were the US National Institutes of Health (29%, 200.6 million USD) and the Gates Foundation (26%, 181.3 million USD) with the UK FCDO contributing 21.1 million USD (3%). Malaria research funding soon will be primarily reliant on philanthropy and industry funding (in 2023 22%,149.8 million USD). This changing landscape raises important questions regarding who will be setting the research agenda and for whose benefit.

As members of the malaria research community, we must be mindful of how we advocate for and shape research priorities- from maximising impact with limited resources, to developing the critical innovations needed to protect and advance progress despite constrained funds. In the face of the pressing need to do more with less, we must not forget the growing risk of biological threats such as drug, diagnostic and insecticide resistance. Thus, it may fall on researchers to maintain focus on surveillance for preparedness and develop strategies for response, especially in contexts of crisis, displacement or fragile health systems. Given the uncertainty of a warming world and the consequences for malaria transmission including spread to regions with previously low incidence, academics will need to work between disciplines to understand potential impacts and solutions to continue the push for elimination.  We must also consider our place within the wider global health landscape, identifying and leveraging synergies with other health programmes such as vaccination and nutrition. Finally, as researchers and academic institutions we need to think more carefully as to how we advocate and use our voices better in order to achieve greater impact, from the use of tangible understandable metrics for risk communication to targeting specific donors to engage on critical topics or contexts.  Underpinning this all, we must maintain a cross-cutting approach and commitment to promoting equity, access and inclusion.

We know the consequences of retreating when the fight is only half over. Stepping back today leaves us at risk of a generational setback, even allowing malaria to re-emerge in areas not affected in decades. Additional proposed funding cuts for climate mitigation and for humanitarian crises, coupled with the economic fallout from malaria resurgence and strain on weakened health systems to manage outbreaks, could have drastic consequences in our increasingly globalised world.

There is no doubt that urgent action is needed to restore funding, prioritise equity, and safeguard innovations. The malaria research community must regroup to resist any erasure of gains and come together to maintain a vision of a malaria-free world.

The LSHTM Malaria Centre is hosting a panel on Friday April 25th 12:30-14:30 to discuss future research priorities for malaria in the face of global funding cuts for aid and disease programming.