Are USAID cuts leading to more malaria cases in Africa?

Malaria is a deadly disease caused by parasites spread through the bites of infected Anopheles mosquitoes - mostly at night, and mostly in sub-Saharan Africa. Cases are both preventable and treatable, but only with sustained funding for mosquito bed nets, insecticides, testing and treatment. However, the numbers are rising fast. Zimbabwe has seen a tripling of infections within the past year, and other parts of the continent are experiencing a similar uptick. One contributor is funding cuts in the United States. Washington has long been the biggest backer of global malaria programmes, but that support has been curtailed. Another factor is that a new species of mosquito vector has stepped into the ring. Jane Carlton is director of the Malaria Research Institute at Johns Hopkins University…

Jane - It's a species called Anopheles stephensi and it's usually found in cities and urban areas in Asia, and it's moved from Asia into the African Rift Valley countries, in particular Ethiopia. This was first found a couple of years ago, so in fact we think the invasion happened perhaps even earlier than that. This is very worrying because it could potentially lead to an increase in malaria cases.

Chris - Do we know why those mosquitoes are able to do what they do?

Jane - The Anopheles species of mosquito which transmit malaria are very prone to becoming resistant to the insecticides that are used either on bed nets—one of the main control methods in many African countries—but also what's called indoor residual spraying, which is the spraying of insecticide either indoors or outdoors on particular structures such as houses. So it's the fact that the mosquito becomes resistant very easily to these formulations of insecticide, which is very worrying.

Chris - Obviously a lot of research that goes into this gets funded from the US. How has the withdrawal of funding—or a lot of the funding being chopped recently—impacted things?

Jane - Terribly, it's awful. The USAID, which was the major programme that the US funded, for example in 2024, provided 270 million dollars for Zimbabwe—just one country—for their health and agricultural programmes. That has pretty much been disbanded now. In particular, the President’s Malaria Initiative, which distributed bed nets, anti-malarial drugs, methods for detecting the parasite, rapid diagnostic tests—all of that has now stopped. Many of these African countries are very worried about what the future is going to hold. It's very unfortunate the way this was done as well. It wasn’t a decrease over time, it was very much a sudden death of these programmes. And now that the malaria season in many African countries is part way through or starting—because of the rainy seasons—we're really starting to see an increase in cases, particularly in Zimbabwe, as you mentioned.

Chris - Do you anticipate, though, that this won’t just be a problem for, say, Africa? Because the thing about infectious diseases is that while they may have a hotbed in one geography, they don’t have to stay there. Very often they will spread, and there are repercussions for other countries, including those that would regard themselves as not really at risk to start with—like America.

Jane - Oh yes, that's very true. In fact, two years ago—I think it was in 2023—we had 10 cases of what's called locally acquired malaria in the United States, several in Florida, and one in my state, Maryland, too. That was unprecedented. We've not had locally acquired malaria cases in the US for the past 20 years. That’s because we do have the right mosquitoes—Anopheles mosquitoes—to be able to transmit malaria parasites. US citizens, when they travel abroad—perhaps back to their original home countries, or for work, or even in the military, for example—will pick up those malaria parasites and bring them back to the US. If a mosquito then bites them and picks up the parasite, it can then transmit it to someone who's never even left the country. So if the number of malaria cases starts to increase in African countries, there’s a possibility that the number of people bringing malaria parasites back into the US will increase. That could potentially lead to more malaria cases.

Chris - Particularly with a more mobile population, because not only are there more people on Earth now, they are travelling in unprecedented numbers. I mean, the figures I've seen quite regularly pop up as something like a million and a half people airborne around the planet on aircraft at any moment in time.

Jane - I think globalisation, as we know, also includes increased travel, which I actually think is, in the long term, a very good thing. But of course, infectious diseases and the vectors—the mosquitoes that carry them—don’t recognise boundaries at all. So you're absolutely right.

Chris - And what do politicians say when you put this to them and say, look, this can be regarded as almost like homeland defence? It’s almost like a security blanket. Chopping this off is punching a gaping hole in that sort of defence—not just for America but for the entire world. So why are they persisting in this course of action?

Jane - It's so short-sighted. It really is. In the long run, I think it's just going to turn around and bite us on the backside. I don’t understand it. I don’t really want to comment on why I think it’s being done. I also know that the international aid budget the US provides is really very small. To target and remove that is incredibly short sighted, in my view.

Chris - So what can we do? I mean, we are where we are. America is where it is. What sorts of things can be done to mitigate the impact of this?

Jane - Well, I know many African countries are now looking internally to see whether they themselves can take over their procurement of bed nets and other control methods. But many of these countries have economies already pushed to the limit. I know Nigeria is another example—it has increased its budget this year in order to provide bed nets, drugs, and other methods of malaria control. Apart from that, I’m not sure what else can be done, really. Many of us here in the United States are continuing our research programmes as much as we can. Obviously, there are some issues with the National Institutes of Health and the funding of those international projects. But we’re just really trying to push through and see what we can do over the next few years to continue to support the work on malaria control in endemic countries.