Malaria: The Canary in the Global Health Mine

Global funding reductions threaten progress in the fight against malaria. How will this impact the most vulnerable countries?

When faced with significant achievements, it is essential to harness the lessons learned to build more effective strategies for the future—and to measure the true impact of our efforts. World Malaria Day is a moment to pause, reflect on the progress achieved, and confront the challenges that still lie ahead.

For the first time in 25 years, we are called not only to celebrate milestones—such as new countries reaching malaria elimination and the long-anticipated introduction of vaccines—but also to confront a shifting financial landscape. Today, affected countries are already shouldering approximately 33% of program costs. The impact of two decades of U.S. investments is measurable—not only in lives saved but also in an estimated $90 billion boost to GDP across the investment period.

A Tectonic Shift in Global Health Financing

Yet there are signs of trouble. We are witnessing the early signals of a fundamental shift in the global financing model for health. After 25 years of successful international collaboration—through mechanisms like Gavi, the Global Fund, bilateral aid, and global philanthropy—2024 has marked a reversal. Development assistance to countries has decreased by at least $10 billion.

After 25 years of successful international collaboration, 2024 has marked a reversal. Development assistance to countries has decreased by at least $10 billion

This decline is driven by numerous forces: war, climate change, migration, and mounting domestic challenges in donor countries. It’s important to note that the global malaria effort had never been fully funded to begin with, receiving only about half of the $8 billion required annually.

The Warning Signs Are Already Here

Malaria was among the first to feel the effects. As early as 2017, the global health community began noticing a stalling of progress. The disease has since faced new biological threats—from resistance to existing tools to the emergence of new mosquito species and malaria variants.

The situation has worsened, as wealthier nations now threaten further cuts to funding. Tragically, this comes at a time when new and promising tools—such as malaria vaccines—are ready to be deployed. Meanwhile, many countries outside Africa are on the verge of elimination or have already been certified malaria-free.

Recent “stop-work” orders from the U.S. now threaten to dismantle vital components of malaria programs that depend on external support—from surveillance to procurement and implementation.

Collateral Damage in a Shifting Landscape

Malaria and immunization efforts are both caught in the crossfire—not because they’ve been directly targeted, but as collateral damage in a broader reconfiguration of global health priorities. The consequences will be swift and devastating.

Malaria is, in many ways, the canary in the coal mine of global health. Its trajectory provides an early warning of how changes in funding reverberate across health systems

Malaria control relies on our ability to both prevent infections (via vector control and vaccines) and treat cases (with diagnostics and effective medicines). Any breakdown in these systems can rapidly lead to epidemics and increased mortality—especially among children in Africa. A single year of disrupted malaria programming can reverse years of progress.

Malaria is, in many ways, the canary in the coal mine of global health. Its trajectory provides an early warning of how changes in funding reverberate across health systems.

The Time for Hard Choices—and Shared Responsibility

What we face now demands urgent, agile action. Affected countries must prioritize national funding and make difficult but strategic choices to improve efficiency and preserve impact. But this is not their burden alone.

No single donor, no single government can fill the gap. This must be a shared effort across the global community.

As the British playwright Edward Bond wrote in 1979: “We live in a time of great change. It is easy to find monsters—as easy as to find heroes. To judge rightly what is good—to choose between good and evil—that is all that is to be human.”

In this time of change, we are all part of the decision. And in the fight against malaria, the cost of indecision will be measured in lives.