1. What is the immediate impact that reduced funding is seeing on the Malaria Control programme worldwide? How does this adversely impact key high stress countries like India and African countries?
According to a recent study by Oxford Economics, the United States disbursed ~$15.6 billion for malaria control through the Global Fund (GF) and the U.S. President’s Malaria Initiative (PMI) from 2003 to 2023, around 27% of total global malaria funding over that timeframe. This resulted in reducing malaria cases, improved quality of life for millions of people, and created more stable and resilient countries. It’s been estimated by the World Health Organization that 2.2 billion cases and 12.7 million deaths have been averted since 2000 due to the concerted action of Western governments.
Malaria control programs in India are likely to be less adversely impacted because PMI/USAID targeted African countries is where 95% of malaria deaths occur. Of more long-term concern is the impact that reduced funding of malaria R&D by the U.S. National Institutes of Health and Centre for Disease Control will have on partnerships between Indian and American scientists, for example the Fogarty International Center research and training grants and International Centers of Excellence for Malaria Research, which have been in operation for many years, training and teaching the next generation of malaria researchers.
However, now we see an immediate impact of U.S. aid cuts upon malaria control and surveillance programmes particularly in African countries. We are hearing from our collaborators in Ethiopia that due to the closure of PMI offices, the supply chain of bednets has been halted. And the malaria control activities in the two highest malaria-burden regions in Ethiopia, Gambella and Benshangul Gumuz, have been stopped. A plan to investigate an outbreak of malaria in the capital Addis Ababa supported by PMI has been halted. Our collaborators in Uganda are telling us that indoor residual spraying funded by PMI has been stopped, and that personnel in charge of medical services at refugee camps are being laid off and won’t be able to supply antimalarial drugs being used for test and treat in the population.
Why is malaria still a threat despite the aggressive, sustained battle against it on all fronts, including research, containment, drugs and prevention mechanisms etc. ?
The malaria parasite is a crafty beast. It is highly genetically variable and has evolved resistance to almost every antimalarial drug that has been developed. It also evades the human immune system by changing the proteins on its surface so that the immune system can no longer recognise it. The Anopheles mosquito that transmits it has also developed resistance to many of the insecticides that are used to prevent people from being bitten. And let’s not forget that malaria is a disease that afflicts the most vulnerable in resource-poor regions that do not have access to good healthcare. So there is a perfect storm of the complexity of malaria that has meant its elimination is much more challenging than other infectious diseases.
What are the newest tools available to us to fight malaria worldwide?
Very excitingly there are now two WHO-approved malaria vaccines, RTS.S and R21-M, which are recommended for use in children in endemic countries in Africa. There is evidence in early studies that malaria has reduced in the children that received the vaccine. Of interest too, are a new generation of bed-nets that are dual-ingredient insecticide-treated and are expected to mitigate insecticide resistance in mosquito populations in sub-Saharan Africa and elsewhere. And in certain countries there have been development of specific, tailored elimination programmes, such as the successful Durgama Anchalare Malaria Nirakaran (DAMaN) programme in Odisha, India, in hard-to-reach and inaccessible regions.
What is the latest development in technology to detect and contain this menace?
At the Johns Hopkins Malaria Research Institute we are developing and characterising genetically modified strains of Anopheles mosquito that prevent the malaria parasite from developing within them. We are also developing AI methods to discover biomarkers in the blood of malaria patients that can be developed into better diagnostic tests. And we are leveraging the research developed during the COVID-19 pandemic to develop mRNA vaccines that are an improvement upon the current two available today.
Has malaria crossed zones and countries that were previously untouched?
Historically yes, malaria was likely introduced to the Americas during the trans-Atlantic slave-trade in the 16th, 17th and 18th centuries. And with the increases in temperature due to climate change, the flight and breeding range of Anopheles mosquitoes will likely move, with the possibility of malaria parasite transmission in areas that used to be malaria-free. We also know that a species of Anopheles mosquito, An. stephensi, common in Southeast Asia, has recently invaded parts of countries in the horn of Africa, bringing with it the possibility of increased urban malaria cases in the towns and surrounding regions there.
Published – April 25, 2025 07:00 pm IST