A 30 per cent reduction in malaria financing would trigger 146 million additional cases across Africa by 2030, nearly 400,000 deaths, and $37 billion in lost economic output, according to projections released Friday by the African Leaders Malaria Alliance. The stark warning came during a high-level event at the 81st United Nations General Assembly, where African leaders confronted a widening gap between ambitious health goals and the fiscal reality of declining international assistance.
The event, titled "Africa's Leadership for Sustainable Malaria Financing: A Multisectoral Path to Elimination," was hosted by President Advocate Duma Gideon Boko of Botswana, who chairs ALMA, in partnership with the African Union Commission and the RBM Partnership to End Malaria. African leaders used the platform to call for stronger domestic financing, multisectoral action and deeper collaboration to protect gains made in the fight against malaria.
The Funding Crisis
Africa currently accounts for 94 per cent of global malaria cases and 95 per cent of malaria deaths. Progress has stalled, with the risk of a resurgence amid major financing shortfalls, extreme weather events, growing resistance to insecticides and medicines, and humanitarian crises. Recent Global Fund and Gavi replenishments fell short of their targets, while official development assistance for health in Africa continued to decline.
The leaders urged African countries to institutionalise malaria financing within national budgets and development plans. They called on development partners to provide predictable support during the transition. African countries should include malaria control in their World Bank IDA21 health compacts, the leaders said, and urged the World Bank to consider a dedicated Malaria Booster Programme under IDA22.
Domestic Responsibility and Fiscal Constraints
Boko said Africa had the tools, experience and leadership to change malaria's trajectory but needed sustainable financing and collective action to match its ambition of a malaria-free future. He urged countries to pursue a managed transition towards sustainable domestic financing while strengthening political commitment to malaria elimination.
Muhammad Jallow, Vice President of The Gambia, cautioned that domestic financing alone wouldn't be enough to sustain the level of investment required to achieve malaria elimination. "We must be mindful of the fiscal constraints facing many of our countries. Domestic financing alone can not sustain the level of investment required to reach elimination," Jallow said. He called for stronger international partnerships and predictable financing to support countries through the final stages of malaria elimination.
WHO Director-General Tedros Ghebreyesus said sustained investment remained critical to preventing a reversal of progress against malaria. "When investment is sustained, malaria retreats. When financing falls, it returns," Ghebreyesus said. He said National End Malaria Councils and Funds could provide a practical mechanism for bringing different sectors together to support malaria control and elimination.
Cross-Sector Solutions
"End Malaria Councils bring government, businesses, civil society, and communities around one plan and one financing platform. Every malaria-endemic country should establish and use such a mechanism adapted to its national context," Ghebreyesus said.
Boko said Africa was ready to lead the fight but that malaria elimination remained a shared responsibility requiring sustained global partnership. "Let us finance the fight, bring every sector to the table, and deliver the big push to zero malaria," he said.
Zarau Wendeline Kibwe, Executive Director for the Africa Group 1 Constituency at the World Bank Group, said malaria should remain a priority as countries moved towards negotiations on IDA22. The event also highlighted cross-border collaboration, local manufacturing and innovation as important components of malaria elimination.
Why This Matters:
The $37 billion in projected GDP losses represents a massive economic burden that would compound Africa's existing fiscal challenges and constrain private sector growth. With international aid declining and replenishment efforts falling short, African nations face a critical choice: absorb malaria costs into already strained national budgets or risk a public health reversal that could undermine decades of progress. The call for domestic financing institutionalization reflects a pragmatic recognition that external aid can't be counted on indefinitely, but the fiscal constraints acknowledged by Gambia's vice president highlight the tension between self-reliance and capacity. The emphasis on multisectoral approaches and private sector engagement through End Malaria Councils offers a market-oriented path forward, leveraging business resources and innovation rather than relying solely on government programs. The World Bank's role in IDA21 and potential IDA22 programs will test whether international financial institutions can provide predictable, efficiency-focused support that helps African nations transition to sustainable domestic systems without creating dependency.