The withdrawal of US funding could see a worsening of mosquito-borne diseases and a reversal in the progress made in beating the spread, with Zimbabwe now being pummelled by a surge in malaria cases, and the WHO warning that chikungunya is spreading rapidly from several Indian Ocean islands into Africa.
However, scientists and leaders in the field are also optimistic about interventions to help reduce the infection rates, with encouraging results from a study using Ivermectin as a treatment along with other measures.
Cases tripled in Zimbabwe
In Zimbabwe, malaria cases have spiralled, threatening decades of progress, with experts warning that the termination of research funding and a shortage of mosquito nets are risking thousands of lives.
They said efforts to control the disease – which has returned since the funding cuts “with a vengeance” – have been hammered, with 115 outbreaks so far this year compared with only one last year, reports The Guardian.
January’s aid cuts, which included funding for TB, HIV/Aids and malaria programmes, crippled the Zimbabwe Entomological Support Programme in Malaria (Zento) at Africa University in Mutare, which provides the country’s National Malaria Control Programme with scientific research to combat the disease.
Cumulative malaria cases increased by 180% in the first four months of 2025, said the Health Ministry, while the number of malaria-related deaths rose by 218%, from 45 in the same period in 2024 to 143 in 2025. As of 26 June, the number of malaria cases had risen to 119 648, with 334 deaths.
The distribution of essential control methods, like mosquito nets, was also disrupted, leaving hundreds of thousands of people exposed to mosquito bites. The ministry said in May that 1 615 000 insecticide-treated nets were being distributed but that there was a shortfall of 600 000 due to the withdrawal of American funding.
Itai Rusike, director of Zimbabwe’s Community Working Group on Health, said funding shortfalls were jeopardising the country’s significant gains against malaria over the past 20 years.
“If mosquito nets and preventive medicines for pregnant women are unavailable, lives will be lost. When the supply of test kits and first-line treatments is disrupted, malaria cases and deaths will spiral.”
Children under five account for 14% of total malaria cases.
Zimbabwe has set out to eliminate malaria by 2030, in line with the ambitious goal set by the African Union, using various strategies such as raising community awareness, preventing mosquito bites with insecticide-treated nets and spraying, as well as improving surveillance systems.
Dr Henry Madzorera, a former Health Minister, said Zimbabwe should mobilise its own resources to bridge the funding gap.
“We have a lot of taxes earmarked for the health sector – let us use them wisely for health promotion and disease prevention,” he said. “People must be treated early for malaria. The country should not rely on donors to do malaria-elimination activities.”
Zimbabwe’s Deputy Health Minister, Sleiman Kwidini, admitted the funding gap left by the US cuts had disrupted the provision of mosquito nets.
“We are now taking over the procurement of those nets after the US withdrew funding. We have just been disturbed, but our vision is to eliminate malaria by 2030,” he said.
Professor Sungano Mharakurwa, director of Africa University’s Malaria Institute, said that since the Zento mosquito surveillance programme began in Manicaland province, there had been a marked reduction in malaria cases and it was about to be extended when the US cuts came.
Africa University data show that Manicaland recorded 145 775 malaria cases in 2020 but just 28 387 after Zento was introduced in 2021. Cases in the province had been further slashed to 8 035 by 2024 – before more than trebling to 27 212 the next year, when American funding was cut.
Chikungunya alert
Adding to concerns on the continent, the WHO recently issued a warning about a large outbreak of the mosquito-borne virus chikungunya, which it says is spreading rapidly from three Indian Ocean islands to Africa, while parts of South East Asia are also experiencing outbreaks.
The virus is transmitted by Aedes mosquitoes, and people infected with the virus can also transmit it back to mosquitoes that bite them, enabling the virus to spread rapidly.
Dr Diana Rojas Alvarez, WHO lead on arboviruses, said that two-thirds of the population of the French island of Réunion has been infected with chikungunya over the past year, with other large outbreaks on the islands of Mayotte and Mauritius, reports Health Policy Watch.
A large global outbreak 20 years ago affecting about half a million people also started in the Indian Ocean islands, Alvarez said, urging health authorities to be on alert.
Since the beginning of the year, Reunion has confirmed 54 410 cases of chikungunya, with 2 860 visits to the emergency room, 578 hospitalisations and 28 deaths, according to a report issued by the Pacific Community (SPC).
Cases have also been reported in France and Italy in people with no history of travel to the islands, and diagnosis in Europe may be slow, as doctors have little experience with the tropical disease.
Since first being identified in Tanzania in the 1950s, chikungunya has been detected in 119 countries, and about 5.6bn people live in areas at risk for the virus, Alvarez added.
Two chikungunya vaccines have received regulatory approvals in several countries, but have not yet been recommended for global use as there is not enough information about their efficacy yet.
Hope with Ivermectin treatment
On a more positive note, however, some research on treating malaria with Ivermectin has produced encouraging results.
Twenty-five years ago, international organisations, philanthropic foundations, governments of donor nations (especially the US), and Health Ministries in countries where malaria is endemic united to invest in an enhanced approach to control the disease, which included a scale-up of an evidence-based intervention “package” featuring new diagnostics and drugs and vector control with insecticide-treated mosquito nets.
Many countries where malaria is endemic delivered the package with high coverage and achieved remarkable progress. In the 25 years afterwards, elimination of local malaria transmission was reported in 26 countries and certified by the WHO in 18 countries.
Between 2000 and 2023, an estimated 2.2bn malaria infections and 12.7m malaria-related deaths were prevented worldwide.
However, writes Dr Richard Steketee, an independent consultant in Bethesda, in The New England Journal of Medicine, the disease continues to be a public health challenge – the most recent annual estimates showing 263m cases and 597 000 deaths in 2023.
Of these, 95% of cases and deaths occurred in 34 countries (30 in Africa), and each of these countries reported more than 1m cases per year.
In this same issue of the NEJM, writes Steketee, Chaccour and colleagues describe a well-conducted trial of Ivermectin, a low-cost, oral endectocide given to all residents of a community to kill mosquitoes when they ingest human blood containing drug concentrations above a lethal threshold.
This cluster-randomised trial was conducted in coastal Kenya, where malaria transmission remains persistent and intense, despite high levels of reported use of insecticide-treated mosquito nets (77% of the residents in the intervention clusters) and access to malaria treatment.
In short intervals of mass drug administration, all eligible residents in the clusters were given a single monthly oral dose of Ivermectin (at a dose of 400 μg per kilogram of body weight) or Albendazole (the comparison drug, at a dose of 400 mg) for three consecutive months at the start of the “short rains” season.
Among children five to 15 years of age (the primary efficacy analysis population), the incidence of malaria infection was shown to be 26% lower with Ivermectin than with Albendazole.
These findings were not unexpected but were the first to show that seasonal mass administration of Ivermectin on a monthly schedule could be performed in alignment with other malaria or health interventions and provide a further substantial reduction in transmission.
The investigators recognised that the monthly dose would kill mosquitoes for only 10 days after administration and have no killing effect for the remaining two-thirds of the month.
It is conceivable that doses could be given more frequently (a challenge for programme delivery) or that a longer-acting endectocide could be identified through future research, thereby leading to a greater reduction in transmission that exceeds the observed 26%.
The trial participants received the 400-μg-per-kilogram dose of Ivermectin with no unacceptable side effects, a finding consistent with the known safety profile of the drug after more than 4bn doses had been given for other parasitic diseases (e.g, onchocerciasis, filariasis and strongyloidiasis).
The ability of Ivermectin to kill bedbugs, lice and scabies mites, as well as its approval by multiple regulatory agencies, could facilitate its acceptance in a community and incorporation into malaria programmes.
Research on other interventions to decrease parasite transmission continues. For example, a recent trial in Kenya showed that household diffusers that released a mosquito repellent containing transfluthrin reduced the incidence of malaria infection in communities reporting high use of insecticide-treated mosquito nets, with approximately the same degree of reduction as that with mass administration of Ivermectin in the trial by Chaccour et al.
Other strategies designed specifically to reduce transmission are being explored, such as mosquito nets treated with a combination of insecticides, longer-lasting antimalarial agents, the addition of low-dose primaquine to antimalarial treatment regimens, genetic modification of mosquitoes, monoclonal antibodies, and vaccines that prevent malaria transmission (the two approved malaria vaccines reduce illness but not parasite transmission).
Unfortunately, news of this encouraging intervention comes at a dire moment for global public health.
The radical funding cuts in staff, commodities, programme operations, and research have devastated existing malaria programmes in Africa, Asia, and the Americas, as well as the many supporting organisations (e.g, the Agency for International Development, the Centres for Disease Control and Prevention, the National Institutes of Health, the WHO, and the Global Fund to Fight Aids, TB, and Malaria).
Saving young lives
Meanwhile, a major analysis has suggested that the key to survival for the hundreds of children arriving unconscious and unresponsive at African hospitals – often with malaria-related complications – is a quick dose of drugs and fast specialist care.
The survival chances of these of these youngsters, who arrive in these conditions daily at hospitals in parts of Africa, have remained unchanged for nearly 50 years. But recent research suggests a different, simpler, approach could improve those chances, reports The Guardian.
Despite huge strides in healthcare and vaccination rates for children in sub Saharan Africa, the odds remain poor for those who become so ill they fall into a coma. Between 17% and 45% are expected to die. Many more are left with disabilities.
Now researchers have found that giving antibiotics immediately a child arrives at hospital could save tens of thousands of lives a year – and getting them to specialist care quickly could also reduce deaths and disability.
An analysis of multiple studies published in The Lancet Global Health shows that most of these children have a complication of malaria called cerebral malaria. The second most common identified cause is bacterial meningitis.
A second study by the same team, focusing on Queen Elizabeth Hospital in Blantyre, found that one in four children hospitalised in a coma with malaria also had bacterial infection.
“Too often, malaria parasites found in the blood of a sick African child stop medical staff looking for and treating additional bacterial infections,” said Dr Stephen Ray of the Oxford Vaccine Group, the study’s principal investigator.
“You treat the malarial parasites as the cause of the coma, and then actually that becomes a risk factor for dying from a bacterial underlying infection that has been untreated … we need to just make sure everyone who comes in with febrile coma gets antibiotics, as well as anti-malarials.”
Making that standard practice could change how 2.3m children a year in Africa are treated and save more than 20 000 lives, Ray says.
Data are patchy, but studies and doctors’ observations suggest non-traumatic coma is much more common among children in sub-Saharan Africa than it is in the global north.
“A child comes in, unfortunately, quite a lot later down the line than they would in a UK setting,” said Ray. “That can mean at up to a day, or more than a day, of full, deep coma. Completely unconscious, unable to communicate, completely disoriented, with a very high fever.”
Those symptoms would prompt a UK ambulance “within minutes”. In Malawi, it can take days.
“That delay is catastrophic – we showed with brain scans, by the time they get to you, they’ve actually got quite a lot of neurological complications: brain swelling, brain injury,” he adds.
Nurse Alice Muiruri-Liomba said transport is an issue for families.
“We have cases where you have a mother carrying a convulsing child on her back the whole night, walking to a health facility. Then they get there, and in this place you don’t have ambulances … so these mothers are forced to go and source their own transport to a bigger hospital.”
Muiruri-Liomba works at Queen Elizabeth Central Hospital, which is relatively well resourced, boasting the country’s only portable MRI scanner.
District hospitals can be poorly equipped with medicine shortages and basic facilities.
Children will usually have been treated at home, then at a clinic and a district hospital before reaching Queen Elizabeth, Muiruri-Liomba said. “We only take patients to the hospital once they complicate, and what that tells me is that they don’t understand the danger of what malaria is capable of doing, or what a febrile illness leading to seizures and coma is capable of doing.”
Muiruri-Liomba wants to raise awareness both in the community and among health professionals.
“Those children who present late are likely to have a bad outcome,” she said, which could be death or brain damage, probably caused by seizures that have not been managed at an earlier stage.
Dr Tarun Dua, who leads the Brain Health Unit at the WHO, agrees that “systemic challenges or barriers that we see in access to care and delivery” is a key problem.
“In many of the countries in Africa, there is only one child neurologist per 4m population,” she says. “If you think about where neuroimaging is available, it is in the capital or a couple of cities. There is a big rural/urban divide.”
WHO guidelines on meningitis care, updated in April, say children with suspected acute meningitis “need to start empiric antibiotics” before tests.
“Our task is, how do we get countries to implement those guidelines?” says Dua. She is hopeful of technological advances. Low-cost brain scans and better bedside tests are in development.
“Things are moving,” she says. “But I think accelerated action is important.”
However, the WHO and external expert advisors are reviewing trial and post-marketing data to inform possible recommendations for use.
See more from MedicalBrief archives:
More African countries get GSK malaria jab for children
Ghana and Nigeria first countries to approve Oxford’s malaria jab
Malawi starts world-first malaria vaccination drive
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US ending WHO funding may harm African polio, HIV/Aids and malaria programmes
SA could eliminate malaria by 2028 – Health Department