We need to move beyond aid and work together

In the fight against malaria, new and emerging threats make the case for renewed investment stronger than ever.

But the global malaria response is facing significant funding cuts. A brewing source of concern is the ever-increasing presence of parasite resistance to artemisinin, a critical compound in artemisinin-based combination therapies (ACTs) and in severe malaria treatments. If this resistance leads to treatment failure across many parts of Africa, as it previously did in southeast Asia, a public health crisis could break out.

Should these threats take root, the resulting resurgence of resistant malaria would have devastating consequences both for human development and socioeconomic progress. The failure to act today will not only squander past gains, but it may also lead to much greater spending down the line. 

Yet, the challenge of funding cuts also presents a chance to reset. The pullback in funding has opened a gap in which we have been able to question our deeply entrenched reliance on aid. It offers a chance to reimagine how we sustain progress, not by simply plugging the aid gap, but by creating something more resilient and enduring.  

The ambitious target of malaria elimination by 2030, though well-intentioned, is looking increasingly unfeasible. We need a new roadmap towards malaria elimination that makes the best use of aid and, at the same time, moves beyond aid dependency. We must lean into innovation, strengthen cross-sector collaboration and build sustainable financing approaches.  

Moving beyond dependency 

Traditional aid has been instrumental in driving down malaria case numbers and malaria deaths. But as the future of aid becomes less certain, so too does our ability to plan and deliver lifesaving interventions.  

Financial resilience must become the foundation of future malaria responses. This means building and blending public, private and philanthropic investments in a way that can withstand shocks and deliver value for money.  

We’ve seen what is possible. In Mozambique, Nando’s Fighting Malaria initiative is a blended financing model, combining a public-private partnership with the Goodbye Malaria campaign, and is a perfect demonstration of how unconventional collaborations can drive progress.   

Another is Malaria Consortium’s programme with Nigeria’s National Malaria Elimination Programme: the Support to National Malaria Programme 2 (SuNMaP 2) supported by the UK government. The project provided support to the national government to alleviate Nigeria’s malaria burden, helping to fund malaria interventions and also increase funding from within Nigeria to fight malaria. Malaria Consortium collaborated with the national programme to introduce two subsidy schemes for antimalarial medicines, significantly reducing the cost of quality-assured artemisinin-based combination therapy (ACTs) and increasing its availability.  

The power of joined forces  

Infectious diseases do not respect national borders, and in the quest to eliminate malaria, borders often pose more of a hindrance than a help. The JC Flowers’ Foundation’s Isdell:Flowers cross-border malaria initiative understands this well. The programme works across national boundaries to address malaria transmission zones which span multiple countries.  

Another inspiring example is the SMC Alliance, a collaborative network that brings together  national malaria control programmes, international technical partners, donors and research institutions to coordinate  seasonal malaria chemoprevention (SMC) campaigns to protect children from malaria. Even during the Covid-19 pandemic, the collaboration showed consistent increases in SMC coverage and is a testament to the power of united efforts in the face of global challenges.  

But to scale these efforts, we must go further. We need greater alignment between donors and a renewed focus on avoiding overlap. We must prioritise cost-effective interventions and maximise value to address the constrained financing context we are in.  

These principles are at the heart of the Lusaka Agenda — a framework that outlines a path towards a future in which countries set their own priorities for their health systems. Regional institutions, such as the Africa CDC, as well as regional economic communities are increasingly supporting this vision by strengthening cross-border collaboration and surveillance and coordinating responses. Yet, to fully realise the promise of these efforts, we must invest in systems that enable countries to learn, adapt and share lessons in real time. 

Something that is often missing in global health strategies is a systematic approach to learning and adaptation during implementing. This represents a missed opportunity to capture ways of improving and share lessons across countries facing similar challenges. Supporting countries to invest in systems that learn and improve means we can multiply the impact of every intervention. 

Charting a hopeful path forward  

The challenges we face are considerable. But so are the opportunities.  

We are at a turning point: Will we retreat in the face of aid cuts, or will we build something more resilient, equitable and enduring? 

Smarter investment, innovative collaboration and unwavering focus will bring us closer to the goal of malaria elimination, once and for all.