African leaders have called for greater domestic financing and stronger action across government and other sectors to prevent a reversal of progress against malaria as international health financing comes under increasing pressure.
The call was made during a high-level side event on the margins of the 81st United Nations General Assembly in New York, where leaders warned that funding shortages, climate change, insecticide and drug resistance, and humanitarian crises are making malaria harder to control.
Africa carries the overwhelming share of the global malaria burden. The World Health Organization estimates that the WHO African Region accounted for about 94% of global malaria cases and 95% of malaria deaths in 2024.
At the UNGA meeting, Africa’s Leadership for Sustainable Malaria Financing: A Multisectoral Path to Elimination, leaders said countries need to increase domestic investment while maintaining international partnerships during the transition.
The meeting was hosted by Botswana President Duma Gideon Boko, chair of the African Leaders Malaria Alliance (ALMA), in partnership with the African Union Commission and the RBM Partnership to End Malaria.
The financing concerns are significant. According to ALMA, a 30% reduction in malaria financing could result in an estimated 146 million additional malaria cases and 397,000 additional deaths by 2030, while Africa could lose about US$37 billion in GDP.
“When investment is sustained, malaria retreats. When financing falls, it returns,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, during the meeting.
Domestic financing under pressure
African leaders called for a managed shift towards greater domestic financing of malaria programmes, while stressing that countries will continue to need predictable international support.
“ Africa has the tools, the experience, and the leadership to change the trajectory of malaria. What we need now is sustainable financing and collective action to match our ambition of a malaria-free future,” said President Boko.
The call comes as countries face declining development assistance for health and shortfalls in international health financing. ALMA has warned that the combination of financing volatility with increasing drug and insecticide resistance and climate-related threats could undermine gains made over the past two decades.
Dr Tedros said malaria programmes need to be less exposed to decisions by individual donors, while domestic financing should be increased and protected within national budgets.
He also called for malaria to be incorporated into broader health and development financing, including World Bank IDA21 health compacts, and backed consideration of a dedicated Malaria Booster Programme under IDA22.
The Vice President of The Gambia, Muhammad B. S. Jallow, cautioned that domestic resources alone would not be enough.
“We must be conscious and mindful of the fiscal constraints facing many of our countries. Domestic financing alone cannot sustain the level of investment required to reach elimination,” he said.
Jallow called for stronger international partnerships and predictable financing to support countries through the final stages of malaria elimination.
Malaria needs more than health ministries
The meeting also emphasised that malaria cannot be treated solely as a health-sector issue.
Dr Tedros called for ministries of finance, agriculture, environment, mining and tourism to work alongside ministries of health, with the private sector and communities also involved.
National End Malaria Councils and Funds were highlighted as one mechanism for coordinating this approach. According to ALMA, 14 operational councils have mobilised more than US$245 million to help address financing and resource gaps in national malaria programmes.
“These councils bring government, business, civil society and communities around one plan and one financing platform,” Dr Tedros said, calling for every malaria-endemic country to establish and use such a mechanism in a way suited to its national context.
Countries turn to regional cooperation and local production
Ministers at the meeting also highlighted efforts to strengthen regional cooperation and reduce dependence on imported malaria commodities.
South Africa, in its role as chair of the Southern African Development Community, committed to stronger cross-border collaboration towards regional malaria elimination.
Zimbabwe and Angola committed to local production of mosquito nets and medicines, while Tanzania highlighted investments in local manufacturing and malaria research.
Tanzania’s Health Minister Mohamed Omary Mchengerwa said scientists at the Ifakara Health Institute, working with the National Institute for Medical Research, are researching gene-drive technology aimed at reducing the ability of mosquitoes to transmit malaria.
He said the technology would require discussion beyond the scientific community, including with communities and across government.
“Our Ministries of Health, Environment and Agriculture are working together on the regulations now, before anything is released,” Mchengerwa said.
Partners urged to maintain support
International partners at the meeting reiterated their support for African-led malaria elimination efforts.
The Global Fund said it would continue efforts to mobilise resources, while the Gates Foundation said it would support development of new malaria products in line with priorities identified by African countries.
Gavi committed to supporting the delivery of malaria vaccines to children who need them, while GLIDE offered collaboration with ministries of health.
WHO said the availability of new tools alone would not be sufficient unless countries have the financing and systems needed to purchase and deploy them.
Africa has made substantial gains against malaria over the past 25 years, but progress has slowed. WHO says the continent now faces a combination of financing constraints, climate change, conflict and increasing drug and insecticide resistance.
The meeting formed part of the Big Push against Malaria, an African-led initiative aligned with the African Union’s malaria elimination agenda.
For African countries, leaders said the immediate challenge is to protect existing gains while building financing systems that can sustain malaria prevention, diagnosis and treatment as countries move towards elimination.
“Africa is ready to lead, but malaria elimination remains a shared responsibility,” President Boko said. “The choice before us is clear. We can allow financing gaps to reverse our progress, or we can choose to lead.”
