African leaders and regional institutions need to take the bull by the horns: a perspective on the impact of the 2025 funding cuts to malaria programmes.

Despite global malaria programmes already operating within resource constraints, 2025 saw a significant decrease in funding following the US government's termination of most of its global health programmes, as well as the decline in development aid spending by the UK, France, Germany, Canada, Switzerland, and other countries. The disruption of funding was sudden, with most African countries lacking adequate contingency plans. This, despite most of the malaria burden being in Africa (94% of 263 million cases in 2023), accounting for a reduction in gross domestic product of up to 1.3% annually, and half a billion lost workdays. Key malaria control programme activities have been severely impacted, including insecticide-treated bed net distribution, seasonal malaria chemoprevention campaigns, and malaria indicator surveys. In the wake of the funding cuts, some African governments have committed to increasing efforts to raise funds for malaria programmes from the private sector. The Africa Centres for Disease Control and Prevention (CDC) has developed a strategy for governments to increase health budgets while seeking additional funding from the private sector, all while maintaining transparency and accountability. If recent malaria control gains are to be sustained and to prevent resurgence across the continent, African governments will need to increase domestic funding and build robust public-private partnerships for their malaria programmes. Lessons can be learnt from countries where these partnerships have succeeded or failed. Leadership by the African Union, the Africa CDC, the African Leaders Malaria Alliance, and other regional bodies is crucial to support countries in taking immediate, substantive steps and benchmarking progress.