Breakthroughs Blog: Malaria

For decades, strong US government investment in biomedical innovation has fueled the development of new vaccines, treatments, and other breakthrough global health technologies that have saved and improved millions of lives around the world and here at home. Unfortunately, in recent months, we have seen these investments decline significantly, as the US government has shrunk its foreign assistance footprint and ended hundreds of medical research grants. With the majority of global health research programs at the US Agency for International Development (USAID) and many other key US agency programs facing an uncertain future, past progress and future gains in global health innovation are now at risk. These disruptions threaten to undermine the United States’ longstanding role as a global leader in biomedical innovation, compromise the return on previous investments, and heighten health risks for people in the United States and around the world.The current US administration has signaled its priority to make America safer, stronger, and more prosperous—a goal which is directly aligned with the outcomes of global health research and development (R&D). By embracing ongoing commitments and continuing to invest in global health R&D, US policymakers can safeguard the well-being, resilience, and economic prosperity of the American people—advancing the agenda of the US administration while simultaneously saving and improving lives around the world. Global health R&D protects Americans from disease threats and promotes international stabilityDisease threats know no borders. Americans are increasingly at risk of emerging and neglected diseases, as underscored by the recent domestic outbreaks of H5N1, measles, mpox, and tuberculosis. Right now, health technologies developed with US funding are protecting Americans and ensuring that the United States is equipped with the proper tools to mitigate disease threats. The 2025 outbreak of Sudan virus, which can cause Ebola disease in humans, in Uganda was the latest Ebola outbreak that endangered the well-being of citizens worldwide. In addition to providing critical monetary and technical assistance contributions to Uganda to combat this outbreak, the US government also donated courses of an experimental monoclonal antibody treatment that was developed with US funding and 500 rapid detection test kits to support ongoing surveillance and prevention of future outbreaks. Additionally, other global partners launched two major clinical trials testing an experimental vaccine and therapeutics, including the monoclonal antibody therapy and an antiviral treatment, all of which were developed with past US government support. Collectively, these interventions and the rapid response effort helped stop the virus from spreading beyond Ugandan borders, ultimately protecting lives around the world and quelling the potential threat to Americans. Thanks to sustained US investment in Ebola research and outbreak response since 2011, the United States had the knowledge, infrastructure, and tools needed to respond quickly and effectively to the recent outbreak—minimizing the threat to regional stability and American public health.Beyond Ebola, the US government has also advanced other global health breakthroughs that have directly benefited Americans, including new drug-resistant tuberculosis treatments, long-acting HIV prevention and treatment options, and vaccines for mpox.Global health R&D strengthens US global influence, while also protecting military personnelGlobal health R&D has historically been a powerful diplomatic tool for the United States in strengthening its partnerships and ties around the world. By drawing back its investments, the United States risks ceding leadership in the foreign policy and medical research space to other countries—including its geopolitical rivals—who could step up to fill part of the vacuum left behind. Take China for example: in recent years, it has continued to grow its R&D investments, diminishing the gap between American and Chinese investments. Additionally, at the 2024 Forum on China Africa Cooperation, the Chinese government announced plans to encourage Chinese businesses to invest in the production of medicines and vaccines in Africa as part of its 2025-2027 action plan. As other global actors expand their influence in global health, including through increased investment in medical innovation and manufacturing, the United States must remain engaged to preserve its leadership, uphold its values, and continue delivering lifesaving impact around the world. Diminished leadership in global health innovation could also increase the vulnerability of US military personnel stationed around the world. Infectious diseases are the single largest cause of hospitalizations of US servicemembers during conflicts, representing an average of nearly 60 percent of casualties in recent conflicts. Global health technologies advanced through foreign assistance dollars and non-defense spending have helped keep US warfighters healthy and safe. For example, the US Centers for Disease Control and Prevention helped create a test to ensure US military uniforms treated with malaria-targeting insecticides remain effective, and USAID supported the development of tafenoquine, a single-dose medicine used to treat Plasmodium vivax malaria, as well as the only US Food and Drug Administration-approved treatment for leishmaniasis, a parasitic disease common in the Middle East. Without continued investments in research, challenges like growing antibiotic resistance could put the US military in an increasingly vulnerable position.Global health R&D drives American innovation and prosperityBetween 2007 and 2022, the US government invested just under $46 billion in R&D for neglected diseases, emerging infectious diseases, and sexual and reproductive health issues (To put this amount in context, in 2022 alone, the US government spent $751 billion on defense and $1.34 trillion on Medicare and Medicaid). This relatively modest investment helped contribute to the development of 67 new technologies approved since 1999 for neglected and emerging diseases (excluding COVID-19) and fueled a burgeoning pipeline of 261 promising products in late-stage development, which could further reduce the human and economic toll of these diseases.Beyond its health impact, this investment has also delivered substantial economic benefits to the US economy. Between 2007 and 2022, at least 86 percent of all funding that the US government directed to global health R&D was reinvested in American companies and institutions. This investment has created an estimated 600,000 new American jobs, spurred $104 billion in direct economic activity, and yielded scientific knowledge to inspire further innovations, which will ultimately generate $255 billion in long-term benefits to the American economy.These investments have also proven their potential to create cost savings, by driving down health care costs or preventing costly care down the line. For example, switching all patients with drug-resistant tuberculosis to regimens incorporating a new drug, pretomanid, which was developed with support from USAID and the National Institutes of Health, could generate global cost savings of $740 million annually. Even modest investments in scientific research can yield significant economic returns for the United States. The good we do makes us great Investment in global health R&D makes up just a small portion of the federal budget—around 0.8 percent in fiscal year 2022—but it has a priceless impact on the lives and livelihoods of Americans and people in need around the world. When the United States invests in global health research, we create opportunities and benefit the health of people in our nation and around the world. We fuel innovation at home. We create jobs. We make friends and allies. We make the world safer, and we make our world safer too. It’s the good we do, in part, that makes us great. As the US government reimagines its foreign assistance architecture and makes future research funding decisions, global health R&D efforts must be prioritized to preserve the progress we’ve made and deliver the bold breakthroughs of tomorrow. Sustaining the US government’s commitment to global health R&D will yield strategic and cost-effective benefits, bringing us closer to a safer, stronger, and more prosperous America and world—but only if we are able to meet the moment we are in.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, scientists announced a new project, funded by Wellcome, to expand the use of a low-cost, field-deployable, and real-time viral genome sequencing technique that has been widely used to detect COVID-19 variants to cover a wider variety of pathogens, helping public health officials surveil known and unknown pathogens of concern and respond to outbreaks more quickly and effectively. The project, which includes an international team of researchers, is supported by the Africa Centres for Disease Control and Prevention, the Asia Pathogen Genomics Initiative, and the World Health Organization International Pathogen Surveillance Network, which will help ensure that the system is broadly accessible around the world, even in places with limited resources and laboratory infrastructure.Harvard University researchers have found a drug combination that can kill the malaria parasite directly in mosquitoes so they can no longer spread the disease. Given the drugs can be absorbed the legs of mosquitoes, the goal is to create a cheap, long-lasting tool that could be applied alongside insecticides to bed nets in malaria-endemic regions. As resistance to the insecticides used on bed nets rises, this new method is less likely to lead to the emergence of resistance. The drugs, which were tested on materials similar to bed nets in a laboratory setting, killed 100 percent of the parasites. The method will be next tested in a real-world study in Ethiopia.A research team at Institut Pasteur has started a project testing a new rapid diagnostic that could detect the presence of the Plasmodium vivax malaria parasites early on after the initial mosquito bite—before symptoms arise—, helping patients receive appropriate treatment faster. Specifically, the researchers intend to design a test that can detect the presence of the parasite in blood samples from individuals whose infection is in the dormant liver stage, when it is difficult to detect infection. The project, which will run through 2030, has received around €6 million in funding from the European Union, as well as the British and Swiss governments.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. A new study published in The Lancet Infectious Diseases ahead of World Malaria Day last week found that adding a low dose of the widely available antimalarial drug primaquine to artemisinin-based combination therapy is safe and effective at blocking Plasmodium falciparum malaria transmission in young children in areas of low- and moderate-to-high transmission. The new study fills a gap in knowledge of the safety and efficacy of this approach for young children, who face the highest burden of clinical malaria and are particularly at risk of artemisinin-resistant strains but could face adverse complications from adult formulations of primaquine. The findings highlight the need for child-friendly formulations of primaquine and support the expanded use of the drug in regions with a moderate-to-high transmission rate and the threat of artemisinin partial resistance.The Drugs for Neglected Diseases initiative, the National Health Service University Hospitals of Liverpool Group, and the University of Liverpool have initiated a clinical trial in Liverpool, United Kingdom to test an oral drug for visceral leishmaniasis, one of the world’s deadliest parasitic diseases. Current treatments for visceral leishmaniasis, which is almost always fatal if left untreated, include daily injections for up to 17 days, which can cause immediate pain, as well as nausea, vomiting, and more serious complications. The new oral drug, DNDI-6899, is easier to store, transport, and administer than current treatments. If proven successful, the drug could help make treatment more accessible to those who need it most.DioSynVax and ACM BioLabs have signed a new deal to jointly develop a next-generation avian flu vaccine with the potential for mucosal vaccine delivery, as the virus continues its worrying spread. The mRNA vaccine targets all major clades of the H5 avian flu subtype and could be scaled for rapid distribution globally in the case of a pandemic. The vaccine is also designed to be delivered via nasal spray, which could help increase uptake; to induce mucosal immunity, which helps fight the pathogen before it starts circulating the body; and to be temperature stable, enabling rollout in lower-resource settings.

In 2001, I traveled to Ghana as a graduate student working on a US Agency for International Development-funded decentralization program. I arrived armed with materials on local governance best practices. But the mayors I met were focused on urgent public health issues: clean water, HIV/AIDS, tuberculosis, and malaria. That trip, meant to be an early lesson in governance, became my first and most personal education in global health. It also nearly killed me. I was taking mefloquine weekly to prevent malaria. Toward the end of our stay, my partner and I set off to explore the country. Somewhere along the way, I developed what I believed to be giardia. That infection likely compromised the absorption of the mefloquine and left me dangerously vulnerable. One night in the village of Kokrobite, I woke with a high fever and chills so intense I could barely stand. A local man saw me and immediately recognized it as malaria. He arranged for a taxi to take me back to Accra. Before I left, he handed me a small, crumpled packet labeled in Chinese characters. Inside was a blister pack of pills. The only word written in English on the package was artesunate. He told me it would help, and, in that moment, sick, scared, and weak, I took it. At the hospital, a blood smear confirmed that I had cerebral malaria caused by Plasmodium falciparum, the deadliest strain. Cerebral malaria can cause brain swelling, coma, and death. I drifted in and out of consciousness for days. At one point, hospital staff told my partner that there was nothing more they could do. I should “go home” and be “as comfortable as possible.”My partner worked relentlessly to get me on one of the next flights back to the United States. I was so sick that the airline nearly refused to let me board. Once we arrived home, I was seen right away by an infectious disease doctor at Johns Hopkins Hospital. After reviewing my labs and the herbal remedy package, he said plainly: this saved your life. The artesunate had bought me enough time to survive the journey and begin treatment. At the time, the World Health Organization had not yet formally endorsed artemisinin-based combination therapies (ACTs) as the global standard for P. falciparum malaria. That came in 2006. But the effectiveness of artesunate alone was already well known in many parts of the world. That medicine saved my life.I missed several weeks of school but made a full recovery. Without that drug and the help of my partner (now my husband) and friends in Accra, I wouldn’t be here today. More than two decades have passed, and we've made tremendous progress. Insecticide-treated bed nets, rapid diagnostic tests, and ACTs have saved millions of lives. Two malaria vaccines, RTS,S and R21/Matrix-M, have been approved. Long-acting monoclonal antibodies are showing promise as seasonal protection for children. Newer insecticide-treated nets help counter resistance. And researchers are exploring RNA-based therapeutics and single-dose cures.Many of these breakthroughs are being developed by members of the Global Health Technologies Coalition, where I now serve as Executive Director. These tools represent our best chance not just to control malaria but to end it.But progress is not guaranteed. Cuts to foreign assistance and global health research and development are already slowing the progress of innovations in the pipeline. Some promising tools may be delayed or abandoned. That means more children at risk, more untreated infections, and more drug-resistant strains emerging. The parasite has evolved before. It will do so again if we let it. And malaria is no longer a disease that happens mostly outside of the United States. In the past two years, locally acquired cases have been reported in Florida, Texas, and Maryland. Climate change, global travel, and changing mosquito habitats are making malaria a threat we can no longer treat as distant. I know how thin the line is between surviving this disease and not. For me, it’s not abstract. It’s the memory of a fevered body, the generosity of strangers, and a medicine in the right place at the right time. This World Malaria Day, I urge leaders and policymakers to stay the course. The science is moving forward. But science alone isn’t enough. If we don’t finish what we’ve started, we risk letting malaria surge back and take more lives with it. Science has given us the tools. The question now is whether we will act in time or let the disease outpace us once again.