Abstract
BackgroundAlthough significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and hence the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur.Methods and findingsWe combined an established mathematical model of Plasmodium falciparum transmission dynamics with epidemiological, intervention, and PMI-financing data to estimate the contribution PMI has made to malaria control via funding for long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), and artemisinin combination therapies (ACTs). We estimate that PMI has prevented 185 million (95% CrI: 138 million, 230 million) malaria cases and saved 940,049 (95% CrI: 545,228, 1.4 million) lives since 2005. If funding is maintained, PMI-funded interventions are estimated to avert a further 162 million (95% CrI: 116 million, 194 million) cases, saving a further 692,589 (95% CrI: 392,694, 955,653) lives between 2017 and 2020. With an estimate of US$94 (95% CrI: US$51, US$166) per Disability Adjusted Life Year (DALY) averted, PMI-funded interventions are highly cost-effective. We also demonstrate the further impact of this investment by reducing caseloads on health systems. If a 44% reduction in PMI funding were to occur, we predict that this loss of direct aid could result in an additional 67 million (95% CrI: 49 million, 82 million) cases and 290,649 (95% CrI: 167,208, 395,263) deaths between 2017 and 2020. We have not modelled indirect impacts of PMI funding (such as health systems strengthening) in this analysis.ConclusionsOur model estimates that PMI has played a significant role in reducing malaria cases and deaths since its inception. Reductions in funding to PMI could lead to large increases in the number of malaria cases and deaths, damaging global goals of malaria control and elimination.
Highlights
Unprecedented effort has seen the global burden of malaria halve since the turn of the 21st century due to the widespread distribution of highly effective preventative interventions such as long-lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS) and the provision of highly efficacious treatment with artemisinin combination therapies (ACTs) [1]
We linked data on President’s Malaria Initiative (PMI) financing, historical intervention coverage, and the underlying epidemiology in modelled countries with estimates of the potential effect of reduction in PMI funding on the coverage of interventions nationally. These estimates were used as inputs for an established transmission model of P. falciparum malaria [11,12] to project the impact of reductions in funding on cases, deaths, and Disability Adjusted Life Years (DALYs) (Fig 1)
We considered 3 budget scenarios, one in which PMI funding was kept constant to 2017 levels, one in which 100% of the PMI budget was removed, and a third in which the budget was reduced by 44% to reflect the difference in budget attributed to malaria control detailed in the 2017 financial omnibus [10] and the proposed budget for 2018 onwards [9]
Summary
Unprecedented effort has seen the global burden of malaria halve since the turn of the 21st century due to the widespread distribution of highly effective preventative interventions such as long-lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS) and the provision of highly efficacious treatment with artemisinin combination therapies (ACTs) [1]. The continued high level of support for foreign aid contributions in a fluid global political landscape is not guaranteed and gains in malaria control can be fragile if intervention coverage, which is largely dependent on donor funding, is not maintained [4]. In May 2017, Congress published the Congressional Budget Justification [9], which outlined a commitment to malaria control for 2018 of US$424 million This is equivalent to a 44% reduction relative to commitments reported for 2017 [10]. Significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur
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