U.S. President Donald Trump wants to cut funding to one of the government’s most effective global health programs.
Trump proposes slashing funding for the President’s Malaria Initiative (PMI) by nearly half, 44 percent. The PMI was launched by the George W. Bush administration to reduce the spread of malaria around the world. Research published in the medical journal PLoS earlier this month shows that it has been a highly effective program.
The PMI saved the lives of 2 million children, finds the study. It finds that risk of children under 5 years old dying from malaria fell by 16 percent in countries targeted by PMI.
It proves for the first time that the program is saving lives by comparing countries that are a part of the program against those that are not.
The researchers behind the study say that the fewer deaths and increased coverage of malaria-preventing bed nets show that the program is saving lives. The impact proves that some programs funded by U.S. foreign aid are highly effective.
“At a time of increasing uncertainty about future funding levels of US foreign aid, our study provides objective evidence that programs such as PMI offer substantial returns on investment,” study co-author Aleksandra Jakubowski, said to MedicalResearch.
Jakubowski and her team compared 19 countries supported by PMI against 13 countries that do not receive the financial support. The researchers looked at under-5 mortality rates and other data related to malaria coverage for the countries from 1995 to 2014.
There were more than 200 million cases of malaria and 429,000 deaths in 2015, according to the World Health Organization. The parasite is spread by mosquitoes and can turn fatal if it is not treated in time. More than 90 percent of malaria cases and deaths occur in Africa, making the region a focal point for elimination.
PMI was launched in 2005 to boost the global effort to respond to malaria. The U.S. spends more than $500 million a year to provide insecticide-treated nets, rapid diagnostic tests, artemisinin-based combination therapy, support for intermittent preventive treatment in pregnancy and indoor residual spraying.
The U.S. is also the largest contributor to the Global Fund for HIV/AIDS, Tuberculosis, and Malaria, a multi-billion dollar health fund that supports countries burdened by the three diseases. The Global Fund provides about twice as much money to sub-Saharan Africa as compared to the PMI. It is a significant reason why malaria rates fell by 21 percent and mortality rates fell by 31% between 2010 and 2015 in the region.
What makes the research unique is the country-by-country comparison. PMI already collects data showing how more people are protected against malaria and fewer children are dying where its programs operate. Comparing countries allows researchers to determine whether PMI is behind the improvements or if malaria death reductions are caused by other things, such as the Global Fund or national-level anti-malaria campaigns.
There is a litany of research showing that distributing long-lasting insecticide-treated bednets stops the transmission of malaria by keeping away mosquitos when they are most active. Spraying homes with pesticides also help kill mosquitoes and artemisinin is one of the most effective drugs to combat a malaria infection.
“While our study suggests that PMI may have significantly contributed to reducing all-cause child mortality rates in Africa, additional research is needed to assess the cost-effectiveness of PMI investments,” Jakubowski said.
An accompanying commentary by Stanford University researcher Eran Bendavid agrees with the study’s authors that the findings show how foreign aid can work. He points to some of the usual arguments in favor of foreign aid – it is less than 1 percent of the federal budget and it is in the best interest of American citizens.
Bendavid concedes that there are parts of foreign aid that are problematic, but global health is one of the best investments. The fact that PMI helped reduce child mortality backs up his case.
“It underscores that the anticipated benefits of effective aid include not only a reduction in the number of children dying in poor countries, but also, arguably, an investment in the well-being of Americans,” he writes.