Why the U.S. President’s Malaria Initiative Should Qualify Under the “Life-Saving Humanitarian Assistance” Waiver

Background on the U.S. President’s Malaria Initiative (PMI)

The U.S. President’s Malaria Initiative, which was established under President George W. Bush nearly twenty years ago and has received strong bipartisan support across Administrations and Congresses ever since, has played a pivotal role in significantly reducing malaria cases and deaths worldwide. Specifically, PMI-supported countries – which account for over 90% of all malaria cases worldwide – have seen a 48% decline in malaria deaths and 29% decline in malaria cases over the past two decades. As shared in their 18th Annual Report to Congress, PMI helps protect 700 million people annually across 27 countries from malaria.

Impact of Freeze/Stop Work order on PMI’s Life-Saving Work

All funding and programs under PMI have been halted following January 20th’s Executive Order Reevaluating and Realigning United States Foreign Aid, which mandated a 90-day pause and review of U.S. foreign development assistance, and the U.S. State Department’s stop-work order on January 24 of all foreign assistance (with exceptions made for emergency food aid and aid to Israel and Egypt). Last week, Secretary of State Rubio approved an Emergency Waiver to Foreign Assistance Pause, which allows implementers of “existing life-saving humanitarian assistance programs” to resume work. It has yet to be announced or officially confirmed that PMI programs and funds qualify for this waiver.

Reports from malaria-endemic countries confirm that PMI funded programs have been fully grounded. Mosquito nets aren’t being delivered, indoor residual spraying has stopped, and antimalarial medicines are not being delivered to health facilities, leaving the most vulnerable – young children and pregnant women – unprotected and untreated. Numerous private sector companies, many of which have significant footprints in the U.S., are also being impacted as orders for life-saving commodities are on indefinite hold.

Not only does this have a negative impact on the supply chain challenges and their bottom lines in the near term; but the lack of market reliability could undermine investments in global health research, development, and innovation going forward. According to an analysis by Malaria No More, halting PMI programs for 90 days would prevent the delivery of approximately: 9 million insecticide-treated bed nets; 25.3 million rapid diagnostic tests for malaria; 15.6 million life-saving anti-malarial treatments; 48 million doses of seasonal malaria chemoprevention; and safe, effective indoor residual spraying for 3.8 million people.

Why PMI Qualifies under the Emergency Waiver

As Secretary of State Rubio stated in his Senate confirmation hearing, malaria is a health and humanitarian crisis with deep economic implications. Malaria remains a leading cause of preventable death worldwide, particularly among young children and pregnant women. Without proper protection, a child dies every minute from malaria; and if left untreated, a child can die of malaria in as little as 24 hours. A 90-day pause in life-saving malaria medicines and health interventions could lead to thousands of premature deaths. Recent history has shown that even brief interruptions in malaria services can derail long-term progress. For example, disruptions to program implementation in 2020 contributed to a significant spike in malaria deaths that offset almost a decade of gains against this ancient disease.

Further, malaria is not just a global health issue. It is also a national security concern. The risk of reintroduction in the U.S. is real, as evidenced by the 10 locally acquired malaria cases in 2023—the first in two decades. Our military, diplomats, and travelers face exposure daily, and the Department of Defense has long invested in malaria research, including the development of the RTS,S vaccine at Walter Reed Army Institute of Research. Economic research shows that reducing malaria by 90 percent by 2030 could generate $142.7 billion in economic gains, including $1.5 billion in U.S. exports to affected regions.