Background
Although 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 findings
We 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 cases (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 costeffective.
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 deaths (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. Conclusions
Our 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.