Nine-month-old baby Mohamat burnt with fever for three days before his family took him to the closest health centre in northern Cameroon. But it was too late — he died of malaria that day.
Mohamat’s death was part of a spike this year in malaria fatalities that local health officials attribute to foreign aid cuts by the US.
Before the cuts, Mohamat might have been diagnosed earlier by one of more than 2,000 US-funded community health workers who would travel over rough dirt roads to reach the region’s remotest villages.
At the health centre, he might have been treated with injectable artesunate, a life-saving drug for severe malaria paid for by US funds that is in short supply. However, the centre had none to dispense.
Reuters travelled to northern Cameroon, where the US had played a leading role in the malaria response for nearly a decade, to document how the sudden cuts are contributing to delayed malaria diagnoses, inadequate treatment and a growing number of deaths.
This story is based on interviews with more than 20 doctors, nurses, community health workers, residents and former US officials involved in malaria programming.
Mohamat’s father, sorghum and banana farmer Alhadji Madou Goni, is mourning a son he had hoped would one day escape poverty.
“I feel so sad about my loss. I hope no-one suffers from this [malaria] again,” Goni, 30, told Reuters while he sat outside his home, his wife next to him holding prayer beads. “Since there is hardship here, and people don’t have the means, we hope aid comes.”
MALARIA PROGRAMME DISRUPTED BY CUTS, END OF USAID
When taking office in January, US President Donald Trump paused all foreign aid, including the president’s malaria initiative (PMI) launched in 2005 by former president George Bush. The PMI is credited with helping to save 11.7-million lives and prevent 2.1-billion malaria cases.
A limited waiver issued in February allowed life-saving work on malaria to continue, but PMI’s 30 partner countries, most of them in Africa, have reported major disruptions linked to the dissolution of the US Agency for International Development, the main implementer of PMI-funded programmes.
In Cameroon’s Far North region, where Goni lives, the cuts stripped support for PMI-funded community health workers who distributed prevention tools such as bed nets and identified serious cases.
PMI funded half, or 1,492 out of 2,824, of all community health workers in the region, said Dr Jean-Pierre Kidwang, coordinator of the regional technical group for malaria control.
The support included a monthly stipend of 15,000 CFA francs (R447), a transport allowance, bicycles and clothing.
Nearly all the US-funded community health workers are out of service. Prosper Laurent Messe Fouda, head of planning, monitoring and evaluation at the National Malaria Control Programme, confirmed 2,105 out of 2,354 US-funded workers in Cameroon’s Far North and North regions were no longer working.
AFTER FALLING FOR YEARS, MALARIA DEATHS RISING
PMI made Cameroon a focus country in 2017, and recorded malaria deaths in Far North dropped from 1,519 in 2020 to 653 in 2024. but appear to be rising, Kidwang said.
“With PMI funding, we moved from a mortality rate of 17% to bring the situation down to 8%. With the September–October peak under way, available trends indicate fatalities are rising sharply, even though official data has yet to be released,” Kidwang said, citing a figure of 15% for the first half of 2025.
“We may get to a point where all the gains against malaria are reversed.”
The Trump administration said it is reforming foreign aid that did not align with its “America First” agenda and secretary of state Marco Rubio has said repeatedly no-one has died as a result of the cuts.
I am struggling to survive. The little I used to get from the PMI project was helpful to support my family
— Oumarou Gassi, health worker
Trump has said the US paid disproportionately for foreign aid and wants others to pay more. Between 2010 and 2023, the US contributed an average of 37% of funding for malaria programmes, the World Health Organisation (WHO) said.
This year the US has cancelled more than 80% of aid contracts, but said life-saving work, including for malaria, would continue. However, organisations on the ground and the WHO in April said “critical gaps” remained in the malaria response after the cancellations.
Going forward, Trump’s initial budget request for fiscal year 2026 included a 47% cut to PMI’s budget from just below $800m (R13.74bn) it had hit in recent years, though Congress will have the final say later this year.
The “America First Global Health Strategy” Rubio announced in September stated some commitments to reducing malaria mortality and incidence, but made no mention of PMI or budgets. A state department spokesperson confirmed to Reuters the programme would continue.
Anne Linn, former senior community health adviser for PMI, told Reuters before the January cuts the programme supported 115,000 community health workers across 30 countries. That all disappeared, she said — though it is unclear how much funding has resumed and where governments and non-profits have stepped in to fill urgent gaps.
The state department spokesperson said in the future it would provide support to fight malaria through bilateral agreements with partner countries, and committed to maintaining 100% of US funding for commodities such as nets and drugs and frontline health workers in fiscal year 2026 before asking governments to coinvest. They gave no details of their annual budget.
CUTS BEING FELT IN SEVERAL AFRICAN COUNTRIES
The effects of the cuts have been felt in some African countries, including Liberia, where some community health workers are volunteering without pay.
In Cameroon’s Far North, a region prone to droughts, flooding and violence linked to the Islamist Boko Haram insurgency in neighbouring Nigeria, the cuts came as officials were training community health workers to deploy during the rainy season, which runs from May to October, Kidwang said.
Oumarou Gassi, one of the health workers, said he was devastated to lose the job. “I am struggling to survive. The little I used to get from the PMI project was helpful to support my family,” he said.
I am devastated,” Amadou said. “The child’s memory keeps coming back to me
— Daouda Amadou
With health workers no longer in the field, more malaria cases are becoming severe, and the US cuts have also hit the supply of injectable artesunate, Kidwang said.
Far North was out of stock for much of the year, he said. About 200,000 vials arrived in Maroua, the regional capital, on September 2, but it is not enough to meet the region’s needs for even three months, he said.
Authorities are trying to fill the gap but face resource constraints, said Olivia Ngou, executive director of Impact Sante Afrique, a nonprofit.
US CUTS ALSO AFFECT DATA COLLECTION
How bad the situation becomes may be difficult to gauge as PMI also played a major role in data collection. That data is no longer online. PMI’s website said it is “undergoing maintenance as we expeditiously and thoroughly review all the content” to comply with Trump’s executive orders.
As a result, “we won’t know the extent to which the bounce back is going to occur,” said Louisa Messenger, a public health expert at the University of Nevada-Las Vegas who has worked with PMI and other malaria programmes in Africa.
The big-picture data matters little to Djidja and Daouda Amadou, who lost their five-month-old daughter to malaria in July. Like Goni, they waited in hopes the child’s fever would subside before taking her to a health clinic, where staffers referred them to Maroua. By the time they arrived, it was too late, and their baby is buried in their yard.
“I am devastated,” Amadou said. “The child’s memory keeps coming back to me.”
• Reuters
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