The Human Cost of Foreign Aid Cuts: Cameroon’s Battle Against Malaria

Life-Saving Programs Face Uncertain Future as Global Health Initiatives Lose Funding

In the humid darkness before dawn, Aisha Hamidou moves with practiced efficiency through the rural village of Mokolo in northern Cameroon. A community health worker for nearly a decade, she carries a weathered bag containing rapid diagnostic tests, antimalarial medications, and educational materials—tools that have become increasingly precious as international funding dwindles. The rainy season has transformed the landscape into a breeding ground for mosquitoes, and with it comes the annual surge in malaria cases that disproportionately affects children under five.

“Before the program came, we lost many children each year,” Hamidou explains, adjusting her headscarf as she prepares to visit her first household of the day. “Now we know how to prevent malaria, how to recognize the symptoms, how to treat it quickly. But we worry about what happens next year, and the year after that.”

What Hamidou refers to is the precipitous decline in support for the President’s Malaria Initiative (PMI), a program established in 2005 that became one of the most successful global health interventions in recent history. The initiative, which operated in 24 high-burden countries across sub-Saharan Africa and Southeast Asia, had helped reduce malaria mortality by 60 percent in participating nations. But severe cuts to foreign assistance under the Trump administration left health workers like Hamidou fighting to maintain progress with drastically reduced resources during what may be their final fully supported campaign season.

The Tangible Impact of Policy Decisions Made Thousands of Miles Away

The morning unfolds with a rhythm familiar to health workers across the malaria belt of Africa. Hamidou visits a dozen households, checking on children who were treated for malaria in the previous week and educating families on proper bed net usage. At the home of Fadi Moussa, whose three-year-old son Ibrahim is recovering from a severe case that required hospitalization, the conversation inevitably turns to the future.

“The medicines they gave my son at the health center saved his life,” says Moussa, a subsistence farmer whose meager income cannot stretch to cover the full cost of malaria treatment without subsidization. “They told me it was free because of help from America. Now they say next year we might have to pay. I don’t know what we will do if another child gets sick.”

The reduction in foreign aid wasn’t simply a line item in a budget document—it represented a fundamental shift in American foreign policy priorities. When the administration implemented an “America First” approach to international engagement, it included cuts of more than 30 percent to global health programs. Officials justified the reductions as necessary to focus resources domestically, but health experts warned of the devastating consequences such pullbacks would have in vulnerable regions where progress against infectious diseases remained fragile.

Dr. Olivier Tchatchouang, who oversees malaria control efforts in northern Cameroon, describes the impact in stark terms. “We were just beginning to see generational change here. Children who survived malaria because of these programs are now in school, learning, thriving. The data shows deaths falling year after year. But malaria is an opportunistic disease—it will quickly resurge if we cannot maintain prevention and treatment efforts.”

Racing Against Time: One Final Rainy Season Under Full Funding

In the regional health center, a facility that serves over 50,000 people across dozens of villages, the effects of the funding reductions are already apparent. Stockrooms that once contained ample supplies now show concerning gaps. Staff have been reduced. Community outreach programs have been scaled back. Yet the determination to maximize the impact of remaining resources is palpable among health workers.

District health coordinator Mariama Aboubakar has transformed her office into a command center for what she calls “the final push”—an all-out effort to protect as many children as possible during what could be the last rainy season with substantial international support. Wall-to-wall maps track malaria incidence, bed net distribution, and medication availability. Teams have been reorganized to cover wider areas. Training has been intensified to ensure that local capabilities remain even as external support recedes.

“We are building systems that can survive with less,” Aboubakar explains, pointing to a graph showing declining case fatality rates. “We’ve trained hundreds of community health workers like Aisha. We’ve educated thousands of families. But eliminating malaria requires consistent effort over many years. One good rainy season with proper resources saves lives, but it doesn’t solve the underlying problem.”

The technical expertise developed through years of international partnership has created a foundation of local knowledge, but maintaining the physical infrastructure of malaria control—from microscopes for diagnosis to medications for treatment to bed nets for prevention—requires ongoing financial support that exceeds what the Cameroonian government can currently provide.

The Science and Economics Behind Malaria Control Programs

Understanding what makes malaria control programs effective helps illuminate what’s at stake as funding declines. Malaria’s complex life cycle—involving mosquito vectors, human hosts, and the Plasmodium parasite—means that successful intervention requires a comprehensive approach targeting multiple vulnerabilities in the transmission chain.

The PMI strategy combined vector control through insecticide-treated bed nets and indoor residual spraying, prompt diagnosis through rapid testing, effective treatment with artemisinin-based combination therapies, and preventive measures for pregnant women and young children. This integrated approach proved remarkably cost-effective, with the U.S. Centers for Disease Control and Prevention estimating that every dollar invested in malaria control delivers $40 in economic returns through improved health, reduced healthcare costs, and increased productivity.

Dr. Sarah Nganjou, an epidemiologist who has studied the economic impact of malaria in northern Cameroon, emphasizes this point. “Malaria keeps children out of school, adults out of work, and traps communities in cycles of poverty. When a parent must choose between buying food or medicine for a malaria-stricken child, they face an impossible decision. The beauty of these programs was that they removed that burden while simultaneously strengthening local healthcare systems.”

Research consistently shows that malaria control represents one of the best investments in global development—improving not just health outcomes but economic productivity, educational achievement, and regional stability. Yet despite this evidence, international commitments to malaria eradication have fluctuated with changing political priorities.

Beyond Cameroon: A Global Health Security Perspective

The withdrawal of support for malaria programs reflects a narrower interpretation of national interests that health security experts warn may ultimately prove counterproductive. Infectious diseases respect no borders, and weakened health systems in one region can create vulnerabilities that affect global health security.

“What we’re seeing in Cameroon is happening across multiple countries where international health partnerships are being scaled back,” says Dr. Michael Levenson, who served as a technical advisor on global health security at the State Department before resigning in protest of the aid reductions. “These programs weren’t just humanitarian gestures—they were strategic investments in global health infrastructure that benefited Americans by helping identify and contain disease threats before they could spread internationally.”

The COVID-19 pandemic has subsequently highlighted the interconnected nature of global health challenges, demonstrating how quickly infectious diseases can spread across continents and how essential strong health systems are to effective response. Many of the same laboratory networks, surveillance systems, and healthcare worker training programs developed for malaria control proved valuable in responding to coronavirus outbreaks, underscoring the broader benefits of these investments.

Yet even as the pandemic emphasized the importance of global health cooperation, the momentum toward reduced international engagement had already disrupted critical programs like those in northern Cameroon. Health workers found themselves simultaneously fighting COVID-19 and trying to preserve gains against endemic diseases with diminishing resources.

The Human Face of Foreign Policy Decisions

As evening approaches in Mokolo, Aisha Hamidou makes her final home visit of the day. Six-year-old Amina Sali greets her with a drawing—a colorful depiction of a mosquito crossed out with a bold X. It’s the result of an educational campaign in local schools teaching children about malaria prevention, part of the community-based approach that had been proving successful before funding cuts threatened its continuity.

“The children understand now. They remind their parents to use the bed nets, they recognize the symptoms,” Hamidou says with visible pride. “This generation could grow up without the fear of malaria that shaped our lives. But only if we can continue the work.”

In the gathering darkness, as mothers prepare evening meals and children settle beneath insecticide-treated bed nets that will shield them through the dangerous night hours, the human stakes of distant policy decisions become viscerally apparent. Each child protected represents potential preserved—future farmers, teachers, doctors, and leaders who might help build more resilient communities if given the chance to grow up healthy.

The story of malaria control in northern Cameroon illuminates broader questions about America’s role in the world and how narrowly or broadly national interests should be defined. For health workers on the front lines and the families they serve, these questions transcend abstract policy debates and translate directly into lives saved or lost.

As the rainy season progresses, Hamidou and her colleagues continue their work with determination and ingenuity, stretching limited resources and leveraging every tool at their disposal. They have one season to protect as many children as possible while hoping that policymakers thousands of miles away might recognize the value of what stands to be lost.

“We will do everything we can with what we have,” Dr. Tchatchouang says, watching the afternoon rain bead on the window of his office. “But the mosquitoes will still come with the rains next year, and the year after. The question is whether we will still have the means to fight them.”