Estimating the potential malaria morbidity and mortality avertable by the US President’s Malaria Initiative in 2025: a geospatial modelling analysis

Since its inception in 2005, the US President’s Malaria Initiative (PMI) has played a major role in the reductions in malaria morbidity and mortality observed across Africa. With the status of PMI funding and operations currently uncertain, we aimed to quantify the impact that a fully functioning PMI would have on malaria cases and deaths in Africa during 2025.

We combined detailed spatiotemporal information on planned 2025 PMI and non-PMI malaria commodity procurement and distribution in Africa (focusing on insecticide-treated bednets, artemisinin-based combination therapies, seasonal malaria chemoprevention, and indoor residual spraying of insecticides) with spatiotemporal Bayesian models of intervention coverage and Plasmodium falciparum transmission and burden in Africa. By comparing coverage scenarios with and without planned PMI contributions (ie, business-as-usual and no-PMI scenarios), we estimated the number of malaria cases and deaths that PMI investment would avert in 2025. For all interventions, the no-PMI scenario was defined in the absence of any mitigation strategies. Coverage supported by PMI under the business-as-usual scenario was assumed to be lost.

We estimated that business-as-usual PMI contributions to vector control, seasonal malaria chemoprevention, and routine malaria treatment in Africa would avert 13·6 million (95% uncertainty interval [UI] 11·4–16·4 million) malaria cases and 104 000 (69 000–161 000) deaths in 2025. These estimates represent 11·3% (95% UI 9·9–12·9) of the total burden of malaria morbidity and 37·5% (34·2–41·5) of the total burden of malaria mortality in PMI’s focus geographies across 27 African countries. These estimates do not account for the additional impact of PMI-supported provision of diagnostics or severe case management commodities, nor preventive treatment for pregnant individuals, which would further lessen these burdens.