Why Ignoring Malaria in Africa Undermines U.S. Interests

As the United States focuses on Africa’s future leaders and gender equality, why are we not explicitly discussing malaria’s immense impact? U.S. policymakers should see the disease for what it really is: inextricably linked to saving the lives of Africa’s women and girls, supporting a new generation of African leaders, and bolstering America’s immediate and long-term security interests.

Malaria is often misperceived by policymakers as a global health problem not vital to the United States. U.S. stakeholders feel pangs of empathy for malaria-affected peoples without realizing the disease’s surprisingly meaningful place in a complicated landscape of geopolitical challenges. Malaria unequivocally and tangibly stunts progress and the livelihoods of millions around the globe, especially women and girls, with broad implications and a significant impact on critical U.S. security interests in Africa.

Malaria Investments Serve African Prosperity and U.S. Security

While there has been great momentum in the Biden administration and Congress around engaging African leaders and a blossoming discourse around the strategic importance of the region to global security, and the need to offset China’s role, there is a need for greater attention paid to the tangible role of malaria, which continues to thwart the progress of millions of Africans.

In Africa, immediate investments in fighting malaria would lead to a significant acceleration of economic growth for African countries and bolster fundamental U.S. security interests over the long run. It is currently estimated that 25 percent of household income in Africa is lost due to malaria infections. This calamitous loss of income for African families results in fewer educational opportunities and widespread poverty for millions of people in the region. Moreover, this household economic loss due to malaria also results in significantly diminished economic growth for African countries, including those of particular geopolitical importance for the U.S.

In December of 2022, President Joe Biden hosted the African Leaders Summit and consistently stressed the critical role of African leaders in tackling the world’s most difficult challenges, including countering terrorism, mitigating climate change, and enhancing global health security. Biden has explicitly pointed to the rising threats of terrorism in Africa as a key national security priority since he took office. President Biden—like Presidents George W. Bush and Barack Obama—recognizes that between global demographic trends and emerging security threats, African leaders and the next generation of Africans will play a pivotal role in shaping geopolitical dynamics in the decades to come.

Acutely aware of Africa’s burgeoning influence, China has been uniquely proactive and even aggressive in its investments in Africa. However, China’s investments in the continent are often predicated upon specific benefits such as access to natural resources, jobs for Chinese nationals, and collateral for massive loans.

U.S. investment could offer an important alternative to China: the United States could provide less baldly conditional and more favorable investment terms with these critical future allies. Investments in malaria prevention and response could not only strengthen partnerships with African countries, but also reinforce U.S. commitment as a partner that delivers in tangible ways for people, prosperity, and political leaders.

Investing in Malaria is Investing in Women & Girls

Investments in malaria could also yield extraordinary and immediate benefits for African women and girls—the next generation of African leadership and enormously important to the continent’s future. They are a crucial half of the enormous and burgeoning youth generation, critical sources of future African economic growth, and pivotal voices to counter violence, extremism, and domestic political polarization.

Economic empowerment is often associated with three Es: access of girls and women to education, employment, and entrepreneurship. But malaria often disrupts this access. Research also shows that half of school absences in Africa are caused by malaria (with older girls disproportionately affected), leading to catastrophic short-term and long-term consequences.

In Ghana, one study found that 83 percent of household malaria cases are cared for by women. In an average agricultural household in Sub-Saharan Africa, women can invest up to 246 days of caregiving, as compared to 66 days by men, for malaria cases among children. Effective malaria response directly unencumbers women’s economic empowerment. Economic growth in low- and middle-income countries depends on fully tapping the potential of the roughly half of their population who are female, and malaria is a serious economic and social obstacle to such.

According to the World Health Organization (WHO), approximately one in four pregnant women are infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa, leading to low birth weight, stillbirths, and sometimes life-long learning challenges. Meanwhile, every year 50,000–70,000 young African mothers die from placental malaria. While rapid progress is being made on the treatment of placental malaria by the National Institutes for Health, U.S. investment in catalyzing and scaling research and investment remains remarkably low. Funding and providing access to intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) can lower the incidence of severe maternal anemia by 38 percent and reduce the consequences of malaria infection for both pregnant women and newborns. Yet just 35 percent of pregnant women currently receive the full three doses recommended by WHO. Likewise, supply and consistent use of insecticide-treated nets helps keep pregnant women safe, including those living with HIV who cannot receive IPTp-SP.

There’s another way effectively battling malaria facilitates women’s empowerment. Throughout Africa, a major element of malaria prevention, diagnosis, and treatment is community health workers (CHWs). These local caregivers serve the needs of marginalized, remote, and less-educated communities, often in informal settings. Their reach is why CHWs have been priorities for the U.S. President’s Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

As of 2019, women make up more than 70 percent of the global health and social care workforce, and only 25 percent of that number holds senior roles. Half of all CHWs in low- and middle-income countries don’t have salaries. Female CHWs spend four times as many hours doing unpaid work as compared to male counterparts. More effective malaria prevention, screening, and treatment in Africa—and elsewhere—requires more equitable pay and advancement paths for women in the health sector. The United States and the private sector can and must be catalysts.

Women’s economic empowerment in turn can help drive malaria’s elimination country by country in Africa. A 2020 study found that providing agricultural education services and support to community-level female agricultural sector networks in Uganda spurred a 22 percent increase in mosquito bed nets used per capita, and malaria prevalence decreased 29 percent at household level, 22.4 percent among children under 5 years old, and 56.8 percent among pregnant women.

Investments targeting malaria are exceptional in their potential impact: they reach huge swaths of the global population effectively and can rapidly catalyze outsized global economic growth. Indeed, malaria response is one of the most cost-effective ways to save lives and advance U.S. partnership and security interests in Africa. It is time to take the blinders off and see that investment in fighting malaria is a critical investment in women and girls and a necessary and timely investment in Africa’s future—and ours.

Sohini Chatterjee is Managing Director for Global Policy and Advocacy for Malaria No More and former Senior Policy Advisor to the U.S. Ambassador to the United Nations.

Mark P. Lagon is Chief Policy Officer, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria; Senior Fellow at The Trinity Forum; and former U.S. Ambassador-At-Large to Combat Trafficking in Persons.

Image: Shutterstock.