Taipei, Taiwan – Until recently, Southeast Asia’s Mekong sub-region appeared to be on track to achieve its goal of eliminating malaria by 2030.
Named after the 4,900-kilometer (3,000-mile) river that flows from southwest China through Myanmar, Thailand, Cambodia, Laos, and Vietnam, the region has long been plagued by the mosquito-borne disease. From 2010 to 2023, the number of cases caused by the most common malaria parasite dropped from nearly half a million to fewer than 248,000, according to the Global Fund, a U.S. government-funded organization that is the world’s largest financier of programs to combat HIV/AIDS, tuberculosis, and malaria.
However, nearly 229,000 of those cases were reported in a single country, Myanmar, where the disease surged following the outbreak of civil war in 2021 and the displacement of millions of people. Health advocates now fear that the progress made in the Mekong region could be undone as U.S. President Donald Trump’s administration drastically scales back foreign aid, effectively dismantling the U.S. Agency for International Development (USAID) and targeting Myanmar’s anti-malaria initiative for elimination.
“We were throwing all our resources at [Myanmar], but by stopping this, malaria is going to spill back into Southeast Asia and the Mekong sub-region,” said Alexandra Wharton-Smith, who worked on USAID’s Myanmar program until being laid off by the Trump administration. She spoke to Al Jazeera from Thailand.
Myanmar’s government estimates that malaria cases have risen by 300 percent since the civil war began, but Wharton-Smith noted that independent research suggests the actual figure is more than double that. New cases are also emerging in parts of Thailand that had not seen malaria in years, as refugees and migrants from Myanmar cross the border. These cases are expected to increase further following the suspension of malaria prevention programs.
[Image: A public health official holds blood test slides taken from children living on the Thai-Myanmar border at a malaria clinic in Sai Yok district, Kanchanaburi province, Thailand. Credit: Sukree Sukplang/Reuters]
The reduction in funding for anti-malaria efforts in the Mekong is just one example of cuts that are alarming humanitarian workers across the Global South, where the collapse of USAID threatens decades of progress in addressing health crises such as tuberculosis, HIV/AIDS, Ebola, and malnutrition.
On Wednesday, a top United Nations official for humanitarian affairs described the Trump administration’s actions as a “seismic shock” to the global aid sector. “Many will die because that aid is drying up,” said Tom Fletcher, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA), during a news conference on Monday.
Once the world’s largest source of international aid, USAID is set to cancel 5,200 of its approximately 6,200 programs – about 83 percent of the total, according to U.S. Secretary of State Marco Rubio. “The 5,200 contracts that are now canceled spent tens of billions of dollars in ways that did not serve, and in some cases even harmed, the core national interests of the United States,” Rubio posted on X on Monday. The remaining contracts will be overseen by the U.S. State Department, he added.
The announcement followed six weeks of turmoil for USAID, which began on January 20 when Trump issued a 90-day “pause” on U.S. development assistance. Thousands of USAID employees, contractors, and support staff were placed on leave or furloughed as projects worldwide received a “stop work order” and ground to a halt.
Confusion ensued as NGOs scrambled to fill budget gaps and determine which programs qualified for an announced waiver for life-saving partners. Last week, the Supreme Court ordered the Trump administration to comply with a lower court’s ruling to release $2 billion in back pay owed to USAID partners and contractors from before the pause. On Monday, a federal judge again called on the Trump administration to release the “unlawfully” impounded funds, emphasizing that Congress had already appropriated them for specific purposes.
U.S. development assistance has been a primary target of the Department of Government Efficiency (DOGE), led by Elon Musk, the world’s richest man and a close adviser to Trump.
[Image: Former USAID employees gather to support current staff as they retrieve their personal belongings from USAID headquarters in Washington, DC, on February 27, 2025. Credit: Manuel Balce Ceneta/AP Photo]
Catherine Kyobutungi, executive director of the African Population and Health Research Center in Nairobi, Kenya, stated that while USAID needed reform, the Trump administration’s dismantling of the agency demonstrated a “total lack of understanding of how the world works.”
“We’ve made the case that USAID’s funding mechanism was very inefficient, with little attention paid to impact, long-term sustainability, and other factors, so it was not a perfect system. The problem is that you don’t upend an imperfect system overnight,” Kyobutungi told Al Jazeera.
“It’s not just that people show up and dispense pills for medical resistance; there’s a whole structure to humanitarian assistance,” she added. “The total disregard for how things work, how the world operates, and how projects are run is astounding.”
Politicized Aid
While the full impact of USAID cuts remains unclear, a humanitarian worker at a leading nonprofit addressing malnutrition in Africa and the Middle East warned that any delay in funding could be deadly.
Among those most at risk are children in intensive care units at emergency feeding stations, being treated for complications such as organ failure and hypoglycemia, said the worker, who spoke on condition of anonymity.
“The global humanitarian community has thousands of stabilization centres around the world, supported by U.S. government funds. This is crucial because, with all the ups and downs of people awaiting waiver requests to resume programs and the cash flow problems, we can’t allow these centres to close for even a day. If the lights go off in these centres, we will see children dying,” the worker told Al Jazeera.
“Until now, this was never a political issue. Feeding starving children was bipartisan, and humanitarian aid was apolitical. Now they’ve politicized it,” the worker added.
It is also uncertain how major U.S. projects like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative will fare in the future. Founded by Republican President George W. Bush 20 years ago, these projects are credited with saving more than 32 million lives, according to UNAIDS and archived USAID data. Both are funded by Congress but implemented through agencies like USAID and the U.S. Centers for Disease Control and Prevention, which have also been targeted by DOGE’s cost-cutting measures.
Last month, UNAIDS, a major PEPFAR partner, announced that the U.S. government had terminated its relationship effective immediately. The agency reported that HIV programs in at least 55 countries had experienced funding cuts.
[Image: Sibusisiwe Ngalombi, a community health worker, shows a USAID jacket she used to wear in Harare, Zimbabwe, on February 7, 2025. Credit: Aaron Ufumeli/AP Photo]
Grants for UNICEF programs targeting polio were also terminated, as was funding for the UN Population Fund, which oversees reproductive and sexual health programs. USAID has explicitly denied waivers for any programs linked to family planning or so-called “gender ideology.”
NGOs in Asia, Africa, and elsewhere are now struggling to fill funding gaps and face major service disruptions after receiving a “stop work order” during the 90-day USAID “pause.” Rubio’s recent statements have done little to resolve the confusion, and USAID-funded food and essential items remain locked in warehouses, according to two NGO sources.
Back in the Mekong, Wharton-Smith expressed concern that the trickle of malaria cases from Myanmar over the past two years could turn into a flood with USAID’s withdrawal.
“We’re going to have more malaria where there hasn’t been malaria before. A lot of people have lost their immunity, so that could mean deaths,” she said.
“What happens when we’ve stopped treating tens of thousands of people for malaria? In a few weeks, the rainy season will begin, followed by summer. It’s going to be a disaster.”
Stay updated with the latest news by visiting our websites. For more news, check out ZTC News and ZNews Today.