In FY2008, Congress significantly increased its funding for global malaria and authorized the creation of the U.S. Global Malaria Coordinator at the United States Agency for International Development (USAID) to oversee all U.S. malaria efforts. Since 2000, 43 countries have reported a reduction in reported malaria cases of more than 50%. Likewise, the estimated incidence—new cases of malaria—has decreased by 17% globally between 2000 and 2010. Malaria Deaths: The malaria death toll declined from 985,000 in 2000 to 655,000 people in 2010. Since 2000, global malaria mortality has been reduced by 26%. 106-570 ). On May 27, 2003, President George W. Bush signed into law the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act, P.L. 108-25 ). The act also prohibited U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) (see " Key Partners in the Response to Global Malaria ") from exceeding 33% of funds contributed from all sources. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act, P.L. 110-293 ). This legislation will be up for reauthorization in FY2013. Global Malaria Programs

The United States has supported global malaria control efforts since the 1950s. Efforts to expand U.S. malaria programs and improve their coordination increased following the announcement of the President's Malaria Initiative (PMI) in 2005. PMI represented a growing acknowledgement of the efficacy of malaria prevention and treatment strategies and built on the success of the President's Emergency Plan for AIDS Relief (PEPFAR) in harnessing resources to combat a disease. President Obama has indicated support for an expanded U.S. malaria program. Key goals include the following:
halve the burden of malaria (morbidity and mortality) in 70% of at-risk populations in sub-Saharan Africa; limit the spread of anti-malarial multi-drug resistance in Southeast Asia and the Americas; assist host countries to revise and update their National Malaria Control Strategies and Plans to reflect the declining burden of malaria; and link U.S. malaria efforts with host country malaria plans. Congressional appropriations for malaria have consistently increased since FY2004. In response to growing calls within the international community for global malaria control, funding for malaria interventions has increased most precipitously since FY2007 ( Table 2 and Figure 2 ) in support of PMI expansion into new countries. The Global Fund is the single largest donor for global malaria efforts. As Congress continues to debate the role of the United States in global malaria control, it might consider the following issues:
Insecticide and drug resistance : Growing instances of drug-resistant malaria and insecticide-resistant mosquitoes threaten global malaria control, particularly in Southeast Asia and Africa. In particular, shortages in health care personnel and weak supply chain networks have limited the delivery of essential commodities for malaria control. There is some disagreement within the global health community about whether PMI has had a beneficial or detrimental impact on the broader functioning of health systems. Control vs. elimination: There is debate within the global health community over the degree to which the international community should commit itself to malaria control (reducing the disease burden to a level at which it is no longer a public health problem) or malaria elimination (reducing incidence of infection to zero in a defined geographic).
In 2010, malaria infected an estimated 216 million people and killed 655,000 people, most of whom were children under the age of five in sub-Saharan Africa. Despite the current burden of disease, malaria is preventable and treatable. Congress has increasingly recognized malaria as an important foreign policy issue, and the United States has become a major player in the global response to the disease. In its second session, the 112th Congress will likely debate the appropriate funding levels and optimum strategy for addressing the continued challenge of global malaria.
Congress has enacted several key pieces of legislation related to global malaria control. These include the Assistance for International Malaria Control Act of 2000 (P.L. 106-570); the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293). These acts have authorized funds to be used in the fight against malaria and have shaped the ways in which U.S. malaria programs are coordinated and managed, including through the creation of the U.S. Global Malaria Coordinator at the United States Agency for International Development (USAID).
In 2005, in response to growing international calls for global malaria control and to the success of the President's Emergency Plan for AIDS Relief (PEPFAR), President George W. Bush launched the President's Malaria Initiative (PMI), which aims to halve the burden of malaria morbidity and mortality in 70% of at-risk populations in sub-Saharan Africa by 2014. PMI brought significant new attention and funding to U.S. malaria programs and made the United States one of the largest donors for malaria efforts. While U.S. funding for global malaria programs has increased each fiscal year since FY2004, support for malaria interventions increased most precipitously beginning in FY2007 as PMI has expanded into new countries. President Obama has continued to support PMI through the Global Health Initiative (GHI).
There is evidence that the growing international response to malaria has had some success in controlling the epidemic. Since 2000, global malaria incidence has decreased by 17% and malaria mortality by 26%. Since 2000, 43 countries have reported a reduction in reported malaria cases of more than 50%, including eight African countries that have experienced 50% reduction in either confirmed malaria cases or malaria admissions and deaths. The decreases in each of these African countries are associated with intense malaria control activities. Despite these successes, several key issues pose challenges to an effective scale-up of the response to malaria. First, increasing reports of drug-resistant malaria in Southeast Asia and insecticide-resistant mosquitoes, largely in Africa, threaten the success of malaria control programs. Second, weak health systems, including shortages in health care personnel and inadequate supply chain networks, have limited the delivery of essential commodities for malaria control. There is also debate within the global health community over whether malaria efforts should increasingly target areas where malaria elimination is possible or whether efforts should remain concentrated on malaria control.
This report outlines basic facts related to global malaria, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to the global response to malaria. The report will be updated as events warrant.