Malawi is currently in the throes of a major mpox, a contagious disease that has skyrocketed across multiple African countries. Malawi’s healthcare system is facing unprecedented pressures. As one of just 16 countries currently reporting cases, it is more dependent on foreign aid—especially from the United States—than ever. The U.S. government has not budged from consistently providing over $350 million per year to Malawi. This support accounts for over 50% of the country’s total donor support. Recent, drastic U.S. funding cuts for HIV programs threaten that capacity and the immediate risks they pose to Malawi’s ability to stop the outbreak are clear.
Ever since the global mpox outbreak emerged in 2022, Malawi has been on the frontlines. This trend was especially exacerbated by the conflict in the Democratic Republic of the Congo. The country announced its first mpox cases in April 2023. As of Friday, July 1st, the Ministry of Health had officially acknowledged and confirmed a total of 11 cases. This includes the first three new cases reported in the country’s capital city, Lilongwe. One of those affected, a two-year-old child from the district of Mangochi, about 150 miles from the capital.
Malawi’s already stretched healthcare system, made brittle by a constellation of other factors, has severely limited the nation’s ability to respond to this outbreak. Long distances to clinics, insufficient funding, a shortage of medical equipment, and a lack of qualified personnel hinder the delivery of essential health services.
Dr. Victor Mithi highlighted the challenge of cultural practices in Malawi that increase disease transmission.
“It is a big concern because in Malawi, most people live in crowded houses and still believe that as a form of expression of love, you need to shake hands, you need to hug people and all those things which are basically the risk factors in the transmission of this disease,” – Dr. Victor Mithi.
Additionally, the intersection of mpox and HIV makes the issue even more complex. People living with HIV—particularly those with uncontrolled viral loads—are at risk for severe mpox cases. In Malawi, millions of doses of critical HIV prevention drugs (PrEP) will expire soon. Reduction in funding has worked against our fight to get a handle on both HIV and mpox.
The Public Health Institute of Malawi has already begun to investigate to identify where people are getting infected. They are vigorously identifying contacts of the positive cases.
“Investigations are under way to establish the possible source of infection and trace contacts,” – Public Health Institute of Malawi.
Richard Mvula noted that several confirmed cases share a commonality: many were immunocompromised, which heightens their vulnerability to the disease.
Malawi is currently on the frontlines of a global public health crisis. The ending of U.S. aid has left a massive hole of resources required to keep the healthcare system running.
Mithi illustrated the toll this withdrawal is taking on the capacity of our healthcare system.
“The challenge exists though because of the withdrawal of the US aid; the capacity of our healthcare system is no longer the same. Almost 60% of our healthcare system is donor dependent, of which more than 50% of the donor aid was coming from [the US]. So the withdrawal means that our healthcare system is completely shaken; we are left in a state where we didn’t build internal capacities to sustain ourselves,” – Mithi.
As authorities grapple with rising mpox cases and dwindling resources, the need for enhanced local healthcare capacity has never been clearer. Making the community aware of these dangers is key. People like Steven Banda have spoken out about their being little to no information on mpox in their local communities.
“I came across an official from the ministry of health who was explaining about it and advised that we should be careful since it is dangerous. She described the symptoms including swellings and mentioned some of the districts affected. I’m not aware of any cases in my area or seen anyone suffering from the disease. We don’t know much about it,” – Steven Banda.
Malawi is at a strategic crossroads as it continues to combat mpox even as the world’s international support continues to wane. Public health challenges, cultural practices, and a waning healthcare infrastructure complicate their efforts substantially. These are all areas that urgently need the attention of local authorities and their international partners.
