AbstractSolar geoengineering is often framed as a stopgap measure to decrease the magnitude, impacts, and injustice of climate change. However, the costs or benefits of geoengineering for human health are largely unknown. We project how geoengineering could impact malaria risk by comparing transmission suitability and populations-at-risk today against moderate and high emissions scenarios (RCP 4.5 and 8.5) with and without geoengineering over the next half-century. We show that if geoengineering deployment cools the tropics, it could help protect high elevation populations in eastern Africa from the encroachment of malaria, but could increase transmission in lowland sub-Saharan Africa and southern Asia. Compared to extreme warming, we also find that by 2070, geoengineering would nullify a projected reduction of nearly one billion people at risk of malaria. Our results indicate that geoengineering strategies designed to offset warming are not guaranteed to unilaterally improve health outcomes, and could produce regional trade-offs among Global South countries that are often excluded from geoengineering conversations.