Today, another 1,100 people will die from malaria. The number will be repeated tomorrow, and the day after.
As a public health researcher, I embrace the idea that all lives have equal value. That our goal is much more to delay death than to stop death, as the latter is inevitable. Therefore as we mark this year’s World Malaria Day, we must emphasise the need for stronger health systems and sustained investments to tackle malaria more aggressively.
This message needs to be conveyed even more urgently than usual amid the coronavirus pandemic. Given the situation in Europe, China and the US, it is clear that COVID-19 significantly disrupts health systems and economic growth. There is genuine fear that if it continues spreading in Africa, the impact may be worse given the continent’s weaker health systems. One of the greatest concerns is the likely shift of attention and resources from control programmes of other infections, such as malaria.
Since 2000, Africa has benefited from some of the greatest efforts against malaria. This included a global coalition that has delivered more than 2 billion insecticide-treated nets to countries where malaria is endemic.
Given the extensive health gains, experts increasingly embraced the idea that malaria eradication, though ambitious, is both a feasible and a necessary goal. This remains the aim.
Recently, a strategic advisory panel set up by the World Health Organisation (WHO) five years ago released a report of a three-year study on benefits, future scenarios and feasibility of malaria elimination. Among its key recommendations is improved access to high-quality people-centred health services, adequate financing and resourcing for malaria programmes as well as stronger engagement with communities.
Unfortunately, in the context of COVID-19, many of these recommendations will be unattainable in the short and medium term. Resources will be shifted to tackle the pandemic and community engagement initiatives will be reduced to a bare minimum to achieve social distancing. Moreover, access to health facilities may be reduced for people with other common diseases such as malaria.
This will mean there will be many more deaths from malaria and other diseases.
This has happened before. Evidence from Africa’s fight against Ebola suggests that during outbreaks, many more people are indirectly killed by other diseases such as malaria, HIV and tuberculosis than by the outbreak itself.
African health authorities must therefore earnestly guard against such outcomes, and create a more rational response.
Protecting gains made against malaria
The past 20 years have seen major scientific developments. These have led to malaria deaths being cut from over 1 million to 405,000 a year.
This has been due in part to advances in treatments. Artemisinin-based treatments have replaced previous mono-therapies such as chloroquine. The new drugs have remained effective across Africa, which has largely been unaffected by treatment failures such as those observed in south-east Asia. About 4 million doses of child formulations of these treatments have been delivered, saving another 850,000 lives.
There have also been advances in prevention measures. For example, to mitigate the threat of insecticide resistance in malaria mosquitoes, scientists from private and public institutions have created new types of insecticidal bed nets and new chemical formulations for spraying houses. And countries such as Tanzania are using innovative distribution approaches involving schools so that they can maintain high coverage and access to essential malaria commodities.
But African countries don’t have resilient communities and strong health systems. This means that these past gains need to be protected vigorously.
Not all fevers are COVID-19
Initial symptoms of malaria – such as a high fever – may be similar to those of influenza and other viral infections such as COVID-19.
This underscores the need for malaria programme managers, community leaders and health workers in affected communities to continue to emphasise prompt diagnosis, effective treatment and improved prevention. But health workers and communities should not be put at any risk. Therefore essential information should be provided about both malaria and COVID-19.
In addition, special efforts will need to be made to avert indirect deaths. For example during the Ebola outbreak, a mass drug rollout was put in place in Sierra Leone to prevent malaria deaths.
Similarly, countries will require innovative approaches to ensure continued distribution of insecticide treated nets. The WHO has already sent an advisory to malaria-endemic countries on how to tailor their control efforts during the COVID-19 pandemic. Without this, Africa will bear the combined consequences of both diseases.
Since zero malaria starts with each one of us, we must keep up the malaria fight through this cloud of COVID-19.