World Malaria Day is a reminder that as the world battles with COVID-19, we still haven’t beaten a much older pandemic. Malaria is a mosquito-borne disease that has plagued humanity for millennia and still kills over 400,000 people per year – mainly children under 5. In fact, that grim number will almost certainly have increased in 2020 and will do so again in 2021, as COVID-19 has severely disrupted malaria testing and treatment services in many of the most affected countries.
New data from Global Fund spot-checks of 504 health care facilities across 32 countries in Africa and Asia in 2020 revealed a 31% drop in malaria diagnoses over a six-month period compared to the previous year, and a 13% drop in malaria treatment. Since swift diagnosis and treatment are key to preventing death, and there’s no reason to believe that the number of cases has fallen, such a sharp reduction in diagnoses and treatment will inevitably translate into increased mortality.
It could have been even worse. The first line of defense against malaria are insecticide-treated mosquito nets that protect people from mosquitoes. When the pandemic first hit we were extremely concerned that supply chain disruptions and the challenges of distributing millions of mosquito nets during lockdowns would leave hundreds of millions of people unprotected. A massive effort, led by countries’ national malaria campaigns, supported by the Global Fund and the U.S. President’s Malaria Initiative (PMI) and with huge engagement of community organizations, prevented what could have been a catastrophe. While some mosquito net distribution campaigns were delayed in 2020, almost all were successfully implemented.
This year, the challenge will be to sustain community health workers’ ability to test and treat malaria. In much of rural Africa, community health workers are the lynchpin of the health system, and in the highest burden regions of central and western Africa, most of their time is spent treating malaria cases. I recall talking to a community health worker in Mali, who told me the malaria situation was much better than it was years earlier when she first started. But when I looked at her register of patient visits, I was surprised to see that every single entry was a malaria case. When I asked her to explain, she said the big difference was in the number of deaths; rapid testing and effective treatment had dramatically reduced mortality. Since 2000, the worldwide malaria death rate has dropped by 60% thanks to the tireless efforts of community health workers like her.
But given the number of people they interact with, community health workers are extremely vulnerable to being infected with COVID-19 and often have limited access to basic personal protective equipment like gloves and masks. In the same round of Global Fund spot-checks of health facilities last year, a shocking 55% of facilities in Africa didn’t have enough basic PPE available for their workers. If a community health worker falls ill, there’s often no back-up.
Community health workers will also be called on to play a vital role in COVID-19 vaccination campaign as these get going. It is crucial to protect people from the new virus, but we also need to ensure that the diversion of focus doesn’t lead to an escalation in malaria deaths.
In the poorest countries in Africa it seems quite likely that unless we take decisive action, the knock-on impact of the pandemic in terms of incremental malaria deaths may well exceed the direct impact of COVID-19.
As the largest funder of malaria programs worldwide, the Global Fund is working urgently with partners to prevent such a disastrous outcome and get us back on track towards ending malaria. From January 2021, we have increased malaria grants by 23% on average, and are committed to deploying about US$4 billion over the next three years. In addition, our COVID-19 Response Mechanism is providing US$3.7 billion in funding to help countries respond to COVID-19, mitigate the impact on HIV, TB and malaria services, and make urgent fixes to health systems.
For malaria, the priorities in 2021 are to continue to ensure we maintain campaigns for mosquito net distribution, spraying of insecticide in homes, and the provision of seasonal malaria chemoprevention for children, and to step up support to community health worker networks. We need more community health workers and we need to support them better – financially, with technology, with training and with personal protective equipment.
Looking beyond 2021, we should take COVID-19 as a catalyst to rethink our approach to malaria. Global policy-makers are already discussing how to better protect the world from future pandemics. Let’s not forget the imperative to finish the fight against older pandemics like malaria, which may not threaten those in Washington D.C., London or Paris, but still kill hundreds of thousands of people every year.
In fact, the best way to build pandemic preparedness in many of the poorest parts of the world would be to mount a significant step-up in the fight against the malaria. The capabilities needed to prepare and respond to any new pathogenic threat are largely the same as those needed to defeat malaria – primary health care that reaches everyone, however remote; rapid diagnostics; genomic sequencing to detect variants; disease surveillance including the ability to trace individual infections; supply chains that ensure essential medicines are available everywhere. New potential malaria vaccines could be used to pilot accelerated models for clinical trials, regulatory approval and deployment.
Rather than predicate pandemic preparedness on hypothetical threats, pathogens that might cost lives, let’s build such protection by beating malaria and by doing so save millions of lives – the vast majority of them young children. For too long we have accepted people dying of a treatable disease we know how to eliminate – and that we have eliminated in dozens of countries. Now we should make this happen everywhere, and in doing so reinforce our defenses against other pandemic threats.
Op-ed first appeared on Health Policy Watch on the 24th of April 2021.