Let’s keep eliminating malaria – while fighting COVID-19 (coronavirus)

As we mark World Malaria Day on April 25, there’s a lot to be proud of. Through decades of work, governments, global development and community actors have made tangible progress in countering the mosquito-borne disease. 

Globally, cases are declining: in 2018 there were 228 million reported cases, compared with 251 million  in 2010. Deaths are also decreasing, with 405,000 in 2018 compared with 585,000 in 2010. Over the last decade, 10 countries have been certified as malaria-free, while five more reported no new cases in 2018.

A recent report by the Strategic Advisory Group on Malaria Eradication of the World Health Organization (WHO) assessed the prospects for global eradication of malaria and identified six key actions required to reach this goal:

1. Reinforcing the Global Technical Strategy for Malaria 2016–2030;
2. Research and development for new tools;
3. Access to affordable, high quality, people-centered health care and services;
4. Adequate and sustained financing;
5. Strengthened surveillance and response; and
6. Engaging communities.

Despite its potential to kill, malaria is preventable, and treatable interventions are both effective and affordable:

• Access to rapid diagnostic tests and life-saving treatment with artemisinin-based combination drugs in local communities has been a game changer in treating malaria. Many people – mostly children – who would have developed severe malaria are now cured and survive.

• Expanded access to intermittent preventive treatment for vulnerable populations such as infants, young children and pregnant women has reduced infections and contributed to better maternal and child health.

• The cornerstone of malaria prevention strategy targets the mosquitos that transmit malaria.  The WHO recommends protection for all people at risk of malaria with insecticide-treated mosquito nets and indoor residual spraying, even where transmission has been greatly reduced. In 2018, about half of all people at risk of malaria in Africa were protected by a net, compared to 29% in 2010; however, coverage has been at a standstill since 2016.

Much work remains

In recent years, global progress in combatting malaria has levelled off. Without accelerated efforts, the target of reducing cases by 90% by 2030, which was set in the WHO’s Global Technical Strategy for Malaria 2016–2030, won’t be achieved and the prospects for global eradication will diminish.

Worse still, malaria is on the rise in some countries of Sub-Saharan Africa; the region has 93% of the world’s cases and 94% of related deaths.  Countries in the Sahel bear a disproportionate burden, with malaria the primary cause of death in young children and the primary reason for visits to health centers and hospitals. Children are most at risk, accounting for 67% of deaths worldwide. In fact, every two minutes, a child dies of malaria. 

Progress to date in controlling malaria has resulted primarily from expanded access to mosquito nets, particularly in Africa. However, these gains are threatened by emerging resistance to insecticides among mosquitoes. Resistance to antimalarial medicines is also a growing problem.

New tools are urgently needed in the global response. Stronger malaria surveillance systems are also needed to prevent outbreaks and resurgences, track progress, and ensure accountability.

The impact of COVID-19

The COVID-19 (coronavirus) pandemic is straining health care systems around the world and posing a substantial threat in Africa. Responding to it is a top priority, but we cannot neglect life-saving services for other diseases such as malaria.

Previous disease outbreaks have disrupted health services and undermined malaria control efforts. The 2014-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone led to a massive increase in malaria-related illness and deaths. Reports estimated that the resulting increase of malaria deaths in these countries greatly exceeded the number of deaths from Ebola.

There are already reports of disruptions in the supply chains of essential malaria supplies including nets, rapid diagnostic tests and antimalarial medicines – resulting from lockdowns and export bans in response to COVID-19. New analysis released by WHO today found that severe disruptions to net campaigns and in access to antimalarial medicines could lead to a doubling in the number of malaria deaths in Africa this year compared to 2018.

Ensuring that malaria prevention measures continue not only protects vulnerable populations against malaria, but also reduces the strain on health systems that may be overburdened by COVID-19.  Following best practices to protect health workers can ensure that anti-malaria campaigns continue. Efforts to limit the spread of COVID-19 should not compromise access to malaria prevention, diagnosis and treatment services. 

What’s being done?

The World Bank has committed $121 million to the Sahel Malaria and Neglected Tropical Diseases Project for Africa. Working with partners including the WHO and the West African Health Organization (WAHO), the project is helping the governments of Burkina Faso, Mali and Niger prevent and treat malaria and other neglected tropical diseases. 

The project is supporting countries’ efforts to harmonize policies and engage in joint planning, implementation, knowledge exchange and evaluation. The benefits of collaboration include regional research, technical advisory groups and pooled drug procurement. Community-based interventions in cross-border areas are also supporting countries’ efforts to jointly control malaria.

To date, over 2.6 million people have directly benefited from these interventions. Some districts have achieved at least 70% coverage of seasonal malaria chemoprevention (a strategy custom-built for use in the Sahel) as well as access to community-based diagnosis and treatment for children under five years old. This exceeds the project target. The countries report that regional collaboration has harmonized malaria management, and each has new or revised guidelines for recruitment and retention of community-based health volunteers.

The role of universal health coverage

Early diagnosis and treatment is the most effective way to prevent a mild case of malaria from developing into a severe or deadly case.  However, household surveys in 20 African countries found that a high proportion of children with fevers did not receive any medical care. Poor access to health care and a lack of awareness of malaria symptoms were contributing factors.

The World Bank finances malaria control as an integral part of essential health services, in the context of achieving universal health coverage. We are working with countries to ensure that malaria prevention and treatment are effectively and sustainably integrated into national health sector plans. Only with country leadership and global financing of universal health coverage can we defeat this disease once and for all.