29 Apr 2020
Higher malaria death rates may result from diversion of focus to the coronavirus

On 25 April, countries and communities marked the annual World Malaria Day, to highlight the global efforts to control malaria and celebrate the gains in the fight against this disease. The theme for the day was ‘zero malaria starts with me,’ which calls for individual commitment to fight the disease.

Over the last two decades, coordinated efforts all over the world have helped save more than seven million lives and prevent over one billion malaria cases, according to the RBM Partnership to End Malaria. The world needs to maintain those gains, despite the COVID-19 pandemic.

Malaria remains a formidable foe. There were an estimated 228 million cases of malaria and 405,000 deaths globally, in 2018 (the last year for which data is available), according to the World Health Organization’s (WHO) 2019 World Malaria Report. About two-thirds of those who died in 2018 are children under the age of five. Other populations vulnerable to malaria include pregnant women, those with compromised immunity such as people living with HIV, as well as migrants mobile populations, and travelers who are ‘non-immune’ (those who have not had the chance to develop a degree of immunity in places where malaria is endemic year-round). About 97% of people who are affected by malaria live in sub-Saharan Africa.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria invested more than $12.9 billion in malaria control programs as of March 2020 and provided 65% of all international financing for malaria. The Global Fund financed 58% of long-lasting insecticide-treated nets (LLINs) delivered globally, between 2015 and the first half-year of 2019.

Progress in the fight against malaria

Globally, 1.98 billion insecticide-treated nets were distributed since 2004. The number of countries reporting fewer than 100 cases of locally acquired malaria increased from 17 in 2010 to 27 in 2018. Some countries such as China, El Salvador, Iran, Malaysia, and Timor-Leste had zero cases locally acquired malaria in 2018. In 2019, WHO certified Algeria and Argentina as malaria-free. Many other countries are moving towards malaria elimination. In 2019, malaria vaccine trials were piloted in Kenya, Ghana, and Malawi. The vaccine has shown promising results,  preventing 39% of malaria cases among children five to 17 months of age.  

COVID-19 epidemic may lead to higher malaria death rates

COVID-19 has created challenges in the global supply chain and in-country in ways that could disrupt insecticide-treated mosquito net campaigns and the availability of antimalarial diagnostic tests and medications. For instance, the production of medication depends on factories in India and China. Both countries are still implementing measures to reduce the spread of the novel coronavirus and assure appropriate stockpiles for their own national needs. Also, many pharmaceutical companies are shifting their focus to producing diagnostic tests for COVID-19 and developing a vaccine; such shifts may come at the expense of producing malaria diagnostic tests and medications.

Postponed planned mass campaigns, such as the distribution of insecticide-treated nets, or reduced access to malaria care could lead to a surge in malaria cases, which in turn could lead to a doubling of malaria deaths this year. These dire potential consequences emerge from a modeling analysis by WHO, in close collaboration with other partners and cited by the RBM Partnership to End Malaria.  

Such outcomes would seriously damage gains made so far in the fight against malaria, but are not a foregone conclusion – if countries act fast to implement mitigation measures. Some resources are available to assist: The Global Fund has provided $1 billion-worth of support through flexibilities in existing grants and through its newly established COVID-19 response mechanism (C19RM) to help countries fight this new pandemic and mitigate the impact of COVID-19 on existing HIV, TB and malaria programs. As of 28 April, 70 countries had taken advantage of these facilities.

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