Longer Term Issues, Implications, and Lessons to be Learned from Addressing Malaria during COVID-19

Who we are

The RBM Partnership to End Malaria is the global platform for coordinated action against malaria. It mobilises resources for action and forges consensus among partners. The Partnership comprises more than 500 partners committed to end malaria, including malaria endemic countries, their bilateral and multilateral development partners, the private sector, nongovernmental and community-based organisations, foundations and research and academic institutions.

A call to action

Malaria infects over 200 million people and kills over 400 thousand people globally each year. Malaria affects the most vulnerable—rural, low-income, pregnant women, and children. Two-thirds of those who die are children under the age of 5. Over half of the world’s malaria burden is in the Commonwealth[1].

 

This actually represents significant progress. Between 2000-2018, global malaria deaths declined by 59%. For 20 years, the global community, including the United Kingdom, has committed political will and investment to malaria endemic countries.

 

Unless we act now, COVID-19 threatens to erase two decades of progress. 29 countries are scheduled to distribute mosquito nets this year. Without additional partner support and advocacy, however, these campaigns are at risk—along with the hundreds of millions of people who need protection. An analysis from the WHO shows that malaria deaths could nearly double to 700 thousand this year[2]. The global community also needs a long-term strategy that strengthens the capacity of developing countries to eliminate malaria and confront novel diseases, like COVID-19.

 

While working to ensure that the spread of COVID-19 does not compromise access to essential malaria and health services, the RBM Partnership recognizes the importance of key longer term issues related to financing the malaria response, maintaining the capacity to produce, distribute, and deliver malaria commodities, and to ensuring that regional and national surveillance capacity can monitor trends in both malaria and COVID-19 transmission.

 

Stronger health systems are our first line of defence against existing and emerging diseases. Current investments in ending malaria are building capacity and helping health systems fight malaria and emerging diseases like COVID-19 by:

 

It will require global solidarity to tackle COVID-19 and address the longer-term impact of the disease. The multilateral system is well placed to facilitate this process, with WHO as the lead technical agency for health-related issues, UNDP coordinating the overall development response, UNICEF addressing the special needs of children, the World Bank providing international finance, and all UN agencies acting together to address the profound and long-term socioeconomic impact arising from COVID-19.

Impact on funding for malaria and other infectious diseases

 

As the global economy suffers during the COVID-19 pandemic, ensuring sustainable financing for malaria and health programs represents a significant risk over the longer term. By January 2020, the debt of 44% of the least developed and low-income countries was already at high risk or in distress. Even with recent debt relief commitments from multilateral and bilateral creditors, there will be significant long-term damage to the economies of malaria endemic countries, which were already struggling to allocate sufficient funding to malaria and health more generally. It is not only low-income countries at risk of financially sustaining their malaria programs. Middle-income countries, home to 75% of the world’s population and 62% of the world’s poor, are highly vulnerable to a debt crisis, lost market access and capital outflows.[5]

 

Without urgent responses addressing the social and economic impacts of the COVID-19 pandemic, the compounding effects of the disease on lives and livelihoods will exacerbate the impact of malaria and other infectious diseases. The World Bank has warned that between 40-60 million people could be pushed into extreme poverty this year, with Sub-Saharan Africa hit hardest, followed by South Asia. The International Labour Organisation expects the equivalent of 195 million jobs lost. The World Food Programme projects that 135 million are facing crisis levels of hunger, while another 130 million are near starvation.[6] These socioeconomic conditions will not only drive the spread of diseases such as malaria, which thrive under poverty conditions, but threaten the available funding to address disease, from both donor and endemic countries.

Potential impact of COVID-19 on global malaria morbidity and mortality

We know from past experience that when resources disappear, malaria resurges. Recent modelling analyses by the WHO and Imperial College London have considered the potential impact of malaria service disruptions and the effectiveness of COVID-19 mitigation measures in Africa.[7] Under the worst case scenario, with LLIN campaigns disrupted, and malaria case management reduced by 75%, the death toll in 2020 would be double the number of deaths in 2018, and would represent a complete reversal in the substantial progress in malaria mortality reductions seen over the last 2 decades. This analysis does not factor in the effects of disrupting seasonal malaria chemoprevention (SMC) and indoor residual spraying (IRS), and these disruptions would also lead to additional excess morbidity and mortality. One potential impact could be a greater risk of drug-resistant malaria spreading, as a result of possible shortages of the recommended artemisinin combination therapies. These immediate threats to preventing malaria cases and deaths will continue to loom beyond 2020, particularly if transmission of the SARS-CoV-2 virus resurges in areas which had previously succeeded in controlling the spread.

 

Lockdown measures in the near term have already disrupted the ability of front-line workers to reach communities in need. Even as these measures are reduced, the threat of a resurgence in COVID-19 cases and reinstatement of lockdown orders will remain a threat until a protective vaccine is widely available. In addition, the fears of front-line workers about exposure to COVID-19 will continue to pose a risk in the delivery of malaria services, particularly depending on the continuous availability of personal protective equipment. There are also long-term risks associated with care-seeking in developing countries with a high burden of several febrile-illnesses from dengue to malaria and other emerging infectious diseases for which a fever is a symptom. Front-line health workers currently do no possess adequate tools and training to diagnose and differentiate between febrile illnesses like COVID-19, but also malaria or dengue fever. This is a concern for the countries’ capacity to detect and respond to future health security threats, as infectious diseases share common symptoms with malaria.

Global supply chain for malaria commodities and COVID-19

One of the most significant, long-term issues to be addressed in the joint COVID-19 and malaria response concerns the global supply chain for medicines and health commodities. Experiences even from this early stage in the global response highlight a number of areas which will need to be addressed over the longer term as well as in the current context, including:
 

Learning opportunities

 

Role of the United Kingdom

There has never been a more important time for the UK to continue its investment in global health. Reducing malaria morbidity and mortality is a key pillar of the UK Government’s commitment to ending preventable deaths, and can play a mutually reinforcing role in the delivery of DFID’s broader health strategy.

 

The UK’s strong commitment to tackling malaria, combined with its unique resources and capabilities, particularly in science and innovation, mean that there is both an immediate and longer-term role the UK can play in ensuring progress against malaria is not undone by the COVID-19 pandemic.

 

It is important that the UK harnesses the best of what it has to offer, to protect hard-won progress against malaria, help build more resilient health systems, and ultimately ensure we are effectively prepared to address other disease outbreaks in the future.

 

The UK Government must continue to act as a champion of the fight against malaria both at the global level and through its partnerships with malaria endemic countries, to ensure the continuation of vital malaria prevention and treatment activities at this critical time. In particular, we encourage the UK Government to support the Global Fund in providing the necessary flexibilities in use of finance to allow malaria endemic countries to respond effectively to the current crisis, whist ensuring malaria funding is protected and existing pledges are fulfilled.

 

We also encourage the UK to make use of the synergies that exist between investments in the fight against malaria and broader health system strengthening and health security, by ensuing malaria is considered as a key component of COVID-19 response planning.

 


[1] World Health Organization. (2019). World malaria report 2019. https://www.who.int/publications-detail/world-malaria-report-2019

[2] Global Malaria Programme, WHO, “The potential impact of health service disruptions on the burden of malaria: a modelling analysis for countries in Sub-Saharan Africa.” https://apps.who.int/iris/bitstream/handle/10665/331845/9789240004641-eng.pdf.

[3] World Malaria Report 2019

[4] See Roll Back Malaria Partnership, Action and Investment to defeat Malaria 2016-2030 (AIM), 2015.

[5] See World Bank, https://www.worldbank.org/en/country/mic

[6] See https://www.undp.org/content/undp/en/home/news-centre/news/2020/UN_sets_out_COVID_social_and_economic_recovery_plan.html

[7] Global Malaria Programme, WHO, “The potential impact of health service disruptions on the burden of malaria: a modelling analysis for countries in Sub-Saharan Africa.” https://apps.who.int/iris/bitstream/handle/10665/331845/9789240004641-eng.pdf. Also see Sherrard-Smith, E., et al. “Report 18: The potential public health impact of COVID-19 on malaria in Africa,” https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-01-COVID19-Report-18.pdf