Malaria in the context of COVID-19

The 25th of April 2020 is world malaria day as sanctioned by the World Health Organization (WHO). And given the current global context that we are currently living in due to the outbreak of the Novel Coronavirus (COVID-19), we are going to look at the African endemic that is Malaria in the context of the global pandemic of the Novel Coronavirus.

What is malaria?

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Most malaria cases and deaths occur in sub-Saharan Africa, however, in 2018, nearly half of the world’s population was at risk of malaria including regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas which resulted in 228 million cases of malaria. The estimated number of malaria deaths stood at 405 000 in 2018 and the sub-Saharan Africa region was home to 93% of malaria cases and 94% of malaria deaths.

While the disease is preventable and curable, a single person can contract it multiple times in a lifetime. Some population groups are at considerably higher risk of contracting malaria and developing severe disease. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers.

Malaria’s impact on Africa

Malaria is one of Africa’s greatest endemics. According to the WHO, the African Region continues to carry a disproportionately high share of the global malaria burden. In 2018, 6 countries accounted for more than half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%), and Côte d’Ivoire, Mozambique and Niger (4% each). More importantly, children under 5 years of age are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272 000) of all malaria deaths worldwide.

Fighting malaria amidst a global pandemic

The impact with which the Novel Coronavirus hit the world was large and unexpected. And five months into the crisis, many countries across the globe are still scrambling to coordinate efforts to respond to the COVID-19 pandemic and flatten the curve. As the virus spreads to all corners of the planet, 37 malaria-endemic countries in the WHO African region had reported cases of COVID-19 by 25 March 2020, with some reporting local transmission of the virus.

While cases of the Novel Coronavirus in malaria-affected countries currently represent only a small proportion of the global total, the situation is evolving rapidly. The most sensitive aspect of the Coronavirus response is the risk that efforts to prevent the spread of the virus could undermine the efforts to prevent, detect and treat malaria. In recent days, there have been reports of the suspension of insecticide-treated net (ITN) and indoor residual spraying (IRS) campaigns in several African countries due to concerns around exposure to COVID-19. Suspending such campaigns will leave many vulnerable populations at greater risk of malaria, particularly young children and pregnant women. The key is using best practices to protect health workers and communities from COVID-19 infection while enabling them to carry out their activities in the fight against malaria. Modifications of planned distribution strategies may be needed to minimize exposure to the coronavirus.

WHO strongly encourages countries not to suspend the planning– or implementation of – Malaria control activities, including ITN and IRS distribution efforts but, instead, ensuring these services are delivered using best practices to protect health workers and communities from COVID-19 infection.

According to The Alliance for Malaria Prevention, the solution was to equip malaria prevention teams the resources to also increase the number of hand washing stations and soap at all operations sites; reinforce morning health checks for all team members, adding temperature checks where feasible; wear N-95 masks and personal protective equipment before entering operations sites; and frequently wipe down any touched surfaces (door handles, vehicle railings, etc) and follow WHO-recommended protective measures.

WHO Global technical strategy for malaria 2016-2030

With the combined efforts made by nations across the world, we are likely to eliminate the Novel Coronavirus, however, we are still a long way off from eliminating malaria. To his effect, WHO global technical strategy for malaria 2016-2030 – was adopted by the World Health Assembly in May 2015 – and provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The strategy sets ambitious but achievable global targets, including:

  • reducing malaria case incidence by at least 90% by 2030;
  • reducing malaria mortality rates by at least 90% by 2030;
  • eliminating malaria in at least 35 countries by 2030;
  • preventing a resurgence of malaria in all countries that are malaria-free.
  • the latest situation reports on the COVID-19 pandemic are available on the WHO website.