This year, we are celebrating World Malaria Day in the shadow of the COVID-19 pandemic, which is just beginning its lethal run through Africa. World Malaria Day is typically a day for the global community to reflect on the collective progress of national malaria control programs and to recommit to the ultimate goal of elimination. This year it is important to recognize that the burden of malaria in Africa does not disappear when a pandemic arises and can, in fact, become worse.
Recent history has shown that when outbreaks happen, resources are diverted from primary health services and people stop seeking care, resulting in excess morbidity and mortality from diseases that are preventable and treatable. For example, when Ebola raged through West Africa from 2014-2016, people became wary of seeking health care when they were ill due to health centers and hospitals presenting a high risk of exposure to the deadly virus. At the same time, health care resources were rapidly channeled into addressing the urgent needs of the Ebola outbreak response. Models have shown that these disruptions to normal health care provision could have resulted in an estimated additional 3.5 million untreated cases of malaria, with 10,500 additional malaria-attributable deaths in Ebola-affected countries in 2014.
We must learn from the past and work together as a global community to maintain robust malaria prevention and case management programming in the face of the COVID-19 pandemic. Continuing to implement and provide support for these interventions will not only prevent lives lost due to malaria, but can complement and enhance efforts to mitigate the impact of COVID-19 in the following ways:
- Reduce the strain on the health system and health workers: Maintaining malaria prevention activities, such as the distribution of bed nets, will greatly reduce the number of people with malaria-related fevers reporting to health facilities, enabling health care personnel to focus their attentions on potential COVID-19 cases. Similarly, drug-based prevention strategies such as seasonal malaria chemoprevention (SMC), which provides malaria prophylaxis to children under five, will further reduce the number of malaria cases in the community.
- Protect the community: Prevention efforts not only reduce the number of malaria cases seen at health centers, but they reduce onward transmission of malaria in the community. Bed nets, SMC and other means of prevention reduce the amount of malaria circulating in the community, meaning fewer people will get infected. Fewer malaria infections translates to healthier, stronger communities that are better able to fight off the COVID-19 virus.
- Guard against excess mortality: Continuing to provide malaria diagnosis and treatment services, as well as other primary care services, prevents additional deaths that might occur if people avoid seeking health care (as seen in the Ebola example above).
The World Health Organization (WHO) and others in the global malaria community have come together to provide guidance on how to safely continue to provide malaria prevention, diagnosis, and treatment services in the context of the COVID-19 pandemic. As COVID-19 starts to move through Africa, countries are taking immediate steps to ensure the continuity of malaria control activities and adapt existing activities to mitigate the spread of the current pandemic.