Dr Benji Pretorius, experienced medical practitioner and malaria survivor, addresses the fundamental points raised in two research reports published in 2021 and why the role of frontline prevention measures will evolve in the years to come.
There can be little doubt that Covid-19 has impacted the progress of eradicating diseases and will continue to do so for some time yet. Yet despite the great adversity of the past two years, the world has rallied and made some truly incredible achievements in a relatively short space of time, not least the swift introduction of new vaccines.
While Covid-19 has had more than its fair share of media attention, malaria remained one of the deadliest diseases on our planet. Two reports, published in September by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and Gates Foundation respectively, earmark the disruption to supply chains and the overwhelming pressure frontline healthcare services have endured as two culprits, yet there are other, underlying reasons for malaria’s continuing resistance.
The Global Fund’s Results Report rightly points to the fact that in a ‘normal’ world, testing for malaria would take place as part of a large-scale campaign, often in line with seasonal changes. With lockdown measures preventing travel, these programmes could not take place as they would have usually, albeit they still continued in an adapted format. Then there is the difficulty in getting tests into high risk areas in the first place. If global eradication is to be attainable, the battle will be won or lost in these areas.
Outside of seasonal campaigns and awareness drives, communities need to be able to protect themselves. Improving information about the mutual symptoms of malaria and, say, Covid-19 is one step, and the Results Report also pays homage to the education in Ghanaian schools as another.
Community health workers – the same people who selflessly continued to work throughout the Covid-19 waves – are also a key link in the chain. Without them and their deep insight of the local socio-cultural landscapes, testing for disease has the potential to become even more challenging.
Similarly, the Gates Foundation Goalkeepers report calls for “investment in communities” to continue, especially when these are home to some of the more vulnerable groups of people. The report uses the example set by the country of Senegal, where children had long been vaccinated for diseases such as tetanus (rivalling the US at one stage), but had been forced to adapt these programmes in the wake of vaccine misinformation. Just as education about malaria in Ghanaian schools ensures this vulnerable group maintains a protective barrier, the trust between members of individual communities is a powerful tool against diseases remerging.
Aside from the initial disruption in the early days of the pandemic, the roll out of insecticide-treated nets not only continued but actually improved by 17% according to the Global Fund Results Report. This could be attributed to the adapted method of going door-to-door, rather than bringing entire villages together in one sport where viruses can easily spread from person to person. Yes, funding will always be important, but the personal connections healthcare workers forge within a locale enables vital information about treatment to be understood and followed which then prevents the spread of malaria into neighbouring communities.
Therefore, should we not be looking to safeguard the dedicated individuals risking their own health for the benefit of others as well as directing resource to the most vulnerable settings?
It is understandable the threat of Covid-19 has made people wary of attending healthcare facilities, yet this, inevitably, has resulted in asymptomatic malaria carriers not accessing the treatment they needed when they perhaps needed it most. Health workers, trained in carrying out rapid diagnostic tests, can bridge the gap, provided that they, too, are protected.
Take the Salva! test developed by Erada with our partners as one example of how this process works in practice. A saliva sample can be examined remotely, rather than in a lab, usually delivering a result in under an hour, meaning that any detection of malaria can be swiftly treated before life-threatening symptoms begin showing. Not only does the test allow for a whole village to be tested quickly, but frontline workers can also check themselves and each other while going about their duties and seek assistance should they come into contact with the Plasmodium parasite.
Perhaps the most crucial lesson to have come out of the Covid-19 pandemic that the global community can learn in the battle against malaria is that communities are intrinsic to the way of life in a particular region. In India, the Goalkeepers Report explains, a women’s self-help group delivered meals during Covid-19, before becoming vital sources of information about vaccinations at a later stage. With the potential for a malaria vaccine entering the market in the coming years, groups like this will be called upon once again to keep their loved ones informed and protected.
There is still a long road ahead of us in ending malaria once and for all, but we are seeing a change in the direction of travel. The next generations – the ones who will be picking up the baton for their communities – are already showing that they are more than up for the fight and have every opportunity to land those telling blows.
If the two recent reports referenced throughout this article can share one lesson, it’s that communities are critical in fighting malaria, Covid-19, and many other diseases still claiming lives. And that is where this once in a lifetime opportunity needs to be seized.