2020 was heralded as the year the global community stepped up its fight to eradicate malaria once and for all. Slowing death rates and mortality1, coupled with advancements in detection and research, painted an encouraging picture.
Now Covid-19 threatens to derail the significant progress we have made.
Malaria still takes the lives of 400 000 people each year. Halting prevention programmes in order to concentrate efforts on Covid-19 will see that number almost double in the worst-case scenario, with sub-Saharan Africa being the hardest hit. Additionally, many countries in the south of the country are approaching their rainy season, when we see the majority of malaria cases. All the components for a devastating spike in cases and mortality rates are aligning perilously close. Experts predict that, in the worst-case scenario, we’ll see levels of cases and mortality rates last seen twenty years ago.
We cannot allow this to happen, and it would not be the first time that hard-won gains against malaria have been devastated by a novel pandemic. The 2014 Ebola outbreak took priority over neglected tropical diseases (NTDs), such as malaria, HIV and tuberculosis. As prevention efforts waned, the number of NTD cases steadily grew and pushed stretched and vulnerable African health systems to the limit.
Failing to maintain prevention of NTDs during the Ebola outbreak cost lives. In fact, the final death toll from diseases such as malaria, HIV, and tuberculosis, outweighed the number of deaths caused by Ebola on its own.
There are worrying signs that history is about to repeat itself. In 2018, The Democratic Republic of Congo reported another strain of Ebola, which coincided with a significant surge in malaria cases. After Nigeria, the DRC has the highest burden of malaria cases and transmission risks, and so is well-versed in experiencing outbreaks.
In fact, it was already fighting four diseases before Covid-19 began to spread: cholera, measles, Ebola, and malaria. In a healthcare system already pushed to its limit, Covid-19 poses an even greater threat to DRC’s recovery2.
Malaria prevention must continue, not just because it is one of the world’s deadliest diseases in its own right, but because its early warning symptoms are similar to that of Covid-19 and Ebola. Whilst it will initially be difficult to distinguish which disease a patient is carrying, diagnostic testing for malaria must remain accessible in order to prevent health facilities becoming overloaded with cases in the future.
The difficulty is gaining access to people suspected of carrying these diseases during the time of physical distancing. Typically, malaria is first diagnosed by a frontline healthcare worker, but this group has been limited in movement due to Covid-19. Furthermore, restrictions on the distribution of anti-mosquito bed nets has put those in malaria-endemic regions in greater peril.
In order to address this issue, the World Health Organisation (WHO) called for countries at a high risk of malaria to maintain their prevention efforts and advised how to tailor these in the face of Covid-19. Such measures include the continuation of net and spray deployment, early treatment for fever, and ensuring diagnostic tests for malaria are still accessible.
While cases of Covid-19 in Africa are fewer than in other regions such as Europe, there is an urgent need for action, especially as we move closer to the peak of the malaria season. Cases appear to be accelerating, putting already stretched health systems under pressure.
It is imperative that the framework for malaria protection is in place and that it aligns with the latest Covid-19 guidance. This is not about choosing one disease to prevent over the other – it is about ensuring communities are prepared for both.
I recently spoke from the South Africa-Zimbabwe border, a region prone to malaria, about the need to maintain progression. Having nearly died from malaria myself, I know just how devastating it can be and why we simply must not allow what happened after the 2014 Ebola outbreak to happen again.