The spectre of climate change threatening our futures is a conversation that has been dropped in recent months in the wake of Covid-19. But it has not gone away and will continue to haunt us in the years to come.
What is at stake is not climate change’s effects on malaria directly, but on human poverty, famine and drought. It will steepen the conditions that already make it an uphill struggle to get protection and treatment to those who need it. Dr Benji Pretorius, GP and founder of Erada Technology Alliance, explains why it is imperative to do all that we can before it’s too late.
Climate change will have some direct effect on malaria and the mosquitoes that carry them. Given their hot tropical preferences, you may expect a simple correlation between heat and mosquito, that rising temperatures would cause both mosquito and malaria to spread. But it is not that simple.
In some places higher temperatures will cause the disease to spread; notably in highland areas that were cooler to begin with. In places like Debre Zeit in Kenya, where 43% of the Kenyan population live,1 people have had the fortune of being relatively malaria free, due to its elevation and cooler temperatures1. But as they have less resistance to the disease, future cases may be devastating. Warmer temperatures will bring mosquitoes higher up, to places where they didn’t go before and they will bring malaria with them. It is estimated that, in these highland areas, an increase of only 1°C would lead to as many as three million extra children being infected every year.1
Cases will also rise in areas where winter usually provides some respite from the disease. The most common malaria parasite, plasmodium falciparum, cannot complete its life cycle in temperatures below 20°C(68°F).2 If winter temperatures rise above this, the parasite will be free to reproduce all year round. But whilst climate change will cause malaria increases in some places, it will cause malaria to decrease in others.
In areas of Sub-Saharan Africa, climate change is expected to reduce the amount of rain.3 Mosquitoes require stagnant freshwater to breed and lay their eggs. The lack of puddles and waterbeds or rain accumulation in places like old tires and buckets would prevent them from reproducing.4 No water, no mosquitoes, no malaria. But how much the result of this reduction in water will compare to the result of malaria spreading to new areas is unclear. It will vary according to place and depends on how high global temperatures rise. But mosquitoes are adaptable,5 and may persist despite increasingly dry conditions. What is clearer is how climate change will affect people and how malaria prevention ties into that.
Treating malaria isn’t free. It causes a financial burden both in terms of direct cost of treatment and in work hours lost. But if you are a subsistence worker, working hand to mouth, you may not be able to afford this loss of income. 6 You work through the vomiting, headache and nausea or you go hungry. In Nigeria, where the impact of Malaria is highest, 40% of people live below the poverty line.7 Living on less than one dollar a day makes it difficult to afford the needed nets, insecticide and malaria medication.
Now imagine if this situation was worse
Despite being the area of the world with the lowest CO2 footprint,8 Sub-Saharan Africa stands to be where the effects of global warming are going to be most keenly felt.9 The majority of African agriculture relies on seasonal rain. This leaves it vulnerable to an increase in climate change induced drought, flash flooding and extreme weather conditions.9 Consequently, this will lead to food shortages and uncertainty that drives up prices, reducing the chances that the already impoverished will be able to afford the cost of treatment.
Treatment for malaria will become more difficult to access in a healthcare system that is already strained. There is insufficient numbers of doctors and nurses in proportion to national populations. This, in conjunction with rural villages being difficult to reach, makes community healthcare workers necessary. The hiring and training of healthcare workers to disseminate diagnostic tests, medication and inform local communities is an essential part of anti-malaria programmes.10 This cannot be done when there’s little food and in the chaos of extreme weather conditions. Furthermore, worsening climate change will cause a host of other medical issues to deal with alongside malaria, over-heating, malnutrition, dengue and damages caused by flash flooding and storms.11 Each crisis creates competition for the limited healthcare resources, funding and manpower available to deal with the problem.
People will flee unbearable conditions in hope of food and safety.12 This means that it will be harder to disseminate resources to those who need them. It puts people in a more vulnerable position, sleeping outside or in temporary accommodation, where they can be bitten by mosquitoes. Large numbers of people without access to sanitary waste disposal systems will also cause additional healthcare problems.
All these effects combined will make simply holding back malaria exceedingly difficult, let alone eradicating it, as per the directives of the WHO’s Global Technical Strategy for Malaria.13 Surveillance and administration of malaria requires a level of national stability and order that cannot be maintained in nations plagued by the worst consequences of climate change. It is already having catastrophic impact on people’s lives 14 and will hit the poor and vulnerable the hardest. An additional 250,000 people are expected to die each year between 2030 and 2050, from climate change induced malaria, heat stress, diarrhoea and malnutrition, according to the WHO15. Consequently, we must do all we can to save people whilst we still have a window of opportunity.