Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

Emergencies must not derail the fight to end malaria

24 April 2020

Emergencies like the COVID-19 pandemic can cause significant disruptions to health systems, interrupting the delivery of lifesaving interventions, reducing health seeking behavior, increasing illness among frontline workers, and derailing the procurement of critical commodities. Lessons learned from other health emergencies and humanitarian conflicts have demonstrated how progress fighting malaria can be affected – and what countries can do to mitigate this potential impact. 

Lessons learned from 2014 Ebola outbreak
The effects of the 2014 Ebola crisis on malaria endemic countries in West Africa were astounding. A study from the CDC estimated that there was a 50% reduction in access to all healthcare services in West Africa during this time, and an estimated 3.5 million malaria cases went untreated in the region. As a result, an estimated 10,900 malaria deaths are thought to have occurred in Liberia, Sierra Leone, and Guinea—close to the 11,310 people who lost their lives to Ebola. In a subsequent Ebola outbreak in late 2018, up to 50% of people screened in Ebola treatment units in eastern Democratic Republic of the Congo were found to have malaria alone, possibly causing unnecessary spread of Ebola to malaria patients. In this region, there was an eight-fold increase in reported malaria cases compared with the same period just a year earlier. High rates of malaria can mask other febrile illnesses, making it more difficult to address outbreaks quickly.

Severe disruptions to malaria effort due to COVID-19
Now, just a few years later, some of these same countries are battling another new health emergency – the global spread of COVID-19. Initial accounts indicate that the malaria responses of these countries are already being hampered. There are reports that resources from mosquito-borne disease programs are being used to fight COVID-19 in Sri Lanka, a country that was certified malaria-free in 2016 but is still at risk for malaria reintroduction and resurgence. In Zimbabwe, where the Ministry of Health reports that malaria accounts for between 30% and 50% of outpatient appointments in malaria-prone areas, there are reports of malaria outbreaks, resulting in more than 100 malaria deaths, as the country locks down to mitigate spread of COVID-19.

A recent WHO-led analysis of the potential impact of COVID-19-related health service disruptions on the burden of malaria concluded that severe disruptions to insecticide-treated net campaigns and access to antimalarial medicines could lead to twice the number of malaria deaths (769,000) in sub-Saharan Africa this year compared to 2018. This would represent a return to malaria mortality levels last seen 20 years ago.

Country preparedness can mitigate impact of health emergencies
MEI recently released a case study series ‘Malaria in Conflicts and Emergencies’ that uses a mixed-methods approach to better understand how malaria efforts can be maintained during both natural and man-made disasters, including: violent conflict in Afghanistan, the 2010 earthquake in Haiti, and the 2014-2015 Ebola outbreak in Sierra Leone.

Several best practices arose across these diverse settings:

  • Community engagement can build trust and can provide an avenue for delivering consistent access to quality care using community health workers.
  • A coordinated approach to partnership can fill gaps where the national government could not operate and clarify the comparative advantages across operational partners.
  • Longer-term focus on malaria programmatic goals should be maintained, even if immediate operations are disrupted by an emergency.

Both The Lancet Commission on malaria eradication and the WHO Strategic Advisory Group on malaria eradication concluded that while complex emergencies are likely to cause disruption of progress towards malaria eradication, they can be overcome. Sustained progress will rely, in part, on national malaria programs and other stakeholders in the malaria community recognizing the threats posed by complex emergencies and strengthening preparedness to alleviate their impact. While COVID-19 represents a serious threat to progress, we must maintain our commitments to ending malaria—a disease that was once itself global pandemic.