Ridding the world of malaria in the near future is a very ambitious goal. Efforts to achieve it have already been weakened by governments shifting resources from malaria control and elimination initiatives to the fight against COVID-19.
And those efforts were recently dealt another sucker-punch.
Catharina Boehme is the chief executive of the Foundation for Innovative New Diagnostics and adviser to the World Health Organisation (WHO). She reported that financial incentives have encouraged many companies to dramatically downscale – or even stop – the production of tests for a number of infectious diseases, including malaria. Instead, they are now focusing on the mass production of novel tests for COVID-19.
This decision could erode the gains made against malaria over the past 20 years.
Malaria rapid diagnostic tests are easy to use at the point of care. They produce a result within 15 to 20 minutes. Their widespread deployment, particularly across Africa, expanded access to prompt, quality diagnosis. This enabled early treatment so that severe illness and death could be avoided.
It is widely accepted that the global uptake of this innovative tool played a significant role in the reduction of malaria-related illness and deaths. The decrease in the global malaria burden by over 60% since the early 2000s is very impressive. Yet it remains a major health problem in Africa, where a child dies from malaria every two minutes. This is an unacceptable reality for a treatable and preventable disease.
In 2018 over 90% of the 228 million malaria cases and 405,000 malaria deaths reported were from Africa. This shows why interventions to control this disease must continue.
When there is a break in control activities, malaria rebounds rapidly – with catastrophic effects. This could be seen when the WHO-led malaria eradication campaign in the 1950s ended. More recently, it was evident during the 2014-2016 Ebola outbreak in West Africa. A detailed review of the data collected during the Ebola outbreak revealed that more people died from malaria and HIV than from Ebola virus disease.
The WHO is well aware of this. It has issued an impassioned appeal to malaria-endemic countries not to compromise on the delivery of malaria control activities and healthcare services as they battle COVID-19.
Maintaining malaria services during the COVID-19 epidemic, however, comes with challenges. Control practices and protocols have to be modified. This is because of restrictions on the movement of people and supplies, and the close contact required for malaria testing.
But modifications must not compromise the safety of the healthcare workers, malaria programme staff and community at large, or the efficacy of the interventions.
Now more than ever there is a need for focused malaria health awareness and education campaigns. It is very important to remind communities and healthcare workers that a fever does not always mean a COVID-19 infection.
Fever is a symptom of many different diseases, including malaria. As malaria often rapidly becomes very severe, individuals with a fever should test for COVID-19 and malaria as soon as possible. This is particularly true in malaria endemic areas.
It is even more crucial that children with fever are tested for malaria. Children are a high-risk population prone to severe complications from malaria.
Africa’s fragile and under-resourced health systems are being stretched thin by the responses required to address the COVID-19 outbreak. The continent can’t afford a massive influx of critically ill malaria patients requiring specialised intensive care.
African governments – with the support of the relevant stakeholders – must therefore take a leading role in ensuring that there are minimal disruptions to the delivery of appropriately tailored essential malaria control activities and services.
South Africa has adopted an innovative strategy to ensure the continuation of its malaria test and treat campaign. In malaria-endemic districts selected for community-based COVID-19 screening, all patients presenting with a fever will be tested for both COVID-19 and malaria. Any patient found to be malaria-positive by malaria rapid diagnostic test will be treated on site.
And African governments and international organisations like the WHO must lobby hard to ensure that there’s no downscaling in the production of tests and treatments for non-COVID-19 infections like malaria.
In the interim, countries should consider stockpiling supplies of malaria rapid diagnostic tests, malaria treatment and essential malaria control commodities. This would include insecticides for indoor residual spraying, and personal protective equipment.
We all must play our part in ensuring malaria is controlled and eliminated so a malaria-free world can be achieved during our lifetime.