Malaria and COVID-19: The dual crisis continues

malaria
Malaria is considered one of the deadliest mosquito-borne diseases in India. Image credit: Mr.Smith Chetanachan / 123rf

Last year, we prefaced our coverage of World Malaria Day with the note that “the era of COVID-19 masks the manifold health issues the world – India included – is grappling with. Malaria is among those issues – and with March 25th marking World Malaria Day, it is important to pay attention to the disease and afford it the gravity it warrants as a threat to public health.” 

Today marks World Malaria Day yet again during a time of international public health crisis due to the ongoing pandemic. India is presently embattled by a second COVID-19 wave, but it is important – even as we deploy the necessary resources and measures to contend with the virus – to avoid neglecting the plethora of health issues plaguing the country.

India is one of the world’s malaria hotspots, though progress has been made. As Health Issues India previously reported, in the wake of the unveiling of the World Malaria Report in 2019, “the number of global cases in 2010 stood at 251 million, compared to 228 million in 2018. Incidence has declined from 71 to 57 cases per 100,000 at-risk people within the same timeframe. Similarly, deaths have declined. 405,000 people died due to malaria in 2018, compared to 416,000 the preceding year and 585,000 in 2010.”

Nonetheless, progress has stalled and the pandemic has only exacerbated the challenges of a concerted, multisectoral and well-resourced effort to combat malaria. As the World Health Organization (WHO) notes, “in 2020, COVID-19 emerged as a serious challenge to malaria responses worldwide. Since the early days of the pandemic, WHO has urged countries to maintain essential health services, including for malaria, while ensuring that communities and health workers are protected from COVID-19 transmission.” 

While the WHO does note that “many malaria-endemic countries mounted impressive responses to the pandemic, adapting the way they deliver malaria services to the COVID-19 restrictions imposed by governments” and that, consequently, “the worst-case scenario of a WHO modelling analysis was likely averted”, challenges are still devastatingly present. 

“More than one year into the pandemic, substantial disruptions to health services persist across the globe,” the agency states. “According to the results of a new WHO survey, approximately one third of countries around the world reported disruptions in malaria prevention, diagnosis and treatment services during the first quarter of 2021. 

“In many countries, lockdowns and restrictions on the movement of people and goods have led to delays in the delivery of insecticide-treated mosquito nets or indoor insecticide spraying campaigns. Malaria diagnosis and treatment services were interrupted as many people were unable – or unwilling – to seek care in health facilities.”

Malaria and COVID-19: The dual crisis continues
Insecticide being sprayed. Mosquito control is vital in the fight against malaria and this is true in cities, where mosquitoes can find breeding grounds owing to pockets of stagnant water. Image credit: Auregar63 [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

As Urban Weber of the Global Fund told me in an interview last year, “we are seeing that bednet distribution campaigns are being delayed because of lockdowns, thus impacting prevention campaigns resulting in potentially increased transmission. People infected with malaria are dying relatively quickly, especially when we speak about children under five.” 

Statistics belie the fact that every life lost to malaria represents one’s loved one – and India is losing many loved ones. As previously reported by Health Issues India

“The southeast Asia region accounts for 3.4 percent of malaria cases (the African region accounts for the overwhelming majority of cases, shouldering 93 percent of the world’s malaria burden). Together with sub-Saharan Africa, India accounts for 85 percent of the world’s malaria burden. Of deaths, India is one of twenty countries accounting for almost 85 percent, the others belonging to the African region. 

“Stalled progress in tackling malaria exacts a particular toll on the health of children and mothers. 67 percent of malaria deaths occur in children under the age of five – translating to 272,000 lives lost. Women exposed to malaria infection during pregnancy are at high risk of delivering children who are underweight at birth. Children who fall prey to malaria are at a substantially higher risk of developing conditions such as severe and moderate anaemia.”

Mosquitoes. Vector-borne diseases concept. World Malaria Day concept.
Image credit: mycteria / 123rf

A malaria-free world is possible. As we previously noted, “India aims to eliminate malaria by 2030. This objective is attainable, according to Dr Altaf Lal, Senior Advisor for Global Health and Innovation, Sun Pharmaceuticals Industries Limited, India. “There is significant reduction in cases of malaria in India over the past several years, which provides optimism that [the] elimination goal of 2030 is achievable,” Dr Lal told Health Issues India when asked how likely it is the government’s elimination target of 2030 will be met.

There has been even more promising news. Last week, a malaria vaccine proved to be 77 percent effective in early clinical trials. Study author Professor Adrian Hill, director of the Jenner Institute and professor of vaccinology at the University of Oxford, said “has the potential to have a major public health impact.” Halidou Tinto, a professor in parasitology and the principal trial investigator at the Clinical Research Unit of Nanoro, Burkina Faso (where the vaccine was trialled), labelled the results as “very exciting” and showed “unprecedented efficacy levels”.

But even as we innovate, we must remain vigilant in implementing existing health measures which can serve to mitigate malaria’s devastating effects. As Weber told me, “if bednet campaigns don’t happen, there will be an immediate loss of life. Infected patients, especially children under five, will die in a matter of days.” 

This is the second World Malaria Day to occur in COVID-19’s shadow, but to tackle one infectious disease at expense of addressing another is a grave error. Backsliding on years of progress in the fight against malaria will cost lives. It is imperative to remember that. 

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