Following the COVID-19 pandemic, the world has been dealing with an unprecedented challenge to health systems, the economy, and our societies now for over two years. Just about every aspect of society is being affected in ways that were unimaginable before 2020. Reflecting this broader societal picture, malaria – a disease that ‘infected’ the world long before COVID-19 was even known – has also experienced notable impacts when viewed through the lens of the “Global Pandemic”. This article explores how the COVID-19 pandemic has affected the fight against malaria, and presents both challenges and opportunities.
The State of Malaria and COVID-19
1. Current Malaria Burden
Malaria is also a persistently critical global health issue, especially in sub-Saharan Africa, where more than 500 million cases have been reported in the past two decades. The World Health Organization (WHO) estimated that in 2019 there were an estimated 229 million malaria cases and 409,000 deaths globally. Malaria control has made major strides over the years through a variety of interventions, including insecticide-treated nets (ITNs), indoor residual spraying (IRS), and antimalarial medicines.
2. COVID-19’s Impact on Malaria
The COVID-19 pandemic is also affecting global health systems and programs, such as those targeting malaria. This disturbance occurred both directly and indirectly. Indeed, the pandemic is creating additional strain on already limited healthcare resources, altering health service delivery, and prioritizing the attention of healthcare workers and policymakers, including those in the area of malaria control.
Challenges to Malaria Control in the Era of COVID-19
1. Disruption of Health Services
COVID-19 has greatly affected health systems around the world, with many countries facing significant disruptions of essential services. Malaria programs have shown various forms of disruption:
- Malaria – interrupted supply chains The COVID-19 pandemic has disrupted global supply chains, leading to shortages of malaria diagnostic tests, treatments, and prevention tools.
- Lower Access to Healthcare: Lockdowns, travel restrictions, and forced closures of health facilities have made it more difficult to access diagnosis and treatment for malaria, particularly in rural areas and hard-to-reach populations.
- System Overload: Rising demand for COVID-19 care has siphoned resources and staff away from malaria programs, leading to decreased access, quality, and delivery of services.
2. Increased Risk of Malaria Transmission
Several factors have contributed to an increased risk of malaria transmission during the pandemic:
- Impaired Vector Control: The pandemic will delay or scale back efforts to control mosquito populations, such as indoor residual spraying (IRS) and distributing insecticide-treated nets (ITNs), leading to an increase in mosquito populations.
- Decreased Preventive Measures: Diminished access to malaria-prevention interventions and services has placed a spotlight on a higher threat of outbreaks in high-transmission settings.
3. Interruption of Malaria Surveillance and Data Collection
Surveillance and data collection are essential for malaria management and control, but the pandemic has undermined both in several different ways.
- Reallocation of resources: The COVID-19 response has reallocated resources, limiting entomological monitoring, key components of vector control, and case reporting.
- Fieldwork limitations: Leaving the lab for fieldwork to collect mosquito samples at impoverished sites and track infected mosquitoes is also challenging as travel restrictions and lockdowns have delayed identifying and responding to outbreaks during a malaria pandemic.
Opportunities for Malaria Control Amidst the Pandemic
While these challenges persist, COVID-19 has also offered opportunities to bolster malaria control and global health systems by harnessing innovation:
1. Strengthening Health Systems
An example of where progress has been made is the pandemic response, which has helped to focus attention on the need for robust health systems that can manage more than one health threat at a time. The key opportunities for action include:
- Improved Health Infrastructure: Increased funding for infrastructure and supply chains will help us better respond to both COVID-19 and malaria.
- A multidimensional approach to public health response: Bundling malaria services with COVID-19 response activities can ensure the continuity of critical malaria services while also tackling the global pandemic.
2. Innovations in Malaria Prevention and Treatment
There is innovation in care provision as part of the COVID-19 response, which can be leveraged for malaria control:
- Digital health solutions: Demand for digital health technologies such as mobile health apps and telemedicine will develop even more during the pandemic as a critical complement to contact tracing to help improve malaria diagnosis, and treatment adherence and could help track and monitor patients.
- New Diagnostics and Treatments: Innovations in COVID-19 diagnostics and treatments could inform or provide technology applicable to new malaria diagnostics or treatments.
3. Increased Funding and Global Attention
The global spotlight on COVID-19 has provided greater health resources and attention. There are opportunities to:
- Resource Allocation: Current COVID-19 funding and resources can support and strengthen malaria program activities in high-burden areas.
- Collaboration on a global scale: Perhaps the most important lesson from the pandemic is that working together in a spirit of international cooperation and partnership was critical in overcoming this challenge. At a time when we continue to see significant challenges in dealing with other global threats such as climate change and the continuing threat of another pandemic, we must harness the power of the spirit of cooperation and collaboration to strengthen the fight against malaria, as well as develop further cross-sectoral support.
4. Addressing Health Inequities
The pandemic has brought into sharp focus pre-existing health inequities where targeted interventions are needed. Examples include:
- Equitable Access: More equitable access to malaria prevention and treatment services and the populations disproportionally affected by the pandemic Pranab Sivakumaran is a PhD student in UCL’s Department of Science, Technology, Engineering, and Public Policy
- Community empowerment: Enhancing community engagement and community ownership of malaria control efforts can lead to more effective interventions and community resilience to future health crises.
Future Directions for Malaria Control in the Post-COVID Era
As the world bravely charts the road to recovery from the COVID-19 pandemic, now is not the time to shift focus from malaria but rather to build on the knowledge gained and bolster malaria control activities. To achieve these goals in the coming years, several steps should be considered.
1. Integrating Malaria and COVID-19 Responses
Combining malaria and COVID-19 response efforts can improve efficiency and outcomes. This approach involves:
- Coordinated Planning: Integrated planning that combines malaria and COVID-19 services can significantly enhance the efficiency of resource use. Additionally, it allows for the creation of shared health delivery platforms, which can streamline services and improve overall health outcomes. By aligning these efforts, health systems can maximize their impact and ensure a more effective response to both diseases.
- Last but not least, the joint monitoring and evaluation (JME) approach helps communities monitor the impact of combined interventions and subsequently evaluate them. Based on those evaluations, effective strategies to support HIV/AIDS program planning, implementation, and monitoring can be devised.
2. Investing in Resilient Health Systems
Building resilient health systems that can withstand multifaceted health threats requires funding for:
- Strengthening health infrastructure, supply chains, and workforce capacity All three need support to respond to both diseases.
- Sustainable Funding: To ensure sustainable funding mechanisms for malaria programs to safeguard the gains achieved, and mitigate any setbacks caused by the pandemic.
3. Promoting Innovation and Research
Enabling innovation and research and making structures available is the key to achieving progress in the control of malaria. Some fields of attention are:
- Further investments in Research and Development: Promoting research into new vaccines and treatments, and into innovative approaches to vector control, that will support improved malaria control in all settings.
- Technology Adoption: Making use of digital health technologies and other innovations to improve malaria prevention, diagnosis, and treatment.
4. Enhancing Global Collaboration
Global collaboration is key to addressing malaria and other health threats. Efforts should include:
- Partnership Building: Strengthening partnerships with governments, multilateral organizations, and the private sector to support malaria control and response.
- Shices: Sharing experiences and best practices from the COVID-19 response to understand what worked well or less well, to inform improved malaria control strategies and outcomes.
Malaria control has also suffered from the closure of health services, disruptions in vector control, and difficulties in vital data collection brought about by the COVID-19 pandemic. These challenges come alongside new opportunities for strengthening health systems, innovating, and improving global collaboration. By addressing these challenges while taking advantage of these opportunities, society can move towards sustained and adaptable control of malaria, as well as health systems that can survive and adapt to future crises. Moreover, lessons learned from the COVID-19 pandemic can help scale up malaria control and enhance the global public health response for decades to come. Ultimately, this dual approach will contribute to more resilient health systems worldwide.
