All eyes are on the spread of the COVID-19 virus. This pandemic is challenging families, communities, health care systems, and governments across the globe. The United Nations Foundation’s Nothing But Nets campaign has been working alongside UN partners, the WHO and the global health community to fight malaria since 2006. We know that progress against deadly diseases is possible but takes political will, resources, dedication, innovation, and time. We also understand just how dire the stakes are when a disease roots itself into a community, country, and region. Malaria is one of the oldest diseases known to humanity and with any enduring battle comes lessons learned for how to address deadly outbreaks. Here are six lessons we’ve learned on how to continue the fight to end malaria during a pandemic:
Global health actors must work together to build resilient health systems better equipped to fight all health threats
From training health workers to building better surveillance systems, many partners and programs fighting malaria are also building stronger health systems. These systems will have to further adapt to the challenge of COVID-19. Imported COVID-19 cases have been documented in a majority of sub-Saharan Africa countries where the most malaria cases and deaths occur and the number of infections is expected to rise significantly. Malaria programs must continue to prevent and treat malaria while adapting their approaches to prevent the spread of COVID-19.
One great example of this is the swift response from the Global Fund to Fight AIDS, TB, and Malaria, the largest multilateral grant funding mechanism in global health. To fight COVID-19 and mitigate the impact the pandemic will have on programs to fight HIV, TB and malaria, the Global Fund is enabling countries to use up to 5% of approved grant funding– approximately US$500 million – to help protect and treat vulnerable communities around the world. As of April 3, over US$25 million had been approved across 41 countries and two regional grants. Collaboration amongst global health entities must continue in order to ensure the widest net is cast to stop the spread of COVID-19.
Diseases don’t exist in isolation from each other
The response to COVID-19 must reflect the stark fact that pandemics compound the effects of other diseases. In high-burden settings, healthcare workers are battling multiple deadly diseases including malaria. Outbreaks like COVID-19 make it more difficult for people to seek healthcare services.
A study from the CDC estimated that there was a 50% reduction in access to healthcare services in West Africa during the Ebola outbreak. This exacerbated already high malaria, HIV/AIDS, and tuberculosis mortality rates. Due to the Ebola outbreak there were an estimated 7,000 additional malaria-associated deaths among children younger than 5 years old in Guinea, Liberia, and Sierra Leone. Leaders in the global health space are already concerned about how COVID-19 could impact malaria.
“COVID-19 could be a disaster for malaria,” said Pedro Alonso, Director of the WHO Global Malaria Programme. “If people stop going to health facilities and don’t get bed nets, we will see a massive increase in malaria mortality, mostly in kids and pregnant women,” he added.
We cannot allow malaria to further compound the effects of the COVID-19 pandemic and the threat it poses to people seeking treatment. We must continue to step up the fight against malaria to ensure history does not repeat itself during this crisis.
Progress against deadly diseases is possible yet fragile
A child currently dies every two minutes from malaria -- but it used to be every 30 seconds. We’ve made tremendous progress against malaria over the last decade. Malaria programs across the globe save an estimated 600,000 lives and prevent 100 million cases of malaria per year. However, COVID-19 threatens that progress for several reasons. Fever is a primary initial symptom of both malaria and COVID-19. If people with fever do not receive treatment because the health system is overwhelmed by COVID-19 or for fear of becoming infected with COVID-19, it is possible that thousands if not millions of malaria cases could go undiagnosed and treated and therefore deaths from malaria could significantly increase.
Between the 1930s and the 2000s, malaria resurged in 61 countries. Most were a direct consequence of the weakening of malaria control programs due to resource constraints and resulted in increased cases and deaths from malaria. In addition to bearing the heaviest burden of malaria, vulnerable populations like women, children, and refugees are at risk of being hit the hardest by resurgence, as they’re often last in line to receive appropriate testing and treatment for emerging diseases. At a time when 405,000 people die annually due to malaria, it’s critical we do not lose momentum against malaria during this pandemic. We must ensure the most vulnerable communities we’ve pledged to protect and serve continue to receive the malaria prevention and treatment tools they need.
We must reduce the strain that COVID-19 puts on health systems
Social distancing was an obscure phrase before COVID-19, and now the global population not only understands but is living through its meaning. Adhering to social distancing saves lives by preventing further spread of the disease and reduce the burden on our health system. Similarly, core preventative interventions for malaria like the distribution of bed nets, indoor residual spraying, and intermittent preventive treatment for pregnant women are that much more critical to quell the number of malaria-infected patients seeking care at overburdened health centers. New guidelines are being developed to ensure that social distancing protocols are respected while carrying out these life-saving measures. For example, rather than being distributed at schools or large community gatherings, bed nets will be distributed door-to-door, which is far more labor-intensive and expensive.
Community health workers are also key players in reducing the strain on health systems. The work of local community health workers to provide integrated community case management of malaria and other fevers relieves pressure on health centers. It allows healthcare workers to treat many malaria cases at the community level, referring only severe malaria cases and fever cases not caused by malaria to health centers. Outbreaks like COVID-19 show us the essential value of community-based care and why we need to expand our efforts to build strong, resilient health systems across the globe.
We must protect our frontline healthcare workers
Outbreaks like COVID-19 threaten the first line of defense against malaria: healthcare workers. Healthcare workers work on the frontlines of malaria elimination and are vital in the fight against outbreaks like COVID-19. They are also some of the most vulnerable groups to these diseases during outbreaks. During the 2014 -2016 Ebola outbreak in West Africa, healthcare workers were between 21 to 32 times more likely to become infected than other members of the public in the affected communities. Everyday there seems to be a new story about the shortage of personal protective equipment (PPE) for healthcare workers across the globe. Consistent and adequate funding for global health helps provide the tools healthcare workers need to address outbreaks and protect themselves from disease.
Consistent and adequate funding for global health efforts is not a ‘nice to have’ — it’s critical
COVID-19 is a harsh reminder that diseases don’t respect borders. As the world shrinks with increased global travel and mobility, this virus is showing us all how quickly and easily diseases can spread. Health systems everywhere need robust funding in order to respond to outbreaks like COVID-19, while also continuing progress against other deadly diseases like malaria.
We know that U.S. foreign assistance makes the world safer, healthier, and more secure for Americans and is less than 1% of the federal budget. This is especially true for the role of U.S. Leadership in funding programs like the Global Fund and President’s Malaria Initiative. The United States made a commitment to the Global Fund of US$1.56 billion for Fiscal Year 2020 (FY20), with the intent to commit a total of US$4.68 billion over the three year replenishment period (2020-2022). Recognizing the need to step up the fight against malaria, in FY20 the U.S. allocated US$770M to the President’s Malaria Initiative (PMI) to enable them to start deploying enhanced bed nets that overcome the burgeoning challenge of insecticide resistance. Looking forward, PMI needs an additional US$54.3M (or $824.3M total) to further scale up these more effective bed nets as well as to double the care and treatment of pregnant women and children in six of the most endemic countries. This funding is now increasingly important to strengthen health care systems in areas where COVID-19 can have the most detrimental impact.
As the world continues to fight back against COVID-19, we can not take our foot off the gas pedal in finding an end to malaria for good. Such incredible progress in this fight is due to U.S. leadership through programs like the President’s Malaria Initiative and the Global Fund. Together, these programs go far beyond protecting the world’s most vulnerable from malaria, and with continued U.S. leadership, millions of lives can be saved from COVID-19 and malaria for years to come.
To learn how you can step up the fight against malaria with Nothing But Nets, click here.
If you’d like more information on how the United Nations Foundation is responding to this outbreak, click here.
For up to date information from the World Health Organization about COVID-19’s impact on malaria, click here.