The World Health Organisation (WHO) has warned that the deaths from malaria could double this year to nearly 8 lakh in sub-Saharan Africa if antimalarial campaigns are suspended, and supply of medicines is disrupted due to COVID-19 and related lockdowns.

Even today, malaria continues to claim 4.3 lakh lives worldwide every year, with the number of well above 20 crores. India, despite tremendous progress thus far, still witness nearly 10,000 deaths due to malaria every year, as per the World Malaria Report 2019.

As the global health community celebrates World Malaria Day on April 25, this serves as a stark reminder from the UN health agency to avoid repeating the mistakes of the past. Despite the novel coronavirus pandemic, the WHO recommends that countries with malaria burden should act now to maintain the progress made so far.

The projections of doubling of malaria-related deaths are based on a worst-case scenario of a new modelling analysis released earlier this week. The analysis was conducted by WHO in close collaboration with partners, including PATH, the Malaria Atlas Project and the Bill & Melinda Gates Foundation. The projections represent a return to malaria mortality levels last seen 20 years ago.

During 2014-15, a deadly spell of ebola broke out in West Africa, forcing all the government health care machinery to shift its focus from malaria. A decade-long battle against malaria was lost within months, as the routine healthcare services collapsed, antimalarial drugs sat still at warehouses, and health workers were stopped from carrying out regular malaria inspection.

In short order, progress against malaria was stopped in its tracks, and thousands of additional malaria-related deaths were estimated in small West African countries of Guinea, Liberia and Sierra Leone in one year. Sub-Saharan Africa accounts for around 94% of global malaria death toll with more than four lakh deaths every year. More than two-thirds of deaths are among children under the age of five.

This time, as the COVID-19 pandemic grips more and more countries, the entire global healthcare system appears to be focusing on the novel coronavirus. However, the disruption in other healthcare services can undo decades of progress, warns WHO.

The pre-monsoon season (March to May) is crucial in malaria prevention campaigns in India, and many African countries as the number of cases spike sharply during the monsoon months. Therefore, despite the pandemic, continued focus on anti-malaria campaigns is very important, say experts.

During the summer months, Accredited Social Health Activists (ASHA) reach out to the most remote parts of India and provide critical early detection and treatment at the community level. However, the lockdown this year has restricted their movement as well, threatening to derail the malaria prevention campaigns this year. If left untreated, malaria can become severe, often requiring hospitalisation and leading to death.

“Due to the lockdown, movement of health workers and ASHAs in mostly rural and tribal areas has stopped, impacting active surveillance and direct interaction with families at risk,” said Dr Sanjeev Gaikwad, the Malaria No More India Country Director. Malaria No More is a non-profit organisation working to support India’s goal of eliminating malaria by 2030.

Representational image

(Malaria No More)

Further, antimalarial drugs like hydroxychloroquine continue to gain popularity as potential treatment option to alleviate the symptoms of COVID-19. Despite unreliable results and known side-effects, a worrying trend of hoarding such medicines has been observed across the globe. Experts warn that this could severely compromise the supply of drugs, which is originally used to treat malaria, over the next few months or perhaps years. Also, experts warn that such disruptions could lead to the proliferation of substandard antimalarial drugs in the market.

An early-stage false hypothesis suggested that coronavirus cases and fatality rates have been relatively lower in Asian and African countries that have higher malaria burden. Several experts have repeatedly debunked this claim, with WHO even indicating the possibility of patients having both the illnesses simultaneously, which could lead to severe health complications.

Moreover, as the lockdowns extend to more than a month in many parts of the world, production and supply of essential malaria commodities like long-lasting insecticidal nets, rapid diagnostic tests and antimalarial medicines, have taken a hit. A coordinated effort among all stakeholders is more necessary than ever to manage the existing supplies and safely continue malaria prevention, diagnosis and treatment services uninterrupted.

“The response to the COVID-19 pandemic must utilise and strengthen the infrastructure that has helped health programmes to address malaria and other infectious diseases around the world… If the systems and staff are not well engaged, however, the gains made in saving lives from malaria and other diseases over the past 20 years may be lost,” says WHO, in its report titled ‘Tailoring malaria interventions in the COVID-19 response’.

There is hope! In the most-vulnerable states like Odisha, the malaria programmes are at-the-ready for a restart once the lockdown is lifted. “Insecticide-treated mosquito nets have already been distributed, and all preparations for the pre-monsoon intensification of antimalarial activities in states like Odisha are in place. If these activities could start immediately after the lockdown is lifted and before the onset of monsoon rains in early June, India’s progress against malaria can be maintained,” says Dr Gaikwad.

Overall, experts believe that with adequate planning, the response to the COVID-19 pandemic can save lives, strengthen the health care systems to address malaria and other infectious diseases better and reduce the burden on already challenged health care systems.

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