On December 4, 2019, the World Health Organisation (WHO) released the World Malaria Report 2019—a comprehensive analysis of the global Malaria situation. The report showed that India was one of the only two success stories among 11 countries facing the world’s maximum malaria burden, as it achieved a sharp reduction of 28% in malaria cases from 2017 to 2018.
Around the time the WHO report was released, a mysterious virus had started to infect people in the Hubei province of China. By December 15, nearly 30 people were reported sick due to the new virus—identified to be a novel coronavirus and named SARS-CoV-2 at later stages. Today, the disease caused by the virus, COVID-19, has infected more than 25 lakh people worldwide and has killed 1.75 lakh within four months.
Now, the novel coronavirus is also restricting the ongoing healthcare services that helped countries to fight several deadly diseases like Malaria. The sudden emergence of COVID-19 has put an unprecedented, massive strain on the global healthcare system. Public health experts, however, warn that while fighting the new threat, we should not ignore other health priorities like achieving a malaria-free India by 2030.
India’s success in fighting malaria
Just a decade ago, India was reporting more than two crore malaria cases, along with more than 30 thousand deaths each year. Now, even as the worldwide number of cases continues to remain well above 20 crores, along with 4.3 lakh deaths every year, the numbers have fallen sharply in India. In 2018, the country witnessed an estimated 67 lakh malaria cases and 9,620 deaths—3% of total malaria cases and 2% malaria deaths across the globe.
The remarkable progress made in the battle against malaria is a result of a targeted campaign involving the government, private sector, civil societies and citizens. In 2018-19 alone, 52,744 Ayushman Bharat-Health and Wellness Centres were approved, and 17,149 were operationalised. A total of 1.81 lakh health workers, including ASHAs, MPHWs, Staff Nurses and PHC-MOs were trained on Non-Communicable Diseases like Malaria that year.
“India has increased awareness and combated the adverse socio-economic impact of malaria, which disproportionately affects the most vulnerable including pregnant women and children under 5,” 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.
India’s worst-affected state, Odisha, reduced malaria cases by more than 80% between 2016 and 2018. Malaria No More is working with the state and national governments to replicate Odisha’s success across the country. More recently, Malaria No More partnered with IBM’s The Weather Company and other partners to harness weather data to fight mosquito-borne disease better globally.
In 2019, the Government of India increased funding for the National Vector Borne Disease Control Programme by more than 25%. The combined efforts of the government health agencies, private and non-profit organisations and citizen groups aim to make the dream of ‘Malaria-free India’ a reality in the near future.
Battling Malaria amid a pandemic
Fundamentally, COVID-19 and malaria are caused by two completely different sets of parasites. While SARS-CoV-2 causes the former, a protozoan named plasmodium causes the latter. The mode of transmission is also very different, as COVID-19 is spread through respiratory droplets and direct contact, whereas malaria parasites are spread through the bites of female Anopheles mosquitoes. However, malaria illness does share some symptoms with COVID-19: fever, headache, body aches and weakness.
Based on a new analysis released earlier this week, WHO has warned that the deaths from malaria could double this year to nearly 8 lakh in sub-Saharan Africa if anti-malarial campaigns are suspended and supply of medicines is disrupted due to COVID-19 and related lockdowns.
Even in India, the lockdown has restricted the movement of Accredited Social Health Activists (ASHA), who reach out to the most remote parts of India and provide critical early detection and treatment at the community level. As the lockdowns extend to more than a month, production and supply of essential malaria commodities like long-lasting insecticidal nets, rapid diagnostic tests and antimalarial medicines like hydroxychloroquine, have taken a hit. The WHO’s warnings precisely highlight these issues and urge countries to act swiftly to avoid losing the gains made in saving lives from malaria over the past two decades.
“Ensuring access to core malaria prevention measures is an important strategy for reducing the strain on health systems; these include vector control measures, such as insecticide-treated nets and indoor residual spraying, as well as chemoprevention for pregnant women and young children. Additional special measures could ease the burden on health systems in the context of COVID-19, such as presumptive malaria treatment and mass drug administration,” says WHO.
Building upon India’s success story
The COVID-19 pandemic, while posing a considerable risk, also provides an opportunity to win the battle against malaria. The disease surveillance programs at the grass-root level targeted towards the novel coronavirus could include malaria-related services as well and such approaches can yield co-benefits against both deadly diseases. At the same time, the devastation caused by COVID-19 could amplify several times if its response undermines the life-saving services of other illnesses.
WHO also recommends certain exceptional measures, such as presumptive treatment and mass drug administration, at a few vulnerable locations. Under these methods, a sensitive population is treated regardless of whether or not they show symptoms. However, the safety of health workers should also be ensured while implementing such measures.
A truly testing time has come for the countries with the malaria burden—a test of whether we can act now to build upon decades of effort and success or undo it due to our short-sightedness.
There is hope! In the most-vulnerable states like Odisha, the malaria programs 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 anti-malaria 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. With several new barriers as we progress, a malaria-free India remains a distant, yet achievable dream. World Malaria Day 2020 is here to remind us not to lose sight of this ultimate goal.