COVID-19 Pulls Resources from Malaria, Leading to Spike in Deaths

As the world has adapted to deal with the coronavirus disease 2019 pandemic, public health resources that might otherwise be deployed to fight diseases affecting the developing world have instead been used to push back against the spread of SARS-CoV-2.

In a new paper in the Journal of Infection and Public Health, investigators from the All India Institute for Medical Science examine how the pandemic is affecting antimalarial efforts and propose strategies for reversing the upward trend of malaria outbreaks.

Corresponding author Poonam Yadav, PhD, and colleagues explained that until the arrival of COVID-19, cases of malaria had been dropping. According to the World Health Organization, there were 839,000 deaths worldwide from malaria in 2000, but by 2015 that number had dropped by nearly half to 438,000. By 2018, the figure was down to 405,000. Yet, estimates suggest a significant jump in malaria deaths occurred in 2020, when approximately 568,000 people are believed to have died of malaria.

Yadav and colleagues noted that regions where malaria is endemic, such as South America and sub-Saharan Africa, have been hit hard by the pandemic, forcing public health officials and nongovernmental organizations to shift their resources away from effective antimalarial strategies. For example, the investigators said programs to distribute insecticide-treated mosquito nets and antimalarial medicines have been suspended in many parts of sub-Saharan Africa.

“Even in India, poor access to medicines, bed nets, and diagnostic kits affected the malarial control activities drastically not only to urban [but] even rural regions,” the investigators wrote. The co-authors reviewed existing literature in search of strategies to reverse the program as the pandemic lingers. One problem, they said, is that COVID-19 and malaria can share symptoms, though people infected with each can also be asymptomatic. That makes rapid and widespread testing for both infections critical; however, they also suggested that mass administration of antimalarial prophylaxis might also prove beneficial in endemic areas.

The investigators said community health workers are an important resource in the fight against both COVID-19 and malaria, but in some regions, such as India, workers that previously would have been deployed to fight malaria were instead deployed against COVID-19. Yadav and colleagues wrote that public health officials need to re-engage community health workers so that they can fight both diseases at the same time.

“Data suggested that community health workers’ engagement towards COVID-19 reduced the fights against malaria,” they wrote. “Hence, [public health officials] must ensure engagement with relevant COVID-19 health workers to use available malaria resources effectively.”

Lastly, the investigators said the fight against malaria will depend on better data collection and distribution, akin to what has been used to track COVID-19 successfully in many jurisdictions.

“Timely dissemination of information and analyses with internet communication and virtual meetings may summarize and share the quality data on malaria across the national system; otherwise, staff meetings and assembling are often required to share information,” they wrote.

Aside from these strategies and the direct redeployment of healthcare resources, Yadav and colleagues said antimalarial efforts have also been affected by challenges such as lockdowns and a reticence among some patients to seek medical care, due to fear of being exposed to SARS-CoV-2. They said closing the “huge gap” in antimalarial activities created by the pandemic will take a coordinated, mult-front effort.