News

Coronavirus (COVID-19) and increased AMF funding need - Update 25 Mar 2020

Summary

The WHO has urged countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic because reducing malaria can be expected to reduce the impact of COVID-19.

We are discussing the situation regularly with all partners and it seems likely that the best way for AMF to contribute to reducing the impact of the pandemic on both COVID-19 and malaria morbidity and mortality will be to fund more nets.

Initially, this will be for AMF’s three programmes with upcoming distributions, in DRC, Uganda and Togo, that involve distributing 30 million nets. We are now increasing our focus on raising funds to enable us to fund these additional nets.

Detail

The WHO has issued guidance that urges countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic.

"As COVID-19 continues its rapid spread, WHO would like to send a clear message to malaria-affected countries in Africa," said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. "Do not scale back your planned malaria prevention, diagnostic and treatment activities."

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…"

The experience of the Ebola outbreak in 2014-2016 showed the importance of maintaining, and indeed increasing, malaria control activities to help reduce the morbidity (illness) and mortality from Ebola and malaria.

"During the Ebola outbreak, malaria mortality increased as net distributions ceased and health systems ran out of drugs. Close resemblance of early Ebola symptoms with those of malaria, led to difficulties in early diagnosis. Fear on the part of community members of contracting ebola in the health-care facilities prevented those suffering from malaria from seeking treatment. As Ebola overwhelmed health-care infrastructure, insufficient resources for malaria control in these regions led to increased mortality and morbidity. COVID-19 is likely to create similar problems. Lessons learned from this Ebola crisis show that preventive measures against both the COVID-19 threat and the existing malaria are required."

An attempt at quantifying the impact of the 2014-2016 outbreak was carried out by researchers as published in The Lancet., an extract of which is shown below:

"Findings

If malaria care ceased as a result of the Ebola epidemic, untreated cases of malaria would have increased by 45% (95% credible interval 43–49) in Guinea, 88% (83–93) in Sierra Leone, and 140% (135–147) in Liberia in 2014. This increase is equivalent to 3·5 million (95% credible interval 2·6 million to 4·9 million) additional untreated cases, with 10 900 (5700–21 400) additional malaria-attributable deaths. Mass drug administration and distribution of insecticide-treated bednets timed to coincide with the 2015 malaria transmission season could largely mitigate the effect of Ebola virus disease on malaria.

Interpretation

These findings suggest that untreated malaria cases as a result of reduced health-care capacity probably contributed substantially to the morbidity caused by the Ebola crisis."

A March 16, 2020 article in the Lancet discussed the importance of ‘Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic’ and the continuity of malaria control activities.

“These features of COVID-19 and the previous experiences of the Ebola outbreak point to the need for malaria-endemic countries to consider preventive measures against not only the COVID-19 threat but also its likely impact on existing malaria control efforts.

Resource allocation should be optimised whenever possible to ensure minimal disruption to malaria control should COVID-19 management become necessary.

…the distribution of ITNs might be considered for short-term malaria relief in hyperendemic areas. Such measures would also aid efforts in COVID-19 management by reducing the strain on medical resources and minimising confounding factors in diagnosis.

…malaria-endemic countries must be prepared for the challenges that COVID-19 might bring while minimising disruption to malaria control.”

It is likely AMF will need to fund more nets for the three programmes we are currently in the middle of (in DRC, Uganda and Togo) that involve distributing 30 million nets. Some adjustments to our standard process may also be necessary to reduce the risk of infection through the net distributions.

The likely additional net need is because as people become infected in these countries, which is to be expected, they will need to sleep separately from other family members so more nets will be needed. Nets may also last for less time, if for example people increase the frequency and intensity of washing nets due to hygiene measures for COVID-19.

The continuation of the net distributions is seen by all of us in malaria control as vitally important to prevent increased and high levels of malaria as co-morbidity suggests that this would lead to an even greater impact from COVID-19.

Given funding requests to AMF prior to the COVID-19 outbreak already substantially exceeded the funds we have available, we expect our funding to come under further strain and are focusing further on raising funds to ensure we can play as much a part as we can in reducing malaria and the impact of COVID-19.

The effect of coronavirus (COVID-19) on AMF: Update, 18 March 2020

We provide below an update on how the coronavirus is affecting AMF’s work. Currently it is minimal, but we keep this constantly under review and are expecting this to change as matters develop in Africa. Net distributions are likely to be an important part of minimising the coronavirus impact as increased malaria rates are likely to increase the mortality rate from coronavirus. We remain focused on fundraising to fill significant funding gaps.

• No change to our last blogpost: currently no delays to our distributions are projected to arise from production problems. We are continuing to monitor the situation closely, but the current easing of the situation in Asia is helping in this area.

• No disruption to distribution dates so far, but clearly there is a high risk of delay
• In country partners are becoming concerned about the potential effects of travel restrictions (as for the Ghana PDM)
• Malaria may increase COVID-19 mortality, which will make it more important to keep distributions going if possible
• We are monitoring country specific coronavirus data and liaising closely with the MOH in each country in which we operate

• The Government of Ghana has now imposed travel restrictions which have forced AMF’s PDM-18 to be suspended for a minimum of 1 month
• This is the one PDM to have been affected so far
• This is likely to change and we are keeping all PDMs under review

• AMF staff will not be travelling in the short term
• No mission critical trips had been planned

• None of the AMF team has been affected so far
• The two staff members previously working in co-working spaces are now working from home
• As other AMF staff work from their offices remotely and we have no central office, there is no large change to work patterns
• No face to face meetings will take place for now

US$240m milestone passed!

We have now reached a total raised of US$240,000,000 since AMF started and the donation that took us past that milestone was one from Cardiff, Wales! Diolch!

This equates to the funding of more than 109 million nets to protect 196 million people and an expected impact, once all nets are distributed, of more than 52 to 63 million cases of malaria averted, 73,000 to 83,000 lives saved, and economic improvement of US$2.8billion.

We have also just passed 504,000 donations received, with this coming from over 130,600 people in 192 countries!

As always, our sincere thanks to everyone for their wonderful support and generosity.

The Economist Documentary

AMF features in a recent documentary published by The Economist, called "Charity: how effective is giving?" and the AMF section is from approximately 21 - 26 minutes.

The interview took place with Julian Austin, AMF’s Operations Director, during his most recent trip to Guinea where AMF distributed 4.8 million nets last year.

The discussion includes an overview of Effective Altruism (EA), and highlights the wider benefits to the economy of a country receiving long-lasting insecticidal nets. It is estimated that for every dollar spent in combatting and fighting malaria through bednets, 12 dollars is generated in GDP for that country.

It includes a review of one of the criticisms of the EA community's approach to giving - that giving is not a science and that the EA community appeals too much to logic and hard numbers. Julian's response was:

"We’re here at the hospital today and there are numerous young children who are suffering from severe malaria, and you can see worried parents everywhere. I don’t see a lack of emotion in any of that at all."

AMF activity update: Jan/Feb 2020

A short update on activities that have taken place at the beginning of this year.

1. In Uganda, where AMF has signed an agreement with the Ministry of Health to fund 11.6 million nets for the 2020 mass distribution campaign, roughly half of these will be PBO nets. In 32 of the 67 districts receiving AMF nets, a study will be carried out to assess the effectiveness of a new type of net, called Royal Guard. This net, designed for areas with pyrethroid resistance, is a dual active ingredient (AI) net, meaning that it has two chemicals that can kill mosquitoes. For Royal Guard, these are alphacypermethrin and pyriproxyfen. Their effectiveness will be compared to PBO nets. Separately, the post distribution monitoring (PDM) 30 months after the 2017/18 distribution was carried out in the Eastern region late last year. The results show sleeping space coverage of 80%, which is a very good result. The PDM-30 in the Western region was carried out in February and paper copies are being sent to the data centre in Kampala for entry into our database.
   
   
2. In DRC, the registration of 550,000 households in Sud Ubangi province using electronic devices is complete and the results are being validated. Distribution will be carried out ‘door to door’, meaning that nets are distributed and hung in households, as opposed to beneficiaries going to a fixed distribution site to collect them. In Haut Katanga province, the registration of 1.4 million households is complete and results are being validated. Our partner AGAPE is entering the paper-based records at the data centre AGAPE has established in Kinshasa, working three 7 hour shifts to enter data at a rate of approximately 40,000 households per day. Distribution is now scheduled for April. Registration in Tanganyika province is also being carried out in April. For the 2020/21 mass distribution campaign, AMF has signed its largest ever agreement with the Ministry of Health to fund 16.2 million nets. Nets for the first two provinces of this agreement, Kongo Central and Kinshasa, have been ordered. There have been moderate delays in production due to coronavirus but distribution dates are not affected.
   
   
3. In Guinea, we have signed an agreement with Cabinet Diagnostic to carry out PDMs. The first PDM at 9 months is taking place using electronic devices. Data is available in near real time and is being uploaded to our database. Nets that were diverted to Mali have been identified in Bamako, of which 45,900 (representing 0.95% of the 4.8 million nets funded) are AMF nets. Discussions are ongoing between the Malian and Guinean authorities for these stolen nets to be returned to Guinea. The nets will be returned to Guinea and all will be used to protect Guineans as intended.
   
   
4. In Zambia, we are investigating an issue regarding the distribution data from the previous campaign in 2018. During the PDM-18 in Central, North-Western and Western province, our partner organisation CHAZ will collect paper copies of the distribution data in order to re-enter a portion into our database. This work begun last month but has been delayed by security concerns in Zambia.
   
   
5. In Ghana, we have completed PDMs 9-months following distribution. The results show hang up rate (the proportion of AMF nets that are found hanging) of 71%, which is lower than expected. We have shared the results with the National Malaria Control Programme (NMCP) to understand what actions can be taken to improve net usage. The first PDM 18 months post distribution in Brong Ahafo region is currently taking place.
   
   
6. In Malawi, our PDM partner has finished the first round of PDMs at 9 months. The sleeping space coverage at 9 months is 72%.
   
   
7. In PNG, our partner RAM has begun their distribution in the provinces scheduled for 2020, starting with Milne Bay. Over the coming year, 1.1m AMF-funded nets will be distributed in areas of Papua New Guinea with high risk of malaria. The 2019 campaign is now complete, with the final nets distributed in East New Britain.
   
   
8. In Togo, orders have been placed for 3.5 million nets to be produced for the 2020 campaign. On the basis of insecticide resistance data, half of the nets will be PBO nets. Registration is scheduled for August 2020.