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.