COVID Contributed to 69,000 Malaria Deaths, Doomsday Scenario Averted

Moderate disruptions in the delivery of malaria services contributed to 14 million malaria cases and 69,000 deaths, yet 47,000 of the additional malaria deaths, were due to disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic.
Disruptions due to the COVID-19 pandemic resulted in considerable increases in malaria cases and deaths between 2019 and 2020, according to the annual World Malaria Report released this evening by the World Health Organization (WHO).

The report shows that moderate disruptions in the delivery of malaria services contributed to 14 million malaria cases and 69,000 deaths. 47,000 of the additional malaria deaths, were due to disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic when countries enforced lockdowns restricting the movement of people.

However, the doomsday scenario projected by the WHO has not materialised. Early in the pandemic, WHO had projected a doubling of malaria deaths in sub-Saharan Africa, as a worst-case scenario. Yet, the analysis found there was an estimated 12 per cent increase in deaths in the region between 2019 and 2020.

The report revealed that globally, 1.7 billion cases and 10.6 million deaths were averted between 2000 and 2020. Most of the malaria cases (82 per cent) and deaths (95 per cent) averted over the last 20 years were in the WHO African Region.  The report noted that the WHO African Region carried about 95 per cent of global malaria cases in 2020, and 96 per cent of global malaria deaths in 2020.

A new, country-driven approach to malaria control in high-burden countries was beginning to gain momentum when COVID-19 struck, and according to the analysis in 2020, global malaria case incidence was off track by 40 per cent and the global mortality rate for 2020 was off track by 42 per cent.

Dr Pedro Alonso, the Director of the WHO Global Malaria Programme said that thanks to urgent and strenuous efforts, the world has succeeded in averting the worst-case scenario of malaria deaths. However, he added that even before the emergence of COVID-19, global gains against malaria were levelling off.” “We are not on a trajectory to success, we are increasingly moving away from reaching the 2020 milestones of WHO’s global malaria strategy,” Dr Alonso said.

The report found that just 58 per cent of countries completed their planned campaigns to distribute insecticide-treated mosquito nets in 2020, with most experiencing important delays. Globally, 72 per cent of all insecticide-treated mosquito nets planned for distribution had been distributed by the end of 2020.

In 2020, of the 65 countries who responded, 37 countries reported partial disruptions (5 per cent to 50 per cent) to malaria diagnosis and treatment services, and by 2021 15 countries reported partial disruptions (5 per cent- 50per cent) and six countries reported severe disruptions.

This year’s World malaria report used a new methodology to estimate malaria deaths worldwide. This resulted in a larger share (7.8 per cent) of deaths among under-five children than previously recognized (4.8 per cent).

On a global scale, progress against malaria remains uneven. The report found that many countries with a low burden of the disease are moving steadily towards the goal of malaria elimination. Two countries – El Salvador and China – were certified malaria-free by WHO in 2021. However, most countries with a high burden of the disease have suffered setbacks and are losing ground. 

Global progress against malaria over the past two decades was achieved, in large part, through the massive scale-up and use of WHO-recommended malaria tools that prevent, detect and treat the disease. However, the most recent data also demonstrate that significant and sometimes widening gaps in access to life-saving tools for people at risk of malaria.

The report warns that the situation remains precarious, especially in sub-Saharan Africa. A convergence of threats in the region poses an added challenge to disease control efforts. These include Ebola outbreaks in DRC and Guinea, armed conflicts and flooding. At the same time, the document reiterates that the pandemic is not over, and the pace of economic recovery is uncertain. Without immediate and accelerated action, key 2030 targets of the WHO Global technical strategy for malaria will be missed, and additional ground may be lost.

The strategy’s goals include a 90 per cent reduction in global malaria incidence and mortality rates by 2030. The report reiterated that this will require new approaches and intensified efforts aided by new tools and better implementation of existing ones. This includes a stronger emphasis on equitable and resilient health systems and data-driven strategies.

The report also recommended the expanded use of the RTS,S malaria vaccine recommended by WHO in October. “the vaccine is feasible to deliver, is safe, has a public health impact and is cost-effective,” Dr Alonso said. “As we speak GAVI is discussing opening up a window for investment in this malaria vaccine,” he added. 

The analysis also emphasized that stepped-up investment is also essential. “Funding has flatlined” Dr Alonso warned “We are about 50 per cent off what we believed the target should be for 2020”.

The report found that a total of USD 3.3 billion was invested globally in malaria control and elimination in 2020. This was against a target of USD 6.8 billion to reach global malaria targets. Annual investments will need to more than triple by 2030 – to USD 10.3 billion per year, the report noted.