COVID-19 has derailed progress on malaria — here’s what we need to do to get back on track

An additional 47,000 people died from malaria in 2020 due to the impact of COVID-19. COVID disrupted supply chains for antimalarial medicines, infected unvaccinated health workers and made communities fearful of seeking needed testing and treatment — helping malaria resurge.

The latest World Malaria Report shows that the world avoided the worst projection – deaths from malaria doubling due to COVID-19 disruptions – but there were more deaths and cases than a decade ago, with the greatest toll in Africa.

COVID-19, our newest pandemic, has derailed progress in the fight against our oldest pandemic, malaria. Here are three actions the world must take to get the fight against malaria back on track.

First, we must protect frontline workers. Africa, where 90 percent of malaria deaths occur, remains the continent least vaccinated against COVID-19. More than 150,000 COVID-19 infections have occurred in health workers in Africa. With a baseline shortage of health workers, when even one falls sick or dies, an entire clinic may shut down. It’s no wonder malaria testing was down by 17 percent in one survey. Several high burden malaria countries such as Malawi, Angola and Mozambique are now fighting the omicron variant. Only months earlier, the delta variant took the lives of health care workers in countries such as Uganda, which had fought malaria and other leading causes of preventable death for decades.

It doesn’t have to be this way. When COVID-19 struck in early 2020, the U.S. President’s Malaria Initiative, through the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), worked with our country partners to adapt support to frontline providers. We expanded remote supervision and virtual training for nurses, revised malaria job aids for laboratory workers to include COVID-19 safety protocols and procured masks and personal protective equipment for community health workers so they could go door-to-door to deliver medicines and nets, avoiding crowded collection points. Only 27 percent of health workers in Africa are fully vaccinated against COVID-19, as of November.

The U.S. has committed to donating more than 1.2 billion COVID-19 vaccines to countries in need and has delivered almost 400 million to date — more than all other countries combined. More countries must commit to helping the world (especially frontline workers) get vaccinated.

Second, we must reach the unreached. While COVID-19 has led to a surge in malaria deaths, the truth is that progress against malaria had slowed in the years prior to the pandemic. After a dramatic 50 percent decline in deaths from 2000 to 2015, the malaria death rate fell by only 2 percent annually between 2015 and 2019. Over that period the population at risk for malaria nearly doubled, from 665 million to 1.1 billion, and the global funding remained flatlined at less than half of what was needed. 

Remarkably, there were still over 10.6 million lives saved and 1.7 billion cases of malaria prevented since 2000. That’s worth celebrating. But today, millions remain left behind. More than one in four families do not even have one bed net to avoid being bitten by infected mosquitoes, four in 10 children with fever are not tested for malaria, and two out of three pregnant women go without sufficient doses of medicines to protect themselves and their babies from the disease.

We must bring care to people. Many unreached people live in rural and poor communities. Countries beating malaria recognize outbreaks start and stop in communities. Many countries have prioritized reaching the unreached through community health workers — often people without a high school degree, hired directly from the communities they serve and trained and equipped to go door-to-door to test and treat their neighbors for malaria among other diseases. PMI partners in many countries such as Rwanda and Nigeria have trained thousands of community health workers to test and treat patients for malaria — and now they’re using them to promote the uptake of COVID-19 vaccines and testing.

Third, we must scale up delivery of the new malaria vaccine. In October the World Health Organization recommended the world’s first malaria vaccine, called RTS,S, for use in young children in Africa. This recommendation is groundbreaking. As part of efforts to reach this point, USAID has been investing in malaria vaccine research for five decades, including funding the research that identified the critical protein comprising RTS,S.

While its effectiveness is modest against severe disease on its own, delivering RTS,S to the highest risk populations could save tens of thousands of lives each year when used alongside existing malaria interventions. The vaccine is also expected to help prevent millions of cases, including drug-resistant malaria infections, a legitimate threat to global health security.

Last month, Gavi, the Vaccine Alliance approved approximately $130 million to buy vaccines through 2025. The donor community has been working with countries for many years to increase immunization coverage and decrease malaria transmission. USAID is committed to work with Gavi and other global and national partners to support countries to deliver essential vaccines that now include this new malaria vaccine as a complementary part of the proven toolkit of malaria interventions.

And we take the success of the new vaccine as a siren call that new and effective tools are possible. We need to continue to invest in next-generation tools – insecticides, drugs and vaccines – that are highly effective, durable, affordable and deliverable to children at greatest risk of malaria.

Protect the frontlines. Reach the unreached. Scale up delivery of the new malaria vaccine while developing new and better tools. These actions can put us back on track to end history’s oldest and deadliest pandemic. They’re also the ideas underpinning the billion-dollar-a-year strategy we just launched to help save 4 million more lives, prevent 1 billion more cases and end malaria within a generation. Malaria still takes the life of a child nearly every minute. We have no time to lose.

Dr. Raj Panjabi, U.S. Global Malaria Coordinator, leads the President’s Malaria Initiative at the U.S. Agency for International Development.

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