Scientists feared the pandemic would result in a rise in malaria deaths. To this point it hasn’t occurred to science
A campaign worker distributed bed nets in Cotonou, Benin, in April, who canceled the bed netting but later resumed it.
YANICK FOLLY / AFP / Getty Images
By Leslie RobertsAug. 17, 2020, 2 p.m.
science‘COVID-19 reporting is supported by the Pulitzer Center and the Heising Simons Foundation.
As early as March, when COVID-19 arrived, Pedro Alonso was alerted about another infectious disease. “I thought I was going to see the biggest malaria disaster in 20 years,” says Alonso, a malaria scientist at the World Health Organization (WHO). The African countries have been locked down to contain COVID-19. They were concerned about mass gatherings and campaigned to distribute bed nets to control mosquitoes. There have been numerous fears that patients in clinics overwhelmed by COVID-19 might not receive treatment for malaria, from which an estimated 405,000 people die each year, mostly African children. In the worst case scenario, malaria deaths could more than double this year.
“It doesn’t seem to be happening,” says Alonso. The WHO Global Malaria Program (GMP), which he leads, and his partners are again campaigning for bed nets. Rapid diagnostic tests and effective antimalarial drugs are available. The situation could still go south if the COVID-19 epidemic accelerates – there are worrying signs – but for the time being, Alonso says, “We’ve probably stopped the first big blow.”
In March, the WHO recommended countries stop mass vaccination campaigns against measles and other diseases for fear they could spread COVID-19. Like other health authorities, the African Centers for Disease Control and Prevention advised people to stay home unless they were very, very sick, Alonso says. But a broad lockdown would be “a bullet straight to the heart of the malaria program,” he says. “For the past 40 years we have said that malaria can kill very quickly. If a child has a fever, go straight to the clinic. “
By March 25, WHO had issued emergency guidelines urging countries to proceed with the prevention and treatment of malaria – and could do so safely. “The WHO has been very effective in getting the message across,” said Thomas Churcher of Imperial College London (ICL), who on Aug. 7 released an alarming model of the effects of reducing malaria interventions in natural medicine.
The distribution of bed nets treated with insecticides was the first concern of GMP. The recent decline in malaria deaths from an estimated 839,000 in 2000 to 405,000 in 2018 is largely due to the massive net expansion across Africa. Bed nets, however, must be replaced every 3 years as the insecticide wears off and the nets tear. 26 African countries were due to mass-campaign new nets this year – but in March many were cautious.
Benin was the most pressing priority. The first phase of their campaign was already over. She distributed door-to-door vouchers that families could use to pick up their bed nets at a central point 1 month later. But the government canceled the second phase. The concern was that people worried about supplies would rush to distribution centers to collect their nets, says Marcy Erskine of the International Federation of Red Cross and Red Crescent Societies. “Crowds can be very difficult to control,” she says, making physical distancing all but impossible.
“We all knew that there would be a massive ripple effect if Benin didn’t continue,” says Erskine. GMP and its partners – including the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the RBM Partnership to Fight Malaria, the US President’s Malaria Initiative, and the Alliance for Malaria Prevention (AMP) – began lobbying in Support Benin and elsewhere. she says armed with models from ICL and WHO. AMP advised the countries on reducing COVID-19 risks – for example by distributing networks from door to door instead of from a central point – and offered technical support.
Benin agreed, distributed 8 million networks in April and set an example for other governments, says Sussann Nasr of the Global Fund: “In the end, every country said yes.” “We don’t want a false sense of security,” says Nasr. “We need to be sure that the 2021 countries are campaigning too,” says Hannah Slater, model at PATH, a global nonprofit health organization based in Seattle. The same goes for indoor spraying with insecticides and seasonal chemoprevention, where children are given anti-malarial medication during the high season of the disease regardless of whether they are infected.
Even if preventive measures continue, malaria deaths could increase if sick children are not treated effectively – for example, if frightened mothers keep them at home, as happened during the West African Ebola epidemic. The ICL model assumes that 129,000 additional malaria deaths would occur between May 2020 and May 2021 if access to treatment was only reduced by 50% for 6 months.
According to Alonso, figuring out how many children are being treated is difficult. But there are ominous clues. Prenatal visits are not possible in some locations, and there pregnant women who are very prone to severe malaria receive chemoprevention and bed nets, as well as regular checkups. Other data show that routine vaccinations against diseases such as measles have fallen. “What really worries me is a child who is not treated and whose deaths are not counted,” says Regina Rabinovich of the Harvard TH Chan School of Public Health – a problem even before the pandemic. A countdown likely explains the “paradoxical” finding that reported malaria cases have declined this year, Alonso says.
Churcher fears that in some countries the peak of COVID-19 will occur during the high malaria season, leaving fragile health systems with simultaneous epidemics. Even countries that are strictly locked down have to continue malaria services, he says: “It’s not a compromise. You have to do both. “