New data from the World Health Organization shows that the COVID-19 pandemic has disrupted malaria services, causing a sharp increase in cases and deaths.
According to the latest WHO World Malaria Report, there were an estimated 241 million cases of malaria and 627,000 deaths worldwide in 2020. This corresponds to about 14 million more cases in 2020 compared to 2019 and 69,000 more deaths. About two-thirds of these additional deaths (47,000) were related to malaria prevention, diagnosis and treatment disorders during the pandemic.
The situation could have been much worse, however. In the early days of the pandemic, the WHO had forecast that the number of malaria deaths in sub-Saharan Africa – with severe service disruptions – could possibly double in 2020. However, many countries are taking urgent measures to shore up their malaria programs to avert this worst-case scenario.
Sub-Saharan Africa continues to bear the heaviest malaria burden, accounting for around 95% of all malaria cases and 96% of all deaths in 2020. Children under the age of 5 account for around 80% of deaths in the region.
The pandemic struck at a time when global progress in the fight against malaria had already reached a plateau. By around 2017, there were signs that the phenomenal strides that had been made since 2000 – including a 27% reduction in global malaria incidence and a nearly 51% reduction in malaria mortality rates – had stalled.
Even before the COVID-19 pandemic broke out, global gains against malaria had flattened out. Thanks to the hard work of public health authorities in malaria-stricken countries, the worst predictions about the effects of COVID have not materialized. Now we need to use the same energy and dedication to reverse the setbacks caused by the pandemic and accelerate the pace of progress against this disease. “
Dr. Tedros Adhanom Ghebreyesus, WHO Director General
Since 2015, the starting date of the WHO Global Malaria Strategy, 24 countries have seen increases in malaria deaths. In the eleven countries with the world’s highest malaria burden, cases rose from 150 million in 2015 to 163 million in 2020 and the number of malaria deaths from 390,000 to 444,600 in the same period.
To get back on track, WHO and its partners recognize the need to ensure better and fairer access to all health services – including malaria prevention, diagnosis and treatment – by strengthening primary health care services, both domestic and international Stepping up investment.
Innovation in new tools is also a critical strategy for accelerating progress. An important new prevention tool is RTS, S / AS01 (RTS, S), the first vaccine ever recommended by the WHO against a human parasite. In October 2021, WHO recommended RTS, S for children living in sub-Saharan Africa and other regions with moderate to high transmission of P. falciparum malaria.
Providing malaria services against the odds
Regardless of the challenges posed by COVID-19, by the end of 2020, around three-quarters (72%) of insecticide-treated mosquito nets had been distributed in malaria-endemic countries as planned. In 13 countries in the African Sahel, 11.8 million more children were reached with preventive anti-malarial drugs during the transmission-rich rainy season in 2020 compared to 2019.
Some countries, particularly those with low malaria exposure and relatively strong health systems, even made gains against malaria during the pandemic. China and El Salvador were certified malaria-free by WHO in 2021, and the Islamic Republic of Iran recorded zero indigenous cases for three consecutive years in 2020.
The six countries in the Greater Mekong sub-region continue to see impressive falls in their malaria cases. By the end of 2020, there were around 82,000 cases of malaria in the sub-region, up from a high of 650,000 in 2012 and around 100,000 in 2019.
Despite these achievements, the WHO African Region recorded a 12% year-over-year increase in malaria deaths in 2020, highlighting the consequences of even moderate service interruptions in a population at risk of malaria.
“While African countries have risen to the challenge and averted the worst predictions about the COVID-19 fallout, the aftermath of the pandemic still means thousands of people are being lost to malaria,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa. “The African governments and their partners must step up their efforts so that we do not lose even more ground on this preventable disease.”
According to the report, 15 countries with high exposure to malaria reported a reduction in malaria tests by more than 20% from April to June 2020 compared to the same period in 2019. National malaria programs distributed fewer treatment cycles in 2020 compared to about 48 million treatment cycles a year earlier. And of the 11 most polluted countries in the world, only India made progress in the fight against malaria. The 10 other countries, all in Africa, reported increases in cases and deaths.
Achieve global goals
According to the report, progress in meeting the 2020 milestones of the WHO’s global malaria strategy has been significantly off the mark. In 2020, the global malaria incidence rate was 59 cases per 1000 people at risk, versus a target of 35-; to steer 40% off course. The global death rate was 15.3 deaths per 100,000 people at risk versus a target of 8.9 -; 42% thrown off course.
Achieving the 2030 goals of the WHO Malaria Strategy, including a 90 percent reduction in global malaria incidence and mortality rates by 2030, requires new approaches, new tools and better implementation of existing ones.
The WHO Malaria Strategy emphasizes the need to carefully align existing approaches to prevention, diagnosis and treatment with the local context and to strengthen health systems as a whole in order to achieve universal health coverage.
Achieving global goals also requires solid funding. According to the report, current funding levels (estimated at $ 3.3 billion in 2020) will have to more than triple to reach $ 10.3 billion a year by 2030.
Applying a new methodology
This year’s report used a new WHO-wide statistical method to estimate the cause of death in children under five for all major diseases, including malaria. The method was applied to 32 countries in sub-Saharan Africa, which account for around 93% of all malaria deaths worldwide. This has resulted in a higher number of estimated deaths in young children each year since 2000.
Even after using the new methodology, the malaria mortality rate has remained on the whole lower since 2000; globally, the malaria death rate (deaths per 100,000 population at risk) fell by 49% between 2000 and 2020. Between 2019 and 2020, the death rate rose for the first time since 2000 due to disruptions during the COVID-19 pandemic.
The World Health Organization