Malaria elimination in the Asia-Pacific: the COVID-19 threat

Battling COVID-19 in the last year has put into perspective the challenge of battling an infectious disease that kills so many across the world every day. For malaria, those daily deaths have been going on for millennia. World Malaria Day reminds us of the progress we have made against this age-old killer and how far we still have left to end a disease which – in addition to the terrible cost in human lives – strains health systems, drains economies and pushes the most vulnerable into poverty.

In the Asia-Pacific (APAC) region, which is home to 60% of the world’s population, most countries have made tremendous progress against the disease, reducing malaria cases by half since 2010. Today there are a staggering 89% fewer deaths from malaria than 10 years ago. The Greater Mekong Subregion, supported by the Regional Artemisinin Initiative to fight drug-resistant malaria, has reduced malaria cases and deaths by over 90% since 2000. Sri Lanka was certified malaria-free in 2015, while Timor-Leste reported no local malaria cases in 2018 and 2019. China and Malaysia are also on their way to being certified malaria-free. Despite the pandemic, six Asia-Pacific countries continued to push policy reforms that contribute to stronger health systems and better preparedness, as revealed in the APLMA Leaders’ Dashboard 2020.

But COVID-19 disruptions to essential malaria services have undermined malaria control efforts worldwide and are expected to set back the Asia-Pacific’s progress towards malaria elimination. The latest data by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows that for April to September 2020, compared to the same six-month period in 2019, malaria diagnoses fell 56% and malaria treatment services plummeted by 59% in Bangladesh, Cambodia, India, Indonesia, Lao, Pakistan and the Philippines, with the deepest disruption reported in rural areas where the more vulnerable and harder-to-reach communities live. In Papua New Guinea, the COVID-19 pandemic has accelerated significantly and is threatening to derail malaria prevention and treatment services.

The situation is grim. But this crisis can also be an opportunity to learn lessons and step up our fight against malaria.

First, the fight against COVID-19 has been a powerful catalyst for better collaboration. In the face of the pandemic, global stakeholders led by strong communities and backed by massive public and private funds have shown us that global solidarity can force the world’s deadliest infectious diseases into retreat. The international community joined together to create the Access to COVID-19 Tools (ACT) Accelerator and the COVAX facility, the fastest, most coordinated, and successful global effort in history to develop tools to fight a disease. At the regional level, leaders of the Quad alliance (Australia, India, Japan and the United States) agreed to pool financing, manufacturing and distribution capacity to distribute US$1 billion worth of COVID-19 vaccines across Asia by the end of 2022. If this level of effort were applied to millennia-old endemic diseases such as malaria, elimination could surely be achieved within a generation. Unfortunately, we have continued to underinvest in the fight against malaria. For instance, the only malaria vaccine we have (RTS,S) has taken 30 years to develop, received less than US$1 billion in funding, and is only 30% effective. Now the good news is the impressive global effort for COVID-19 vaccine research in 2020 could hugely benefit malaria vaccine development.

Second, the pandemic has challenged countries to adapt to the threat by deploying innovative malaria prevention strategies and modifying critical actions to prevent malaria reintroduction. During lockdowns, countries including Cambodia, Lao PDR, Indonesia and Malaysia started house-to-house distribution of long-lasting insecticidal nets (LLINs) to avoid community gathering and maintain social distancing. Thanks to these innovative approaches, the majority of malaria prevention campaigns – such as insecticide-treated nets and preventive medicines for children – went ahead without major delays across Africa, Asia and Latin America in 2020 according to the WHO, reducing the number of malaria infections and easing the strain on health systems.

It is not a choice between saving lives from COVID-19 versus malaria – we need to fight both diseases together. Efforts to combat COVID-19 and sustain malaria control are inextricably linked – COVID-19 shares 7 out of 10 primary symptoms with malaria. Investments in malaria programs in the Asia-Pacific have strengthened supply chains, surveillance systems and health workers; these same systems and capabilities are needed to fight COVID-19 and future pandemics. For example, researchers using genetics to typically track malaria spread in southern and Central Africa are now using their malaria expertise to track COVID-19 variants in the United States; in near-elimination countries like Bhutan and Malaysia, field activities such as case investigation and contact tracing have been harmonised when possible to fight both malaria and COVID-19, in country and at ports of entry.

The COVID-19 crisis has given the international community a sobering insight into the reality of health insecurity that is all too familiar to billions at risk from malaria. Beyond the sizeable economic damage, this pandemic has reminded us that health may not be everything, but nothing else matters without health.

As we are heading to the Global Health Summit in May, now is the moment to increase global leadership and resources needed to protect the gains we have made against malaria over the last two decades, mitigate the long-term impact of the COVID-19 pandemic on malaria, and eventually defeat it. Fighting malaria is one of the best investments we can make. Australia and India have a prime opportunity at the upcoming G7 Summit to advocate for continued support to low- and middle-income countries for malaria elimination and health systems strengthening efforts. Sustained and increasing investment in primary health care, community health workers, and innovative tools to fight malaria has helped to save millions of lives globally, yet 2.5 billion people remain at risk in Asia-Pacific. The rapid progress we have made against COVID-19 in the last year should reinforce our commitment to that goal, particularly as many countries in the region are facing a spike in cases.

Sunday 25 April is World Malaria Day.

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Lady Roslyn Morauta

Lady Roslyn Morauta is Vice-Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sarthak Das

Dr Sarthak Das is the CEO of the Asia Pacific Leaders Malaria Alliance.

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