By Naomi Kitur

New data from the World Health Organization (WHO) reveals that the COVID-19 pandemic has disrupted malaria services, leading to a marked increase in cases and deaths.

According to WHO’s latest World malaria report, there were an estimated 241 million malaria cases and 627 000 malaria deaths worldwide in 2020. This represents about 14 million more cases in 2020 compared to 2019, and 69 000 more deaths.

Approximately two-thirds of these additional deaths (47 000) were linked to inteference in the provision of malaria prevention, diagnosis and treatment during the pandemic.

However, the situation, according to WHO Global Malaria Programme, could have been far worse. In the early days of pandemic, WHO had projected that with severe service interference, malaria deaths in sub-Saharan Africa could double in 2020. But many countries took urgent action to shore up their malaria programmes, averting this worst-case scenario.

Sub-Saharan Africa continues to carry the heaviest malaria burden, accounting for about 95% of all malaria cases and 96% of all deaths in 2020. About 80% of deaths in the region are among children under 5 years of age.

The pandemic struck at a point when global progress against malaria had already stabilized. By around 2017, there were signs that the phenomenal gains made since 200 were stalling, according to WHO Global Malaria Programme.

“Even before the COVID-19 pandemic struck, global gains against malaria had levelled off,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “Thanks to the hard work of public health agencies in malaria-affected countries, the worst projections of COVID’s impact have not come to pass. Now, we need to harness that same energy and commitment to reverse the setbacks caused by the pandemic and step up the pace of progress against this disease.”

Since 2015, 24 countries have registered increases in malaria deaths. In the 11 countries that carry the highest burden of malaria worldwide, cases increased from 150 million in 2015 to 163 million cases in 2020, and malaria deaths increased from 390 000 to 444 600 over that same period.

WHO acknowledged the need to ensure better and more equitable access to all health services including malaria prevention, diagnosis and treatment, by strengthening primary health care and stepping up both domestic and international investments in order to get back on course.

Innovation in new tools is also a critical strategy for accelerating progress.  One important new prevention tool is RTS,S/AS01 (RTS,S), the first vaccine ever to be recommended by WHO against a human parasite. In October 2021, WHO recommended RTS,S for children living in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission.

Despite the challenges imposed by COVID-19, about three-quarters (72%) of insecticide-treated mosquito nets had been distributed in malaria-endemic countries as planned by the end of 2020.  Thirteen countries in Africa’s Sahel sub region reached 11.8 million more children with preventive antimalarial medicines during the high-transmission rainy season in 2020 compared to 2019.

Some countries, particularly with a low burden of malaria and relatively strong health systems, even registered gains against malaria during the pandemic. China and El Salvador were certified by WHO as malaria-free in 2021, and the Islamic Republic of Iran attained 3 consecutive years of zero indigenous cases in 2020.

Despite these achievements, the WHO African Region saw a 12% increase in malaria deaths in 2020 over the previous year, highlighting the consequences of even moderate service disruptions in a population at risk of malaria.

“While African countries rallied to the challenge and averted the worst predictions of fallout from COVID-19, the pandemic’s knock-on effect still translates to thousands of lives lost to malaria,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “African governments and their partners need to intensify their efforts so that we do not lose even more ground to this preventable disease.”