It seems unavoidable that the COVID-19 pandemic will continue to pose severe challenges to programs that supply essential interventions in the fight against malaria. The intensity of changes to interventions and the resulting outcomes is still unpredictable. However, researchers have set out to better understand the potential changes in malaria morbidity and mortality to inform healthcare systems of potential consequences and at the same time advocate for greater attention to malaria eradication efforts.
In late September 2020, the Lancet published an article outlining the indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa. Using geospatial estimates the authors established baseline assessments for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis with possible scenarios in which effective treatment with an antimalarial drug and distribution of insecticide-treated bed nets (ITNs) were reduced to varying extents. Study researchers then appraised resultant changes in malaria incidence and mortality. In a baseline scenario of undisrupted intervention coverage they estimated roughly 215 million malaria cases and 386 thousand deaths in malaria-endemic African countries in 2020. The worst-case scenario, in which mass ITN distributions are cancelled with decreases in effective treatment of cases with an antimalarial, the incidence of malaria would increase by 21·5%, giving way to 46.4 million additional cases. Mortality would double with an estimated 768.6 thousand deaths. The large increase in deaths is a result of the crucial role of antimalarial drugs in preventing progression to death in malaria-infected individuals. However, the true impact of malaria incidence will not be fully realized until future years and is dependent on countries’ epidemiological context and baseline intervention status.
Nevertheless, there is hope that internal health policy is nimble enough to mobilized needed resources to fill gaps to optimize the control and treatment of malaria. Aligning COVID-19 interventions with existing malaria strategies could help relieve pressure on health systems. Integration of malaria control efforts with the COVID-19 response in African countries is vital to prevent reversing important public health progress of past decades.