Disruptions due to the COVID-19 pandemic resulted in considerable increases in malaria cases and deaths between 2019 and 2020, according to the annual World Malaria Report released this evening by the World Health Organization (WHO).
Using a new methodology that analyses the causes of death for children under the age of five across all diseases*, the World Malaria Report 2021, published today by the World Health Organization (WHO)* increased estimates of malaria’s global impact from 2000-2020.
The estimates confirm that, since 2000, global efforts reduced malaria death rates by half and saved 10.6 million lives. However, 627,000 people still died from this preventable and treatable disease in 2020, with the African continent accounting for 96% of global malaria deaths. The report also verified the pandemic’s impact for the first time, confirming that collaborative efforts by countries and partners averted a worst-case scenario of a potential doubling of malaria deaths last year.
However, the doomsday scenario projected by the WHO has not materialised. Early in the pandemic, WHO had projected a doubling of malaria deaths in sub-Saharan Africa, as a worst-case scenario. Yet, the analysis found there was an estimated 12 per cent increase in deaths in the region between 2019 and 2020.
The report revealed that globally, 1.7 billion cases and 10.6 million deaths were averted between 2000 and 2020. Most of the malaria cases (82 per cent) and deaths (95 per cent) averted over the last 20 years were in the WHO African Region. The report noted that the WHO African Region carried about 95 per cent of global malaria cases in 2020, and 96 per cent of global malaria deaths in 2020.
A new, country-driven approach to malaria control in high-burden countries was beginning to gain momentum when COVID-19 struck, and according to the analysis in 2020, global malaria case incidence was off track by 40 per cent and the global mortality rate for 2020 was off track by 42 per cent.
Dr Pedro Alonso, the Director of the WHO Global Malaria Programme said that thanks to urgent and strenuous efforts, the world has succeeded in averting the worst-case scenario of malaria deaths. However, he added that even before the emergence of COVID-19, global gains against malaria were levelling off.” “We are not on a trajectory to success, we are increasingly moving away from reaching the 2020 milestones of WHO’s global malaria strategy,” Dr Alonso said.
The report found that just 58 per cent of countries completed their planned campaigns to distribute insecticide-treated mosquito nets in 2020, with most experiencing important delays. Globally, 72 per cent of all insecticide-treated mosquito nets planned for distribution had been distributed by the end of 2020.
In 2020, of the 65 countries who responded, 37 countries reported partial disruptions (5 per cent to 50 per cent) to malaria diagnosis and treatment services, and by 2021 15 countries reported partial disruptions (5 per cent- 50per cent) and six countries reported severe disruptions.
This year’s World malaria report used a new methodology to estimate malaria deaths worldwide. This resulted in a larger share (7.8 per cent) of deaths among under-five children than previously recognized (4.8 per cent).
“This year’s World Malaria Report shines new light on the heavy toll malaria continues to have on the world’s poorest and most vulnerable people, particularly children in Africa. Furthermore, this unacceptable reality is contributing to overburdening health systems and impeding economic growth. As the pandemic persists, it’s clear that malaria investments must be at the heart of strengthening health systems and the COVID-19 response,” said Dr Abdourahmane Diallo, CEO of the RBM Partnership to End Malaria.
“The recent malaria vaccine funding decision by Gavi is the first major investment in a new tool that can help save more lives from malaria, at a time when COVID-19 and other humanitarian crises are making the fight against this deadly disease even more challenging,” he said.
On a global scale, progress against malaria remains uneven. The report found that many countries with a low burden of the disease are moving steadily towards the goal of malaria elimination. Two countries – El Salvador and China – were certified malaria-free by WHO in 2021. However, most countries with a high burden of the disease have suffered setbacks and are losing ground.
Global progress against malaria over the past two decades was achieved, in large part, through the massive scale-up and use of WHO-recommended malaria tools that prevent, detect and treat the disease. However, the most recent data also demonstrate that significant and sometimes widening gaps in access to life-saving tools for people at risk of malaria.
“We are now at a critical juncture, and I urge global leaders for renewed commitment and investment. With increased funding, access to life-saving tools, and robust innovation in new tools to stay ahead of the evolving mosquito and parasite, we can accelerate transformative action and end malaria within a generation. The time to act is now,” said Dr Diallo.
The report warns that the situation remains precarious, especially in sub-Saharan Africa. A convergence of threats in the region poses an added challenge to disease control efforts. These include Ebola outbreaks in DRC and Guinea, armed conflicts and flooding. At the same time, the document reiterates that the pandemic is not over, and the pace of economic recovery is uncertain. Without immediate and accelerated action, key 2030 targets of the WHO Global technical strategy for malaria will be missed, and additional ground may be lost.
The strategy’s goals include a 90 per cent reduction in global malaria incidence and mortality rates by 2030. The report reiterated that this will require new approaches and intensified efforts aided by new tools and better implementation of existing ones. This includes a stronger emphasis on equitable and resilient health systems and data-driven strategies.
The report also recommended the expanded use of the RTS,S malaria vaccine recommended by WHO in October. “the vaccine is feasible to deliver, is safe, has a public health impact and is cost-effective,” Dr Alonso said. “As we speak GAVI is discussing opening up a window for investment in this malaria vaccine,” he added.
The analysis also emphasized that stepped-up investment is also essential. “Funding has flatlined” Dr Alonso warned “We are about 50 per cent off what we believed the target should be for 2020”.
The report found that a total of USD 3.3 billion was invested globally in malaria control and elimination in 2020. This was against a target of USD 6.8 billion to reach global malaria targets. Annual investments will need to more than triple by 2030 – to USD 10.3 billion per year, the report noted.
Long-term investments in fighting malaria enabled countries to be more resilient in their COVID-19 responses, while heroic efforts by countries, partners and community health workers using innovative strategies, strong political will and mobilizing new funding were all crucial to avoiding the worst-case scenario.
Despite the challenges, countries and partners ensured that 72% of life-saving insecticide-treated net distribution programmes went ahead in 2020. Over 33 million children were also reached with seasonal malaria chemoprevention, more than ever before. However, the findings suggest that COVID-related disruptions contributed to an increase of 69,000 more malaria deaths and 14 million more malaria cases in 2020 compared to 2019.
The RBM Partnership to End Malaria calls on all countries to significantly step up malaria investments to enhance malaria programmes and the use of real-time data and surveillance tools, while accelerating the development and delivery of transformative tools.
This critical investment will help strengthen countries’ pandemic preparedness, protect gains made against malaria and reach global targets for elimination – and ultimately, eradication.