“Today if you have malarial symptoms you are in big trouble because they are quite similar to COVID-19 symptoms. Will you go to the hospital when it is said we should not go there?”, says Yap Boum II, the regional representative for Epicenter Africa, the research arm of Doctors Without Borders. “Hospitals are struggling because they do not have the good facilities and equipment; it will be hard to take in a patient with malaria because people are scared. As a result the management of malaria is affected by COVID-19,” Boum, who is also a Professor of Microbiology at Mbarara University of Sciences and Technology in Uganda, said, pointing out that HIV/AIDS and tuberculosis are also being ignored.

In fact, the World Health Organisation (WHO) has warned that four times as many people could die from malaria than from coronavirus. “With COVID-19 spreading, we are worried about its impacts on health systems in Africa and that this may impact negatively on the delivery of routine services, which include malarial control. The bans on movement will affect the health workers getting to health facilities and their safety from exposure,” states Akpaka Kalu, team leader of the Tropical and Vector-borne Disease Programme at the WHO Regional Office for Africa.

The WHO has urged member countries not to forget malaria prevention programmes as they race to contain the COVID-19 spread. Without maintaining prevention programmes, the question remains should all insecticide-treated net campaigns be suspended and if access to effective antimalarial medicines is reduced because of lockdowns, malaria deaths could double to 769,000 in sub-Saharan Africa this year.  

At the same time, the agency has predicted that some 190,000 people could die of COVID-19.

According to the WHO, as of May 11, Africa has recorded over 63,000 confirmed COVID-19 cases with 2,283 deaths in 53 affected countries in the region.

Though preventable and treatable, Africa is battling to eliminate malaria despite a decline in cases over the last four years. The continent has the highest malaria burden in the world, accounting for 93 percent of all cases of the disease. Malaria is one of the top ten leading causes of death in Africa, killing more than 400,000 people annually.

Poorly equipped and understaffed national health services in many countries in Africa could compromise efforts to eliminate the scourge of malaria, notes Kalu.

Africa must cope with COVID-19 without forgetting malaria

Mamadou Coulibaly, head of the Malaria Research and Training Center at the University of Bamako, Mali, concurs that the pandemic is straining health systems in developing countries. He urges malaria-endemic countries not to disrupt prevention and treatment programmes.

“To avoid this catastrophic scenario, countries must tailor their interventions to this challenging time, guaranteeing prompt diagnostic testing, treatment, access and use of insecticide-treated nets,” says Coulibaly, who is also the principal investigator of Target Malaria in Mali. Mali is one of the top 10 African countries with a high incidence of malaria.

Malaria needs more national money

Kalu stresses that domestic financing for malaria is needed. He commended the Global Fund to Fight AIDS, Tuberculosis and Malaria and other private sector partnerships that provided funds for malaria. However, he points out that this is neither ideal nor sustainable unless national governments contribute a lion’s share to malaria control.

• There is a $2 billion annual funding gap when it comes to malaria prevention, which should be closed to sufficiently protect people in malaria affected countries, according to the RBM Partnership to End Malaria, a global private sector initiative established in 1998. The partnership has sourced funding and equipment for malaria prone countries, providing mosquito nets, rapid diagnostic and antimalarial tests.

More action, less talk

While pleased with progress made towards eliminating malaria in Africa since 2008 when the Abuja Declaration on Health investment was signed, Kalu says Africa could do better.

• In 2001, African governments drew up the Abuja Declaration to invest 15 percent of their national budgets in improving health care services.

• Nearly 20 years later, a handful of countries such as Swaziland, Lesotho, Ethiopia, Liberia and Burundi have invested in building their health systems, according to 2016 WHO assessment report on public health financing for health in Africa. Many African countries have reduced their spending on health as a percentage of total public expenditure than they did in the early 2000s.

• For every $100 that goes into an African nation’s state coffers, on average $16 is allocated to health. Of this amount, only $10 is spent, with less than $4 going to the right health services.

“For the first time in our lifetime, human beings and the world are realising that the most important thing we have is our health,” says Boum, questioning why African governments have not all prioritised health spending despite the Abuja Declaration.

“With our borders closed we are all being taken care of in the poor health system that we have built,” according to Boum. “There is no more flying to India, London or the United States. We are all in the same boat because we have not invested what we were supposed to invest and I hope beyond the pandemic, we will make health care a just cause and even manage to go beyond the 15 percent health investment agreed upon.”

With the current level of investment in health systems, the WHO fears Africa will not achieve the United Nations Sustainable Development Goals (SDGs), particularly SDG3 on ensuring healthy lives and wellbeing for all and ending malaria by 2030.

“We do not want a situation where we are protecting people from COVID-19 and they die of malaria and other diseases,” states Kalu. “We are not asking governments to put money in malaria alone but in national health systems. COVID-19 is showing that Africa needs facilities and equipment which it does not currently have to effectively deal with the pandemic.”

See the original text, Africa’s Health Dilemma: Protecting People from COVID-19 While Four Times as Many Could Die of Malaria