While malaria cases have risen elsewhere in the world, in the Asia-Pacific region, governments have set an example by reducing its spread. However, COVID-19 threatens to undo some of that work, particularly within ASEAN.
Last month, as part of Malaria Week 2020, Vietnam’s National Institute of Malariology, Parasitology and Entomology (NIMPE) hosted a meeting of senior officials from 14 Asian countries. They committed to eliminating malaria in the region by 2030 and called for increased collaboration in the face of the COVID-19 pandemic.
“We have seen undeniable progress in [the] Asia-Pacific over the past decade due to the strengthened commitment from leaders and increased funding,” said Professor Tran Thanh Duong, NIMPE director. “We must commit to staying the course with continued involvement of community and [the] private sector to enhance the fight—especially in these times when malaria is increasing in high-burden countries.”
In 2015, the World Health Organisation (WHO) launched its global technical strategy for malaria for 2016-30, aiming to reduce malaria cases and deaths by 90% and eliminate malaria in 35 countries by 2030. The strategy also aims to prevent the disease from returning in those countries that are declared malaria-free.
Although progress elsewhere in the world has been slow, in the Asia-Pacific, deaths due to the mosquito-borne disease have dropped by 70% and cases have dropped by 22%. Within ASEAN, those figures—according to the Asia Pacific Leaders Malaria Alliance (APLMA)—are 92% and 67% respectively.
Malaria in ASEAN is not high-risk, but still deadly
Although malaria is both preventable and curable, it still killed an estimated 405,000 people in 2018 with 94% of those fatalities in Africa. While ASEAN nations are not among the 11 countries that the WHO defines as “high-burden” (India is the only Asian nation that is), neither are they malaria-free like, for example, the Maldives and Sri Lanka.
“In many countries [in ASEAN] we are close to reaching our goals: zero deaths in Cambodia and zero human cases in Malaysia on the course to elimination,” APLMA and Asia Pacific Malaria Elimination Network (APMEN) secretariats said in a statement to ASEAN Today.
“Despite the huge progress, there are still some challenges—as of 2018, 52 million people continue to remain at risk,” they warned, citing issues such as reaching vulnerable, mobile and migrant populations, eliminating poor-quality anti-malarial drugs and improving supply chains.
The battle to eliminate malaria is continually evolving with different species of disease-carrying mosquitoes and parasites presenting new challenges. In 2008, a new strain of malaria that proved resistant to the anti-malarial drug artemisinin, nicknamed “super malaria”, emerged in Cambodia. It spread through the Greater Mekong region into Laos, Thailand and Vietnam and by 2017, it had developed resistance to another drug, piperaquine.
In response, scientists and researchers focused their resources on areas where the new strain was present and were making headway towards eliminating it. COVID-19 could threaten that progress. “We have enough evidence from the Ebola epidemic to suggest how progress on malaria elimination could be derailed and we are seeing some clear warnings now,” APLMA/APMEN commented.
How has COVID-19 impacted the fight against malaria?
Historically, malaria cases have risen in countries where healthcare is interrupted due to conflict, disaster and war. COVID-19 has hampered the fight against malaria in several ways. It has diverted healthcare resources away from routine vaccinations and treatments. It has also exposed frailties in the region’s healthcare infrastructure and presented officials with new challenges to overcome.
“COVID-19 has highlighted the structural weaknesses and inequalities of our health system. We cannot continue with a ‘business as usual’ approach,” said Indian Member of Parliament Gaurav Gogoi, the founder of Indian Parliamentarians for Malaria Elimination. “It is our collective responsibility to ramp up investments and implement innovative strategies and concerted interventions to tackle malaria among hard-to-reach and vulnerable populations,” he added.
Furthermore, COVID-19 threatens to disrupt the supply lines of anti-malarial drugs, meaning those in hard-to-reach areas cannot gain access. The situation could worsen if health professionals currently engaged in the fight against malaria are reassigned to deal with COVID-19.
Countries have been underreporting cases due to travel restrictions, preventing health workers from gaining an accurate picture of what is happening. This leads to what the APLMA/APMEN team describes as a “double threat” from COVID-19.
What more can health organizations and governments do?
But medical workers are adapting quickly. APLMA/APMEN told ASEAN Today that workers have changed how they are distributing vital equipment such as long-lasting insecticidal nets and are using mobile phones and social media to share information and reports. Nevertheless, a BMC Medicine paper, authored by the University of Melbourne’s Stephen J Rogerson, warned, “Successful malaria programs that are depleted by the COVID-19 epidemic must be rebuilt as quickly as possible to prevent a novel pathogen from giving a new lease of life to an old one.”
The senior officials who met in Vietnam agreed that the most effective way to fight any disease—treatable, preventable or otherwise—and overcome this challenge is to work together. “The COVID-19 pandemic is having a serious impact on the most vulnerable and marginalized communities,” said Amita Chebbi, senior director of APMEN.
“Fighting two life-threatening diseases at once requires innovation, inclusion and collaboration,” she added. “Sustaining our collective efforts towards malaria elimination will not only help to save millions of lives, but also strengthen our health systems to mount an effective response for COVID-19 and confront other health challenges.”
The APLMA/APMEN team cited the work in progress to eliminate the drug-resistant “super malaria” in the Mekong sub-region as one example of collaboration delivering results and saving lives. Meeting the challenge has required cross-border collaboration between Cambodia, Laos, Myanmar, Thailand and Vietnam. They also lauded the work Indonesia has done in partnership with Timor Leste, Malaysia and Papua New Guinea, highlighting how ASEAN is setting an example for others to follow.
In any case, APLMA and APMEN remain optimistic that they will win the fight against malaria. “If there is a silver lining, it is that COVID-19’s impact on global health will, hopefully, lead to an even greater emphasis on building quality public health platforms critical to malaria elimination and countering future threats,” they told ASEAN Today.
Furthermore, they believe that accelerating the fight to wipe out malaria could help the world “free essential and scarce health resources for bending the COVID-19 curve as well as other infectious disease threats.”