The fight against malaria and why we must learn from COVID-19
On April 25, we celebrated World Malaria Day. It reminded people around the world that despite COVID-19, diseases such as malaria are far from over. This deadly yet preventable vector-borne disease remains endemic in more than 80 countries and territories worldwide, including Nigeria. In 2019, malaria claimed over 400,000 lives.
During this period of greater awareness, we are reminded to commemorate the victims and the survivors and give credit to a global community dedicated to the elimination of malaria. Health workers, researchers, national malaria control programmes, international organisations and private companies, all make up the community engaged and committed to the fight against the disease. We are also offered a moment to reflect on what it will take to make Nigeria – and the world – malaria-free.
Lessons learned from COVID-19
We are still in the midst of multiple global health challenges. COVID-19 has extracted a heavy toll on health systems, particularly in Africa. This has undoubtedly impeded the fight against malaria. Nevertheless, the pandemic has provided new insights about how best to defeat malaria.
Although 2020 data is not yet available, the Global Fund has recently released a survey of the impact of COVID-19 on malaria programmes. Africa has seen a steep decrease in malaria diagnosis and malaria treatment, with stockouts of antimalarial medicine for children under-five years of age. A sharp reduction in malaria diagnosis might ultimately lead to an increase in mortality in 2021.
On the other hand, the COVID-19 pandemic has taught us that it is possible to innovate and rapidly deploy the most effective tools to combat killer diseases. At the beginning of the pandemic, after a few weeks of uncertainty, national malaria programmes started gathering political and financial support, while continuing on the ground activities, in creative ways, to minimise social interactions. Switching to door-to-door distribution of bednets, instead of crowded events, has been one of the effective approaches to keep COVID-19 infections at bay. Nigeria should be acknowledged for their outstanding efforts in ensuring that delays to distribution campaigns were minimised.
Meanwhile, access to real-time data on COVID-19 helped shape the most effective strategies. Within a year, coordinated international efforts brought the most effective vaccines to market. This unprecedented achievement proves that when all the right stakeholders join all efforts, success follows. This should inspire us to step up the fight against malaria.
Quality control is key
Bednets are a simple, affordable and the most cost-effective tool in the fight against malaria – and they are instrumental to the success of the WHO’s 2030 malaria targets. Quality control is essential to ensure that the global community is still on track to achieve those goals. Recent gaps in quality inspection systems highlight the importance of more comprehensive testing and sampling of finished nets at the pre-shipment level. Robust standards are also essential to ensure that quality-assured products reach the population and continue to perform over the lifetime of the net.
Increased need for digital solutions and real-time data
According to the 2019 World Malaria Report, Nigeria had the highest number of global malaria cases in 2018 (25 per cent). Malaria is transmitted all over Nigeria; with significant regional, rural-urban, and socioeconomic differences. To successfully reduce the malaria burden locally and globally, surveillance of the mosquito vector must be increased and strengthened. In a private-public partnership, Vestergaard, a major manufacturer of long-lasting insecticidal nets (LLINs), and the Nigerian Institute of Medical Research (NIMR) are taking significant steps. Their teams conducted entomological studies in six states. With insecticide resistance as an emerging challenge, more effort needs to be placed on expanding the number of sentinel sites in all 36 states.
In addition, the need for locally generated data is greater now than ever before. Vector surveillance must be coupled with digital solutions to generate near real-time data. Such data are a vital tool to assess threats and aid informed decision-making. Nigeria is now better positioned to select the most effective tools based on locally generated data, where we hope to see the positive results in the coming months and years.
Systematic surveillance of PBO nets
In the case of pyrethroid-PBO nets, systematic post-market surveillance programmess in the field are of particular importance. Manufacturers have taken different approaches to incorporate PBO synergists into net materials, leading to variability in initial PBO concentration in the different nets. The ability to release and retain PBO in the product, despite the various factors of loss throughout the lifetime of the net, is key in ensuring effective protection.
There are currently no long-term field studies confirming the insecticidal activity of low-content PBO nets that were recently introduced to the market. Post-market surveillance activities can play a critical role in closing the evidence gap and for informing procurement and deployment decisions.
Mutation versus innovation: A matter of speed and joint effort
Bednets will remain a central element of malaria control programmes for as long as there is malaria transmission through vectors. Unfortunately, basic biology tells us and practice confirms, that mosquitoes will mutate to become insecticide-resistant. We need to innovate faster than the mosquitoes mutate. New chemistry takes years of research, evaluation tools need to be tailored to conditions in different geographic regions, and new products must be widely integrated into current campaigns.
To keep up with the rapidly mutating mosquitoes, we need to bring tools to market faster than ever. There is only one way that we can master this tremendous challenge – through key institutions, malaria-endemic countries and the private sector working hand in hand. Until malaria is eliminated from the globe, we must continue to enable collaborative work and focus on our innovation. This is our commitment and pledge to Africa: to raise the quality of life and provide a better future for the affected communities.
•Michael Joos is the Chief Executive Office of Vestergaard