Protecting gains against malaria—in a pandemic

We know that outbreaks can have devastating effects on delivery of routine health services. For example, during the 2014-2016 Ebola outbreak, researchers estimate that service disruptions resulted in as many as 10,000 additional preventable deaths due to malaria, HIV/AIDS, and tuberculosis. Each year, malaria control and elimination efforts save nearly 600,000 lives and prevent close to 100 million new cases. As countries respond to COVID-19, we must safeguard these incredible gains. The global community is working hard to quickly adapt the delivery of essential health services to minimize transmission of COVID-19. Preventing, testing, and treating malaria requires person-to-person interaction, posing a challenge in the current environment. We are working with countries across Africa and Asia to support the COVID-19 response, while mitigating the impact on malaria morbidity and mortality.

PATH is playing a crucial role, from providing our technical expertise in global fora to navigating national, subnational and community-level implementation alongside national malaria control programs and other implementing partners in countries. PATH worked with the World Health Organization and partners to develop guidelines for delivering core malaria interventions while following the necessary precautions for responding to COVID-19. At the country level, we are supporting data-informed decision-making regarding intervention implementation, continuing to ensure health workers are equipped with the information and resources they need to do their jobs safely and effectively, and leveraging our lab capacity and surveillance systems.

In partnership with WHO, the Bill & Melinda Gates Foundation, Global Fund, PMI, and other organizations, PATH is analyzing data and modelling different scenarios to predict how the COVID-19 pandemic will impact malaria transmission in countries with the highest malaria burden. This work is crucial to understand how the two diseases will interact at the population level and equip decision-makers within Ministries of Health to prioritize interventions.

To reduce the pressure that COVID-19 is placing on health systems, it’s critical that we continue to deliver malaria interventions at the community level. These services include vector control measures such as distributing insecticide-treated nets and indoor residual spraying; and providing preventative treatments for pregnant women, and young children. This also includes the provision of the first malaria vaccine, RTS,S, in target high burden districts across Ghana, Kenya, and Malawi through routine immunization services, alongside other childhood vaccines.

PATH is also working directly with leaders in Senegal and the Democratic Republic of the Congo to integrate data visualization dashboards used by national Emergency Operations Centers (EOCs) and National Malaria Control Programs. The goal is to track trends in malaria (and other important public health priorities) in near real-time that might be affected by the COVID-19 epidemic and response, building on systems already in place, while in the longer term focusing on designing and strengthening a sustainable interoperable data architecture that can track and respond to routine diseases and epidemics.

In the near term, to maintain malaria gains, it will be critical to proactively monitor commodities and their flow to ensure prevention and control activities are not paralyzed. There will also be a need to ensure that planned intervention campaigns take place, while adhering to WHO guidance on minimizing contact that could enable COVID-19 transmission. Building on previous malaria experience and success, it will be exceptionally useful in this response to explore ways in which EOCs can be used to provide platforms for data integration and visualization systems for COVID-19 and malaria. EOCs also may play a key role in serving as a coordination, planning, and monitoring platform for malaria campaigns such as seasonal malaria chemoprevention, insecticide-treated bed net distributions, and indoor residual spraying; additionally, these campaigns could provide an opportunity to deliver important information and education to community members on COVID-19 health messages.

Since 2005, PATH has supported the training and deployment of over 10,000 community health workers (CHWs) globally to combat malaria and bring other essential health services closer to home. Now we are arming them with both the personal protective equipment they need, and clear safety guidance so they may continue their work.

We are supporting WHO and countries in producing and disseminating updated guidelines and standard operating procedures for case management that reduces risk of COVID-19 transmission, but also allows for service delivery.

For example, in Zambia, we are working with the National Malaria Control Program and the National Public Health Institute to provide CHWs and health facility supervisors tailored messages on COVID-19 sensitization, personal protection during patient interactions, and the importance of continuing community case management and surveillance.

Our work in strengthening systems for malaria prevention and control includes diagnostics (labs, sample collections, and rapid point-of-care tests) as well as surveillance systems that exist at the individual- and community-reporting level, all the way to the district, provincial, and national levels. When both are integrated, governments can share and analyze reliable data from clinical settings, laboratories where testing occurs, and emergency operations centers which are equipped to respond to these data rapidly.

PATH actively collaborates with a network of private and public sector organizations and country governments to evaluate the potential of more than 200 diagnostic tools to detect COVID-19 infections, as well as co-infections with malaria.

We are working with WHO and the RBM Partnership to End Malaria to ensure changes that occur in health systems and data flows are tracked and assessed. This is necessary to ensure that routine data can be understood and interpreted for decision-making, even as changes are made in response to COVID-19. We are also working with WHO to determine how currently scheduled ante-natal malaria surveillance, and community cross-sectional studies, can provide a platform to understand malaria and COVID-19 interactions.

Using rapid assessments, modeling and by leveraging integrated surveillance dashboards, PATH is also working with national programs and partners to gain an understanding of the overall disruptions to the malaria program and the downstream consequences of COVID-19. These same tools and approaches can also act as an early warning system to detect emergent COVID-19 hotspots. For instance, we are leveraging genomic sequencing technology to detect malaria parasite resistance to antimalarial drugs, and we are now taking a similar approach for sequencing COVID-19 to monitor changes in the virus that may affect virulence or transmissibility.

The pandemic has triggered delays in drug manufacturing and supply chains for key malaria commodities. In response, PATH is collaborating with countries and across WHO working groups and other regional groups to monitor supply chains and ensure that health systems in Asia and Latin America are adequately stocked to deliver malaria prevention and treatment services.

COVID-19 challenges the gains the world has made against malaria. But, as the pandemic spreads, PATH will continue to support and strengthen both the malaria programs and health systems that protect millions of lives around the globe.

PATH is leveraging our malaria expertise and in-country platforms to support national partners in their response to COVID-19, while trying to mitigate the impact on malaria efforts. We are providing operations and logistics support, as well as facilitating cross-country learning opportunities so that the malaria community may quickly adapt to programming in this new context. Please contact us at malaria@path.org with questions or requests for support.