As we mark World Malaria Day 2023, we are reminded once more that the fight against malaria must remain a Public Health priority. Indeed, in recent years we have observed stagnation in progress around malaria elimination, worsened by the COVID-19 pandemic. And the burden is high: malaria killed more than 600,000 people worldwide in 2020. During the two peak years of the pandemic (2020 and 2021 – see Figure 1), about 63,000 of the additional malaria deaths could be attributed to disruptions in the provision of malaria prevention, diagnosis and treatment. This situation highlights the crucial importance of health system strengthening and resilience to address such global health security threats and reduce excess mortality.
Figure 1: Global trends in a) malaria case incidence (cases per 1,000 population and b) mortality rate (deaths per 100,000 population at risk), 2000-2021. Source: WHO estimates
International SOS has been committed to the fight against malaria for more than 20 years in endemic regions, from conducting health risk assessments to implementing vector control programmes and supporting community outreach. Under the theme "Time to deliver zero malaria: invest, innovate, implement", International SOS reiterates its commitment to raising awareness around malaria, protecting lives through the administration of life-saving vaccines, providing technical assistance to Governments and showcasing the role the private sector can play a role in achieving SDGs.
Rise of malaria cases during the COVID-19 pandemic
Malaria remains one of the world's major infectious diseases. The last World Malaria Report published by the WHO gives us warning information on the recent trend of malaria. There were an estimated 14 million more malaria cases in 2020 compared to 2019 (241 million vs 227 million – see Figure 2) and most of this increase was reported in Africa. An estimated 69,000 more people died from malaria in 2020 compared to 2019 (627,000 vs. 558,000 – see Figure 2). Children under five accounted for about 80% of all deaths in Africa in 2020.
Figure 2: Evolution of cases and deaths of Malaria between 2019 and 2020, world. Source: World Malaria Report 2021, WHO
Malaria updates between 2021 and 2022:
- Cases continued to rise between 2020 and 2021, although at a slower rate. There were 247 million cases in 2021 compared to 245 million in 2020 and 232 million in 2019
- More than 600,000 people lost their lives to malaria in 2021, a slight decrease from the number in 2020, but still above the pre-pandemic levels
- The impacts of COVID-19 continued to be felt, as 63,000 additional malaria deaths and 13 million malaria cases were attributed to COVID-related disruptions
- On a positive note, an estimated 185 million malaria cases were prevented and almost a million lives were saved in 2021
- 35 malaria endemic countries recorded fewer than 1,000 malaria cases, and five of the highest burden countries recorded a decline in deaths
Figure 3: Countries with indigenous cases in 2000 and their status by 2021. Countries with zero indigenous cases for at least three consecutive years are considered to have eliminated malaria. In 2021, the Islamic Republic of Iran and Malaysia reported zero indigenous cases for the fourth consecutive year; also, Belize and Cabo Verde reported zero indigenous cases for the third time. China and El Salvador were certified malaria free in 2021, following four years of zero malaria cases. Source: World Malaria Report 2021, the WHO
Malaria in pregnancy
Malaria infection during pregnancy has substantial risks for the pregnant woman, the foetus and the newborn child. For the pregnant woman, malaria infection can lead to severe disease and death. There has been an increase in exposure to malaria in pregnancy in Africa where West Africa had the highest prevalence of exposure with almost 6.5 million (40.7%) of an estimated 16 million pregnant women with malaria infections in 2022.
Given this increased exposure, without a pregnancy-specific intervention it is estimated that exposure to malaria infection would have resulted in much higher prevalence of low birth weight which is a strong risk factor for neonatal and childhood mortality. Averting a substantial number of low birthweights will have a considerable impact on all-cause mortality in children, and therefore, malaria prevention in pregnant women should remain a crucial element in public health programmes.
Malaria is a preventable and treatable disease, despite the global burden of disease
Malaria is an acute febrile illness caused by Plasmodium parasites, spread by the bites of female infected mosquito. The disease is easily preventable (vaccines, chemoprophylaxis and protection against mosquito bites) and curable if assessed and treated quickly. Without prevention, people with no immunity are at high risk of contracting malaria in endemic regions and developing severe illness.
International SOS has been promoting the ABCDE of malaria prevention (Figure 4) to promote healthy practices that reduce transmission of malaria (Awareness, Bite prevention) and prevent severe illness (Chemoprophylaxis, Diagnosis and Emergency). International SOS organises malaria e-learning to travelling employees and helps in the implementation of vector control programmes locally to reduce mosquito populations. Reminding people about basic prevention and providing the necessary tools can make a difference. International SOS also deals with improving case management by distributing emergency standby treatment kits and providing help through Assistance Centers staffed by health professionals trained in malaria response protocols.
Figure 4: ABCDE of Malaria Prevention. Source: International SOS
2021 was a remarkable year in malaria prevention as the first vaccine was commercialised for children living in endemic countries (RTS,S vaccine). We remain hopeful that the numbers of cases and deaths will improve in the coming years as countries recover from the acute phase of COVID-19 pandemic and start to roll out the new vaccine in areas with middle and high prevalence. At International SOS we are ready to play our role in supporting Ministries of Health in their vaccine introduction efforts, leveraging our extensive expertise and networks to deliver technical assistance and advice.
Malaria is an issue of global health security and therefore needs to be tackled through collaborative multi-sectoral public health programmes
As an organisation that operates in many locations where malaria is endemic, we believe that prevention can make the difference for future generations. For the past 30 years, International SOS has partnered with companies and public authorities in Africa to help protect communities, workers, and travellers against this infectious disease. Through our expertise, we have successfully implemented malaria vector control programmes and awareness campaigns that help protect communities across the continent.
For example, in the DRC, International SOS led an integrated malaria control programme which involved developing education materials for local children to encourage early awareness of the risks. The programme achieved a 74% reduction in malaria rates in the targeted population of over 12 years, despite a huge amount of migration in and out of the Fungurume Health Zone. Moreover, the surveillance data put in place by International SOS are the best data available on malaria in some areas. These data are useful for companies, but also for other stakeholders as surveillance indicators for making decisions in malaria control programmes.
In conclusion, COVID should not overshadow other deadly infectious diseases such as malaria any longer. The commitment of companies to the fight, through the development of sustainable programmes and the search for innovation, is a valuable lever in the fight against malaria and offers hope for a reduction in its burden in the years to come.