Covid-19 threatens to destroy 20 years of progress against malaria

By Isabel Saco

Geneva, May 8 (efe-epa).- The pandemic has interrupted vital work against malaria which could leave 500 million people unprotected as the health industry is focusing on producing Covid-19 tests, Pedro Alonso Fernández of the World Health Organization warns.

Work against malaria, which affects parts of Africa, Latin America and Asia, is one of the many collateral victims of the coronavirus crisis which could see progress against the disease set back by 20 years.

Alonso, director of the WHO’s global malaria programme who has been investigating the virus for more than 35 years, says in an interview with Efe that infectious diseases had been forgotten by western countries which focused on other chronic illnesses and are now paying the consequences.

QUESTION: How has the pandemic altered work against malaria and what could be the consequences?

ANSWER: In Africa, the pandemic is delayed, but we fear that it will develop as in other areas of the world, with a sharp increase in cases, deaths and disruption of health systems. We commissioned a series of studies to estimate the impact of Covid considering interruptions in the distribution of insecticide-impregnated mosquito nets or in access to diagnoses and treatments.The most negative scenario but which we consider highly feasible indicates that in Africa the number of malaria deaths could double to 750,000 or 760,000 this year. It is a pessimistic scenario, very worrying and that would put us back to where we were more than 20 years ago.We are also seeing the effect of border closures and decreased production of certain supplies, so we are monitoring the production of derivatives or combinations with artemisinin (a group of drugs used against malaria) that are our first line of treatment, but the greatest concern is the interruption of rapid tests for the diagnosis of malaria.Some of the world’s largest producers are transferring their capacity to producing Covid-19 diagnostics, which in a matter of weeks could pose a major general shortage problem. In addition, we are receiving signs of an increase in malaria cases that could be related to lockdown measures and restrictions on mosquito net distribution and spraying campaigns, which can have a terrible impact on the fight against malaria and for this reason the WHO has issued directives to continue distributing mosquito nets without danger of spreading the coronavirus. We cannot leave a large part of the population unprotected against malaria, which is the greatest risk we face.

Q: How many people could potentially be affected?

A: Forty per cent of the global population lives in countries where malaria is transmitted. In Africa, we distribute 250 million mosquito nets annually that benefit more than 500 million people, who are the ones that would be left unprotected if the planned distributions are not made.

Q: You mentioned that producers of malaria tests are transferring their capacity to produce Covid-19 tests. What is the scale of this problem and where are those producers?

A: Sixty per cent of all the tests we use come from a United States supplier that intends to move all of its production to Covid. If we do not have access to these tests it would be a huge catastrophe, so we are negotiating with them and explaining that this is not the time to abandon the diagnosis of malaria, that if it is organised six months or a year in advance others could increase their capacity.

Q: The vaccine developed for malaria has limited efficacy. What weight does it have in the global anti-malaria strategy? Could it be a reference for the search that is being made for a vaccine for Covid-19?

A: The pilot implementation of the vaccine started a year ago with 250,000 children, with a plan to vaccinate 350,000 per year for five years in three countries: Kenya, Ghana and Malawi. During that time we will collect data and hope that in a year and a half the WHO can consider recommending it on a large scale.We are used to vaccines with an 80 or 90 per cent efficacy and here we’re talking about 40 per cent, but the fight against malaria is the combination of different imperfect interventions.Nets are not the perfect solution, nor is spraying households with insecticides but advances have been made when we have been able to combine things that are not fantastic on their own, but which together have saved seven million lives in 10 years.Of course we would like to have a vaccine with an effectiveness of 80 per cent or more, imagine an imperfect vaccine for Covid-19 but that reduced infections by 40 per cent, no one would hesitate in using it and financing what was needed.

Q: How is the pandemic affecting access to chloroquine and hydroxychloroquine, medications used for malaria which have been used on Covid patients?

A: As a result of its use and above all the favourable comments by the president of the United States, everyone started to buy chloroquine and many doctors have used it despite the fact that we still do not have enough evidence about its effectiveness in prevention or treatment against Covid. This has caused enormous tensions in the international market and has limited access to this product. In the case of malaria between 13 and 14 million treatments are used per year and at the moment we are not very concerned but if there were a lack of stock we would have alternatives based on artemisinin.

Q: What could be the global consequences of a significant setback in the fight against malaria?

A: I hope that we come out of this crisis with at least some learning. The western world put infectious diseases aside because it believed that they were something from the 19th century, an outdated topic. But if there is only one thing in the health field capable of posing an existential risk to humanity it is an infectious disease. In three months a virus has left five billion people at home and has caused a worldwide health and economic disaster. The second lesson is that you have to come out of this with more equality and not with more inequality, with ways of thinking that cross borders and make us understand that what happens in another part of the world should interest us.The risk of malaria re-entering Europe or the United States is minimal. But this should not guide our action but rather the fact that 40 per cent of the global population lives in countries where malaria is transmitted, that Africa is a very close continent with great demographic growth and that malaria is a barrier to its economic and social development.We forget that 35 years ago a virus that was somewhere in central Africa passed to humans, went down the road to Kinshasa (Congo), jumped to the Caribbean and from there to the west coast of the United States and has stayed with us: it is HIV which has killed 60 or 70 million people. So it is striking that we should be permanently reminded that what is happening in a remote part of Africa may have implications for everyone and for the following generations.

Q: Outside of Africa, Latin America is one of the regions where malaria persists. What is its evolution there?

A: We are following the situation there and we see worrying situations, with focuses on the Pacific coast of Colombia and in Venezuela. In its relationship with Covid, Brazil is the place of greatest concern. Peru and Ecuador are two other countries where Covid is affecting areas with malaria and therefore it is a situation in a phase of growth. In Venezuela there is a general problem with malaria, the situation is worrying with or without Covid. EFE-EPA


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