Abstract
SummaryBackgroundSubstantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control.MethodsUsing an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents.FindingsWe estimated 215·2 (95% uncertainty interval 143·7–311·6) million cases and 386·4 (307·8–497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7–326·8) million cases and 487·9 (385·3–634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7–342·5) million cases and 597·4 (468·0–784·4) thousand deaths with a 50% reduction; and 242·3 (158·7–358·8) million cases and 715·2 (556·4–947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%–75% also increased malaria burden to a total of 230·5 (151·6–343·3) million cases and 411·7 (322·8–545·5) thousand deaths with a 25% reduction; 232·8 (152·3–345·9) million cases and 415·5 (324·3–549·4) thousand deaths with a 50% reduction; and 234·0 (152·9–348·4) million cases and 417·6 (325·5–553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5–358·2) million cases and 520·9 (404·1–691·9) thousand deaths with a 25% reduction; 251·0 (162·2–377·0) million cases and 640·2 (492·0–856·7) thousand deaths with a 50% reduction; and 261·6 (167·7–396·8) million cases and 768·6 (586·1–1038·7) thousand deaths with a 75% reduction.InterpretationUnder pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19.FundingBill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.
Highlights
The ongoing COVID-19 pandemic is the most sustained, disruptive, and lethal infectious disease outbreak since the influenza pandemic of 1918
The effects of and the proposed response to the COVID-19 pandemic pose an immediate threat to distribution of insecticide-treated nets (ITNs) and access to effective treatment with antimalarial drugs, the two most important components of malaria control in Africa
Convert prevalence to modelled incidence granular information with which to compare the relative threats posed by the spatially varying deterioration of malaria interventions. In this Article, we focus on the two primary tools for reducing malaria transmission and disease burden in Africa: ITNs and effective treatment with antimalarial drugs
Summary
The ongoing COVID-19 pandemic is the most sustained, disruptive, and lethal infectious disease outbreak since the influenza pandemic of 1918. Countries in Africa are mounting a concerted public health response to limit the potential extent of COVID-19 morbidity and mortality on the continent,[1,2] drawing on decades of experience in large-scale public health activities to mitigate the burden of endemic and epidemic infectious diseases. Compared with the responses to COVID-19 in high-income nations, the measures taken in Africa come amid the backdrop of more acute healthsystem resource limitations[3] and persistently higher morbidity and mortality from other infectious diseases.[4,5]. Of the 97 articles returned, three were commentary or policy pieces that highlighted the possible indirect effect of the COVID-19 pandemic on malaria control and burden but did not include quantitative analyses. Plausible effects of the COVID-19 pandemic on malaria interventions and the resulting implications for malaria burden have not previously been assessed through quantitative analyses
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