Malaria vector control in sub-Saharan Africa in the time of COVID-19: no room for complacency.

Abstract

### Summary box The COVID-19 pandemic can potentially bring public health interventions in low-income countries to a collapse. In sub-Saharan Africa (SSA), the saturation of health systems can expose pre-existing fragilities and exacerbate the myriad health problems afflicting human populations. In particular, SSA bears the brunt of malaria,1 which caused around 200 million cases and 400 000 deaths in 2018, mostly in young children.2 The challenges for health systems of coping with COVID-19 and malaria at the same time are onerous due to complex interactions between both diseases. Malaria and COVID-19 can be symptomatically similar, complicating differential diagnosis. Therefore, malaria infections may go undiagnosed in people presenting fever and testing positive for COVID-19, potentially causing malaria cases to go untreated. In another scenario, symptomatic, malaria-infected individuals could be deterred from seeking healthcare due to fear of COVID-19 infection or could be denied treatment if health centres and hospitals were overwhelmed. Perhaps most importantly, the increasing demand for resources to curb COVID-19 and the curtailment of economic activities driven by the pandemic could lead to substantial reductions in government revenues,3 undermining their ability to finance essential social services, including life-saving malaria vector control interventions. Here, we focus our discussion on vector control for preventing malaria in SSA in the context of the current pandemic, …