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A few years ago, it looked like the world was on track to stamp out malaria for good. Malaria cases and deaths fell fast in the first 15 years of the millennium. But then progress stalled. In 2017, there were an estimated 219 million cases of malaria in 87 countries. 435,000 people died, most of them children under the age of 5. African countries accounted for nine out of ten cases and deaths.

 

Malaria is preventable, treatable and can be eliminated. Sustainable Development Goal Three (SDG 3) aims to end malaria for good by 2030. Research on malaria is essential to meet this goal. The London School of Hygiene & Tropical Medicine (LSHTM) houses The Malaria Centre, one of Europe’s largest research groups on malaria. The Malaria Centre has a major international profile with members working across 40 countries. On this World Malaria Day, Saturday 25 April, Professor Colin Sutherland and Professor Siân Clarke, co-directors of the Malaria Centre speak on how Covid-19 is impacting progress towards SDG3.

 

Across the globe, Covid-19 lockdowns mean that malaria prevention activities have largely been put on hold. In many communities there is growing unease as the distribution of mosquito nets and access to other preventive medicines has slowed or in some cases stopped. As Professor Clarke noted:

 

“We know from the Ebola outbreak in West Africa that malaria treatment was severely affected and that there was an increase in malaria because of Ebola’s impact on the health system.”

 

The World Health Organization has cautioned while there is an urgent need to aggressively tackle the novel coronavirus it’s important to ensure other killer diseases, such as malaria, are not neglected. Yet there is a glimmer of hope: Could use of the existing malaria infrastructure make it easier for some countries to manage Covid-19? As Professor Sutherland noted:

 

“Infrastructure for malaria research could be expanded and diversified to also provide for example sample collection and contact tracing in the local community, and these countries have trained staff with experience in public health and epidemiology.”

 

Another critical issue relates to clinical cases. Individuals with malaria symptoms often seek treatment from informal providers, who they know and trust. But as Professor Clarke and colleagues offered: informal providers are often overlooked in national Covid-19 response plans. Without adequate training and protective equipment, such informal providers may become unintentional hotspots for virus transmission. There is a risk one disease simply gets swapped for another. But equally we know little about co-morbidities between malaria and Covid-19.

 

But it’s also important to understand the impact of Covid-19 on the nuts and bolts of Malaria research. For example, many malaria research projects depend on in vitro cultivation of malaria parasites. To keep them alive, researchers must attend to them every 24-48 hours. The laboratories in London were kept open for as long as possible, but the lockdown and closure of university buildings finally forced researchers to abandon their experiments.

 

“All our laboratories have been closed. Some of our students and postdocs had to throw out long-term experiments that they had been working on, in some cases, for many months or over a year,” says Professor Sutherland.

 

The end result is that research projects are unable to get the expected outputs and students’ and postdocs’ careers will be delayed and underfunded. But Covid-19 also poses problems for field malaria research and interventions.

 

“Essentially, all field research has been halted. This is a concern for the incomes of staff, because a lot of them are on short-term project contracts. And obviously, it provides a gap in the data collected”, says Professor Clarke.

 

Gaps in data and indeed research capacity are important: in order to eliminate malaria, we urgently need to better understand this parasite and have a cadre of world-class researchers globally who can continue to respond to the challenges of elimination. Yet there is a glimmer of hope: Could Covid-19 ultimately be a positive force by driving the global community to commit resources to strengthen health systems in LMIC countries? Only time will tell.

 

More information:

The Malaria Centre at LSHTM

WHO urges countries to move quickly to save lives from malaria in Sub-Saharan Africa

Tackling Covid-19 in Uganda: private medicine outlets at the front-line