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Home , Health security, Malaria

Thematic brief Global Security and COVID-19 has served as a reminder of how interconnected the world is. Strong health systems, cross-border collaboration, sustained political will and significant and coordinated financial commitments to innovation and in are all needed to fight threats to , whether ancient like malaria or new like the COVID-19 . Investments in malaria serve a double-duty solution that contribute to pandemic preparedness and global capacities to reduce the risk of widespread health emergencies, while

also enabling continued gains towards malaria eradication. End Malaria to © Maggie Hallahan - RBM Partnership by Photography

Key messages

Health systems that are overburdened by malaria Investments in capacity to detect and treat can miss new before they are contained febrile illnesses in a timely manner are critical to advance Detecting, diagnosing and treating hundreds of thousands and achieve malaria elimination and strengthen global health of malaria cases compromise countries’ capacity to security. These investments include maintaining real-time identify as many as 7,000 potential threats and surveillance and reporting systems, strong laboratory networks, to respond to disease outbreaks in a timely manner. well-run supply chains, a multi-sectoral approach, cross- border networks to facilitate communication and collaboration, hot spots can be the blind spots of the next pandemici and a vast and well-trained health workforce. Healthcare capacity to effectively diagnose at the community level is critical to ensure that every fever is diagnosed. Global health security is more than pandemic preparedness. Unaddressed fevers in the most remote areas of the world – It includes protection from biological weapons, the spread of hotspots for zoonotic spillover events and malaria alike – put the resistance or “superbugs”, and from the entire world at risk of the emergence of the next pandemic threat. the world is already facing like malaria, HIV/AIDS and .

Health emergencies and , such as COVID-19, The substantial economic costs of responding to malaria put effective malaria interventions and services at risk. and infectious disease outbreaks are greater than the costs Overwhelmed health systems, reductions in health seeking to prevent these threats. The Interational Monetary Fund behaviour, illnesses among frontline workers, and procurement forecasts that the financial impact on the by disruptions compromise malaria service delivery and access. the COVID-19 pandemic will amount to $22 trillion by 2025, Disruptions in access to life-saving malaria interventions can with the pandemic recession causing a 3.5% contraction in the lead to a surge in malaria cases, causing greater stress on global economyi. Lost economic growth in malaria- health systems, and even greater numbers of malaria . countries is estimated to be as high as 1.3% per yearii.

Global Health Security and Malaria 01 The Malaria Fight Contributes to Global Health Security

For countries with weak global health security capacities, Investments in preventing and controlling malaria investments in preventing and controlling malaria can can simultaneously build resilient health systems and be an entry point for outbreak detection, data-driven protect the world from current and emerging disease targeted interventions, a whole-of- response, threats. Expanded investment is required to further scale and cross-border collaboration. Ending malaria and up essential health infrastructure, which was built through protecting the world’s citizens from health threats requires investments in the malaria fight over the last two decades. collective action, disease detection, robust prevention and Many of these investments have been repurposed to deal a rapid response. The recent emergence of , Zika and effectively with the current pandemics, including: COVID-19 have tested global capacities in surveillance, diagnosis, treatment, and resources for health • Testing more than two billion fevers since 2010iii; —all core components of an effective malaria response. • Training tens of thousands of community healthcare High rates of malaria overburden health systems and their workers – particularly in remote areas – to conduct early ability to identify common causes of febrile illness and respond diagnosis and treatment and integrated community to disease outbreaks in a timely manner. Eliminating malaria in case management of people with malaria/fevers; areas at high risk for or pandemic outbreaks of febrile disease will prevent malaria surges, relieve competition for scarce • Increasing access to life-saving treatments, rapid healthcare resources, and free up capacity to be more focused diagnostics and preventive interventions; and to mount effective responses to acute health emergencies. • Building and digitizing data systems to improve Maintaining essential health services, including malaria real-time surveillance of infectious ; treatment, is critical to minimize the compounding mortality associated with epidemics and pandemics. Pressures on health • Improving supply chains and availability of effective systems, diversion of resources from delivering essential health medicines and medical equipment; and services, and costs to economies and livelihoods as a result of infectious disease threats can cause increases in morbidity • Building in-country laboratory capacity. and mortality, and in some cases, disease resurgence.

Community Case Management and Health Emergencies

Community case management is an effective method for Outbreaks show us the essential value of community- reducing the burden on health systems during a health based care. Lockdowns and other immediate mitigation emergency and can be used to identify and refer non- tactics restrict access to health facilities, increasing the need malarial fevers. As health-seeking behavior may decrease for community-based care. Integrated community case during an epidemic due to fear, linking community platforms management of malaria and other fevers by community health with the health system is critical to reinforce trust and access. workers relieves pressure on overburdened health clinics Malaria action plans, co-created with communities, can serve and hospitals by allowing treatment of many malaria cases as the foundation for enhanced community involvement during at the community level, referring only severe malaria cases health emergencies. Investments in digitizing community case and fever cases not caused by malaria to health centers. management at scale will be important to maximize opportunities for the fight against COVID-19, malaria and other diseases. Outbreaks threaten the first line of defense against malaria: healthcare workers. Healthcare workers are on the frontlines of malaria elimination and are vital in the fight against outbreaks; they are also some of the most vulnerable groups during outbreaks. Providing tools, such as adequate Personal Protection Equipment (PPE), to healthcare workers enables them to address outbreaks and protect themselves.

Global Health Security and Malaria 02 and theCOVID-19 response, guidedby atripleresponse framework oftechnical, are countries and services, taking anintegrated approach to both the malariafight that accelerated onmalariarelies having action oncountries stronger healthsystems importance ofglobalhealthsecurityandthefightagainst malaria.Recognizing The COVID-19 pandemichasprovided several learnedfor themutual lessons years dueto malariaserviceinterruptions by caused theCOVID-19 pandemic that malariadeaths suggests could increasemodelling 36% over thenext five of COVID-19 onmalariaresponses may not knownfor be sometime.Current However, anddeaths are malariacases expected to rise,andthefullimpact lives andcreated andprograms newefficiencies that willhave lasting impact. scenariopredicted, avoidedsuccessfully saved theworst-case thousandsof in malaria-affected behavior. countries to encouragecare-seeking efforts These andengagedwithcommunities affordability malariacommodities, oflife-saving workedservices, andpartners to withcountries ensure continuedavailability and UNICEF andpartners provided newguidancefor howto safely maintain core malaria theWorldthe pandemic, HealthOrganization, theRBMPartnership to EndMalaria, malariainterventionsessential according to COVID safety Throughout guidelines. andpartners, more than90%ofpreventive malariaprograms delivered to toThanks andthequickinnovative aglobalcall action response ofcountries, ofCOVID-19the impact onmalariaservicedelivery health. Early indicated modelling malaria deaths couldhave doubledin2020 dueto difficulty appropriately andrisks diagnosing to frontlinefebrile illness healthworker disruptions, reductions behavior, inhealth-seeking overwhelming healthsystems, COVID-19services. disrupts thedelivery through ofhealthservices supplychain The COVID-19 amajorthreat pandemichasposed to thedelivery malaria ofessential COVID-19 Pandemic Spotlight: modelling formodelling public healthandfor prioritizing andtargeting limited resources. also reinforcing theimportance of timely, data accurate and andgeo-localized health systems andmultilateral responses. TheCOVID-19 pandemicresponse is Malaria andthe

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v . Global Health Security and Malaria Global Health Security 03 Photography by © James Roh/Cotopaxi Foundation Solutions: Leveraging Malaria Interventions for Global Health Security

Rapid response to infectious disease threats – including • Investing in early detection and real-time surveillance the COVID-19 pandemic – must utilize and strengthen and data: Strengthening real-time surveillance systems and health programmes and infrastructure that are required tools for malaria can bolster essential infrastructure for early to maintain essential health services, including those for detection and response to emerging pandemics to help malaria. Efforts to improve pandemic preparedness and response identify — in real-time — drivers of and target interventions through malaria investments could include: interventions. The use of mobile technology and risk mapping can support efforts to enhance rapid reporting and contact- • Surging community health workforce in hard-to-reach tracing. They also help to ensure that limited resources are areas: Increasing the number and capacity of community health prioritized and targeted to where they are needed most. workers to enable detection and treatment of malaria and other febrile illnesses and distribution. District health units • Extending the reach of laboratory systems – including that have successful integrated community case management the accompanying human resources, infrastructure, and and community engagement models to deliver integrated commodities: Laboratory capacity is essential to global health malaria and other disease diagnosis and treatment can activate security allowing for rapid detection, diagnosis, and treatment. those systems to assist with outbreak response effortsvi. Essential malaria services can adapt to continue safely during • Strengthening of procurement and supply chain global health emergencies to prevent unnecessary morbidity systems: Maintaining supply of adequate levels of malaria and loss of life. While solutions to emerging infectious disease commodities and addressing the increased costs due threats may be immediately unavailable, highly effective to COVID-19 disruptions to global supply chains. malaria prevention and treatment are well established. Malaria interventions should continue during health emergency threats to • Addressing anti-microbial and resistance: protect lives and ensure that gains in fighting malaria are not lost. Funding next generation anti-malarial and bed nets to combat the constant evolution of the A coordinated and whole-of-government approach is malaria parasite and malaria-carrying mosquitoes. essential for both successful malaria elimination and outbreak response. A multisectoral approach to malaria can be leveraged for emerging disease threats to propel a whole of government approach. Ensuring leadership from all ministries focuses on efforts to drive down malaria and other outbreaks provides the political will and resources needed to protect health in the face of emerging disease threats.

References

i. Leave No Fever Unresolved: the Malaria Pathway to End this Pandemic and iv. World Malaria Report 2020. World Health Organization, Geneva Prevent the next. https://spark.adobe.com/page/Ie5fhnI0FtxjB/ v. https://www.who.int/publications/i/item/9789240004641 ii. Gopinath G. A long, uneven and uncertain ascent. In: IMFblog [blog]. vi. Hogan et al. Potential impact of the COVID-19 pandemic on HIV, Washington (DC): International Monetary Fund; 2020 Available from: https:// tuberculosis, and malaria in low-income and middle-income countries: blogs.imf.org/2020/10/13/a-long-uneven-anduncertain-ascent/. a modelling study. Lancet Glob Health 2020; 8: e1132–41 iii. Samba E. The Malaria Burden and Africa. In: Breman JG, Egan A, Keusch vii. Baltzell, K., Harvard, K., Hanley, M. et al. What is community engagement and GT, editors. The Intolerable Burden of Malaria: A New Look at the Numbers: how can it drive malaria elimination? Case studies and stakeholder interviews. Supplement to Volume 64(1) of the American Journal of Malar J 18, 245 (2019). https://doi.org/10.1186/s12936-019-2878-8 and Hygiene. Northbrook (IL): American Society of Tropical Medicine and Hygiene; 2001 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK2620/

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