Flattening the malaria and COVID-19 curves

Long before COVID-19 sickened communities, took lives, and shut down economies, the U.S. government launched a program that has helped 27 African and Asian countries prepare for the pandemic.

The U.S. President’s Malaria Initiative (PMI) was launched 15 years ago to reduce deaths from malaria, a cruel and ancient killer that preys on young children and pregnant women in particular. At the time, malaria was killing a child every 30 seconds. Thanks to strong bipartisan support and increased funding from Congress, PMI now protects more than 570 million people from malaria every year. 

Together with its partners, PMI has helped save 7 million lives — most of them pregnant women and young children — and prevent more than one billion malaria cases. In addition, PMI has worked with partner countries to build capacity and systems to combat malaria, which also equip them to better respond to other public health threats.

As a result, PMI’s leadership has been a key driver of global progress against malaria and helped strengthen health systems in ways that are proving critical for responding to today’s pandemic.

Consider the case of Rwanda. When Dr. Lisine Tuyisenge began her work as a pediatrician at University Teaching Hospital in Kigali in 2006, the hospital was so overwhelmed by malaria cases that listless and fevered children slept two to a bed.

Today, thanks to PMI and its strong collaboration with Rwandan leadership and partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, to significantly reduce malaria cases and deaths through prevention, treatment and monitoring programs, the hospital rarely admits a malaria case. 

That’s important for Rwanda’s pandemic response because it means Dr. Tuyisenge and her colleagues have the time to treat and the beds to admit COVID-19 cases. 

It turns out, investing in flattening the malaria curve will help us flatten the COVID-19 curve.

In the same way that U.S. hospitals postponed elective surgeries to clear beds for COVID patients, it’s essential that countries with a high malaria burden have effective malaria prevention programs to ensure their hospitals and clinics have the capacity needed for COVID patients.  As Rwanda demonstrates, PMI is poised to have a profound ripple effect during a pandemic in which the availability of hospital beds and ICU capacity is directly linked to COVID survival rates. 

The same is true across all PMI countries where remarkable gains include Ethiopia cutting the incidence of malaria by 65 percent and Myanmar reducing the incidence of malaria by 90 percent. In part because of progress against malaria, a child has a better chance of survival now than at any other point in history. Further, beyond the direct benefits of better health, malaria-fighting programs have a high return on investment and contribute to substantial gains in education, productivity, and economic development. 

With an increase in funding at this pivotal moment, PMI could deliver even stronger dividends over the long-term fight to end malaria and in the short-term protect hard-fought gains against malaria and contribute to the global pandemic response. These twin impacts are what make boosting PMI’s life-saving efforts particularly essential right now. 

In the short-term, the same community health workers who travel Rwanda’s hills visiting rural hamlets — distributing new insecticide-treated bed nets, spraying homes with insecticides and diagnose and treating malaria before it requires a trip to a health facility or becomes deadly – are primed to also educate families about the coronavirus. This includes how to prevent contracting it and what to do if they have symptoms. Further, the supply chains and fever-detecting capacity established by PMI could also serve double duty, helping with the COVID response.

Just as important is PMI’s long-term transformative work to eliminate malaria — which is currently at a decisive juncture. Today, more than half of the world’s countries are malaria-free and malaria has been pushed back so effectively that world leaders recommitted to malaria eradication in our lifetime as their shared audacious goal. Last year, experts confirmed that, with the right investments, eradication is within our reach. 

But here’s the catch: currently, a child dies from malaria every two minutes. Malaria is a wily foe and history demonstrates that when funding and political will wanes or life-saving health services are limited, malaria comes surging back with a vengeance. As we saw during the Ebola outbreak in West Africa in 2014, when people hesitated to seek health care because they were afraid of infection or because health facilities were overwhelmed, malaria cases and deaths increased and exceeded deaths from Ebola. 

The World Health Organization recently warned that malaria deaths could double this year to a rate we haven’t seen in 20 years if malaria programs are severely interrupted due to COVID-19. A new survey by the Global Fund confirms that program disruptions are happening. To avoid this tragedy, the US must double down on its investments now to ensure we don’t erase progress-to-date and hospital wards like Dr. Tuyisenge’s in Rwanda do not fill up with malaria cases at exactly the moment those critical beds are needed to treat COVID-19 patients.

Josh Blumenfeld is managing director of global policy and advocacy at Malaria No More. Margaret Reilly McDonnell is executive director of the UN Foundation Nothing But Nets campaign.