Lancet Commission Holds Virtual Wrap Up Meeting
March 9, 2021
On March 9th, 2021, the UCSF Secretariat of the Lancet Commission on malaria eradication hosted a two-hour virtual gathering of Commissioners to discuss the implications of the COVID-19 pandemic on malaria eradication and reflect on the future priorities for the global malaria community. Twenty-six of the 28 Commissioners attended, representing perspectives from 13 countries.
During the meeting, there was consensus that the Commission’s findings and recommendations, released in the Commission’s report in September 2019, remain critical and relevant despite the COVID-19 pandemic. Commissioners noted the links between malaria eradication and pandemic preparedness and response, global health security, the importance of strong program management, and the role of leadership and community engagement. Additionally, Commissioners highlighted the increased investments in global and public health spurred by COVID-19 and the opportunity to harness the public’s newfound interest in infectious disease to drive action on securing the world from novel emerging diseases and endemic diseases like malaria.
Although the March 9th gathering was the final meeting of the Lancet Commission on malaria eradication, Commissioners expressed support and commitment to advancing malaria eradication in years to come.
Global health security requires endemic disease eradication
In 2019, the Lancet Commission on malaria eradication contended that malaria can be eradicated within a generation by improving management, operations, and leadership, developing and deploying innovative tools, and spending an additional US$2 billion per year.1 WHO released a report in 2020 reaffirming its vision for a malaria-free world.2 These reports described the numerous benefits of malaria eradication, including the synergistic nature of eradication, global health security, and the achievement of universal health coverage. Several countries, regions, and global organisations expressed their commitment to an eradication goal, and enthusiasm in the malaria community was high. Then came the COVID-19 pandemic.
Global health experts were quick to warn of the potential negative impacts of COVID-19 on endemic disease programmes. Modelling studies indicated that disruptions to health services and supply chains from the COVID-19 response could set back efforts to control HIV/AIDS, tuberculosis, and malaria by up to 20 years.3 In a worst-case scenario, malaria deaths in 2020 were projected to more than double compared with those in 2019.4 This extreme outcome did not come to pass given the coordinated action by multiple stakeholders to ensure that more than 90% of planned malaria prevention campaigns, including mass net distributions, indoor residual spraying, and seasonal malaria chemoprophylaxis among children, were undertaken in accordance with COVID-19 safety protocols. Still, irregular access to antimalarial treatment could lead to a considerable increase in malaria deaths in sub- Saharan Africa—even a 10% disruption in access could result in 19 000 additional deaths.5 However, COVID-19 has not universally impacted malaria trends. Countries that recently eliminated malaria, including China, El Salvador, and Malaysia, maintained zero transmission throughout 2020, and El Salvador was certified malaria-free by WHO on Feb 25, 2021.5–7 Many of the countries that are nearing malaria elimination stayed on track in 2020, most notably in the Greater Mekong Subregion.5
The COVID-19 pandemic is far from over. Malaria programmes will continue to face operational and financial challenges, and the attention and resources of the malaria programme staff and researchers will be stretched to additionally address COVID-19.5,8 The global economy is hard hit and malaria funding, which has been stagnant for the past several years, is poised to decline in the near term as malaria-endemic countries face budget shortfalls and major donors cut their aid budgets.9 Existing health inequities within and between countries that exacerbate the spread and severity of malaria are being deepened by COVID-19. Having pre-purchased most of the global COVID-19 vaccine supply through 2021, many high-income countries are expected to achieve vaccine-induced population immunity long before most low-income and middle-income countries, so long as protection from emerging SARS-CoV-2 variants is maintained.10
Yet COVID-19 has also brought attention to the importance of resilient and equitable health systems that can respond to routine health needs and health emergencies while contributing to global health security.11 Ample evidence exists showing that health emergencies can disrupt and undermine progress against other infectious diseases.1,2 Thus, the goal of global health security must be to ensure that the global population is safe from all infectious diseases, both emerging and endemic, including malaria, tuberculosis, and HIV/AIDS.12 Health emergencies should not deter the global community from the ultimate goal of malaria eradication.
Malaria eradication would free up substantial human and financial resources that could then be reallocated to other health priorities, including investment in a systematic approach to disease control and pandemic preparedness based on principles established by successful malaria programmes and repurposed by some countries in the COVID-19 response.1 These principles include targeting and tailoring interventions to local circumstances; leveraging efficiency gains to achieve greater impact of interventions with fewer resources; strengthening community-level surveillance, action, and leadership; ensuring access to prevention and treatment in the most vulnerable populations; and prioritising investment in the development and deployment of new diagnostics, drugs, and vaccines. Eradicating malaria would also improve detection of other febrile illnesses, allowing for more rapid response and containment of potential pandemics.1,13
Global health security requires a comprehensive and integrated approach to simultaneously fight endemic diseases, respond to the COVID-19 pandemic, and prepare for future pandemics. Malaria investments in community-based case management, surveillance and real-time data for decision making, and robust supply chains, particularly in settings with poor access to health services, build health-system resilience and mitigate the impacts of global health security threats.13 COVID-19 has shown what is possible when global stakeholders backed by massive public and private funds are determined, focused, innovative, and collaborative. If this level of effort was applied to centuries-old endemic diseases such as malaria, eradication could surely be achieved within a generation. As the Lancet Commission concluded, malaria eradication by 2050 remains ambitious, achievable, and necessary, and will contribute to a healthier and more secure world.1
RGAF and WM-S are Co-Chairs of the Lancet Commission on malaria eradication. GN is a member of the UCSF Secretariat of the Commission. WM-S previously served as Assistant Director General at WHO and Board Chair for RBM Partnership to End Malaria; she is currently a Board Member of RBM Partnership to End Malaria. GN and RGAF are affiliated with the Malaria Elimination Initiative (MEI). The MEI collaborates with numerous governments and organisations around the world, and funding comes from multiple sources including the Bill & Melinda Gates Foundation. We declare no other competing interests.
*Gretchen Newby, Winnie Mpanju-Shumbusho, Richard G A Feachem
Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94158, USA (GN, RGAF); RBM Partnership to End Malaria, Geneva, Switzerland (WM-S)
- 1 Feachem RGA, Chen I, Akbari O, et al. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet 2019; 394: 1056–112.
- 2 WHO. Malaria eradication: benefits, future scenarios, and feasibility. Geneva: World Health Organization, 2020. https://www.who.int/publications/i/item/9789240003675 (accessed Feb 24, 2021).
- 3 The Global Fund. Mitigating the impact of COVID-19 on countries affected by HIV, tuberculosis and malaria. The Global Fund, 2020. https://www.theglobalfund.org/media/9819/covid19_mitigatingimpact_report... (accessed Feb 24, 2021).
- 4 Sherrard-Smith E, Hogan AB, Hamlet A, et al. The potential public health consequences of COVID-19 on malaria in Africa. Nat Med 2020; 26: 1411–16.
- 5 WHO. World malaria report 2020. Geneva: World Health Organization, 2020. https://www.who.int/publications/i/item/9789240015791 (accessed Feb 24, 2021).
- 6 RBM Partnership to End Malaria. Countries responding to the dual challenge of malaria and COVID-19: Malaysia case study. RBM Partnership to End Malaria, Jan 12, 2021. https://endmalaria.org/sites/default/files/Countries%20responding%20to%2... (accessed Feb 24, 2021).
- 7 Pan American Health Organization. El Salvador certified as malaria-free by WHO. PAHO, Feb 25, 2021. https://www.paho.org/en/news/25-2-2021-salvador-certified-malaria-free-who (accessed Feb 25, 2021).
- 8 Ntoumi F. Tropical diseases need attention, too. Nature 2020; 587: 331.
- 9 Worley W. Breaking: UK cuts aid budget to 0.5% of GNI. Devex, Nov 25, 2020. https://www.devex.com/news/breaking-uk-cuts-aid-budget-to-0-5-of-gni-98640 (accessed Feb 24, 2021).
- 10 So AD, Woo J. Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis. BMJ 2020; 371: m4750.
- 11 Lal A, Erondu NA, Heymann DL, Gitahi G, Yates R. Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage. Lancet 2021; 397: 61–67.
- 12 Sands P. COVID-19 must transform the definition of global health security. The Global Fund, Nov 19, 2020. https://www.theglobalfund.org/en/blog/2020-11-19-covid-19-must-transform... (accessed Feb 24, 2021).
- 13 RBM Partnership to End Malaria. RBM Partnership to End Malaria position on the next Global Fund strategy. RBM Partnership to End Malaria, 2020. https://endmalaria.org/related-material/rbm-partnership-end-malaria-posi... (accessed Feb 24, 2021).
Bill Gates reiterates the call for malaria eradication in the midst of COVID-19 pandemic
September 5, 2020
In recognition of this year’s World Mosquito Day, Bill Gates posted an entry to his personal blog, GatesNotes, that advises the global health community not to lose sight of malaria and other mosquito-borne diseases during the COVID-19 pandemic. During the 2016 Ebola outbreak in West Africa, regular health services were severely disrupted, leading to an increase in preventable deaths due to malaria. Gates warns that a similar increase could occur during the COVID-19 pandemic, if malaria endemic countries are not supported in their efforts to combat multiple health threats at once. Gates also points out that health service disruptions disproportionately affect the poorest and most vulnerable populations, the same people already suffering the highest rates of morbidity and mortality due to malaria.
The UCSF Secretariat of The Lancet Commission on malaria eradication applauds Bill Gates’ call to action, which reinforces the Commission’s core conclusions. In its report, the Commission demonstrates that progress toward malaria eradication contributes to broader health and development goals, including the alleviation of poverty, the promotion of equity, the achievement of universal health coverage, and the strengthening of global health security. Additionally, investing in malaria eradication will bolster the health system capacities and infrastructure of malaria-endemic countries, enhancing their ability to respond to other global health threats such as COVID-19. Once eradication is achieved, the resources previously devoted to malaria can be allocated to other health priorities and emergency preparedness, further improving population health and strengthening economic development. These messages are echoed on the GatesNotes blog, underscoring the significance of the Commission’s conclusion that malaria eradication is possible within a generation.
Gates’ blog post ends on a positive note, highlighting the role malaria program infrastructure is playing in the COVID-19 response and emphasizing the profound importance of malaria eradication as a global public good. Gates concludes with: “The progress the world has made against malaria is one of the greatest global health success stories. The COVID-19 pandemic only reinforces why eradicating malaria is so essential. So long as malaria exists, it will continue to flare up and burden the most vulnerable communities. Ridding the world of preventable, treatable diseases like malaria will save millions of lives and lead to healthier, more prosperous communities. And that will make them better prepared to confront any new health challenges like COVID-19 in the future.”
Africa declared free of wild poliovirus, moving closer to eradication
September 5, 2020
The UCSF Secretariat of The Lancet Commission on malaria eradication is celebrating an exciting piece of good news in what has otherwise been a tumultuous year for global health. On August 25th 2020, Africa was certified wild poliovirus-free by the Africa Regional Certification Commission (ARCC), an incredible achievement for the global health community. The certification comes after four years without a single case of wild poliovirus on the continent; the last cases in Africa were reported in Nigeria in 2016. The bold vision and incredible work that led to this achievement will both inspire and inform ambitions to eradicate other deadly diseases – including malaria.
The Global Polio Eradication Initiative (GPEI) was launched in 1988, at a time when polio was responsible for paralyzing 1000 children every day worldwide. Aggressive vaccination campaigns and intensified surveillance efforts led to a significant drop in annual global burden, but polio was still paralyzing an estimated 200 children in Africa each day in 1996, when Nelson Mandela started the Kick Polio Out of Africa campaign. Over the next 20 years, a vast network of stakeholders in dozens of endemic countries – including national and local governments, global and multilateral institutions, the private sector, philanthropic organizations, religious leaders, community members, and tens of millions of volunteer vaccinators – worked together to end wild poliovirus transmission in five of the six WHO regions. Wild poliovirus transmission is now confined to just Afghanistan and Pakistan – the two countries reported 176 total cases in 2019 and 102 cases to date in 2020 – and global eradication is within reach. The global malaria community celebrates this historic achievement.
Professor Rose Leke, chairperson of ARCC since its creation in 1998, recently spoke of the challenging last-mile efforts to eliminate wild poliovirus transmission in Nigeria, which experienced a 2016 outbreak in a northern state affected by conflict and population displacement after two years of no cases. Professor Leke attributed Nigeria’s success to the strong commitment and continued engagement of government officials, local leaders, health teams, community health workers, and survivors of polio, all of whom were involved in outbreak response coordinated by Nigeria’s Emergency Operations Center. Reflecting on the lasting impact of the polio eradication campaign on public health in Africa, Professor Leke said, “The polio response has brought many skilled technicians into Africa’s health systems. The GPEI paved the way for working closely with traditional healers and community leaders and has really helped to strengthen the systems that report on other diseases. The polio laboratory network is being used for other diseases, giving capacity in the region for doing all sorts of other diagnostics.”
The malaria community can draw both inspiration and practical lessons from Africa’s polio success story as we focus our efforts on ending global malaria transmission within a generation. Multi-stakeholder engagement and collaboration, maintaining strong political and financial commitment even when challenges seem insurmountable, and creatively deploying new tools and approaches have facilitated tremendous progress toward polio eradication and are all essential for achieving malaria eradication. National malaria programs can make use of the public health infrastructure developed for polio eradication, and, in turn, can further strengthen that infrastructure for the benefit of other disease programs. Dr. Helen Hiwat from the Ministry of Health in Suriname noted this phenomenon on a recent WHO webinar on malaria and COVID-19. The Suriname COVID-19 taskforce sought out the malaria program’s expertise in accessing hard-to-reach populations based on their years of experience working with mobile groups in remote gold mining areas.
Polio and malaria are diseases that can and should be eradicated within a generation. Africa’s eradication of wild poliovirus from the continent is a landmark achievement and serves as a call to action to the world that while COVID-19 may be dominating our attention we should continue striving to eradicate the diseases within reach.
Malaria leadership during the COVID-19 pandemic
Commissioners from The Lancet Commission on malaria eradication respond
Experts from around the world are deploying their extensive skills and expertise in malaria to fight the COVID-19 pandemic, including several members of The Lancet Commission on malaria eradication. In addition to supporting COVID-19 treatment trials in health care workers and soldiers, Commissioners are supporting efforts to leverage malaria surveillance systems and health infrastructure at national borders to be included as a possible component to the COVID-19 response.
Collective action, disease detection, robust prevention, and rapid response are significant pillars in protecting humanity from emerging health threats, like COVID-19, and in advancing public health goals, including the eradication of malaria. COVID-19 has tested global capacities in surveillance, diagnosis, treatment, and human resources for health—all core components of an effective malaria response. For countries with weak health systems, malaria can be an entry point for outbreak detection, data-driven targeted interventions, a whole-of-government response, and cross-border collaboration. Investments in malaria can simultaneously build resilient health systems and protect the world from current and emerging disease threats.
The following is a series of interviews detailing how individual Commissioners are responding to the COVID-19 pandemic:
- Dr. Ken Staley, Coordinator of the U.S. President’s Malaria Initiative (PMI); Executive Director of the USAID COVID-19 Task Force; Commissioner on The Lancet Commission on malaria eradication
- Dr. Richard Nchabi Kamwi, Steering Committee for Africa CDC’s Taskforce for Coronavirus (AFCOR); Commissioner on The Lancet Commission on malaria eradication
- Dr. Ning Xiao, Joint Prevention and Control Mechanism of State Council on COVID-19; Commissioner on The Lancet Commission on malaria eradication
The Lancet Commission on malaria eradication is an international group of 27 leading experts that, in September 2019, published the first comprehensive, peer-reviewed academic document to examine the scientific, operational, and financial challenges on the path to eradication and identify solutions that will enable us to achieve a world free of malaria within a generation. The report addresses a bold proposition: malaria, one of the most ancient and deadly diseases of humankind, can and should be eradicated by 2050.