WHO is continuously monitoring and responding to the COVID-19 pandemic. This Q&A will be updated as more is known about the novel coronavirus, how it spreads and how it is affecting malaria responses worldwide.
Malaria-endemic countries in all WHO regions have reported cases of COVID-19. In the WHO African Region, which carries more than 90% of the global malaria burden, 37 countries had reported cases of the disease as of 25 March; of these, 10 countries reported local transmission of the disease. The latest situation reports on the COVID-19 pandemic are available on the WHO website.
Should core malaria vector control interventions be maintained in view of the rapid global spread of COVID-19?
In recent days, there have been reports of the suspension of insecticide-treated net (ITN) and indoor residual spraying (IRS) campaigns in several African countries due to concerns around exposure to COVID-19. Suspending such campaigns will leave many vulnerable populations at greater risk of malaria, particularly young children and pregnant women.
WHO strongly encourages countries not to suspend the planning for – or implementation of – vector control activities, including ITN and IRS campaigns, while ensuring these services are delivered using best practices to protect health workers and communities from COVID-19 infection. Modifications of planned distribution strategies may be needed to minimize exposure to the coronavirus.
The Alliance for Malaria Prevention has provided valuable guidance for national malaria control programmes on the distribution of ITNs in the context of the COVID-19 response; these recommendations are consistent with WHO global guidance.
For the implementation of IRS campaigns, WHO supports guidance developed by the U.S. President’s Malaria Initiative in the context of COVID-19. Among other actions, the guidance advises IRS deployment teams to: increase the number of hand washing stations and soap at all operations sites; reinforce morning health checks for all team members, adding temperature checks where feasible; wear N-95 masks and personal protective equipment before entering operations sites; and frequently wipe down any touched surfaces (door handles, vehicle railings, etc).
In addition to the above recommendations, basic WHO-recommended protective measures should be provided for the general population.
Yes, delivery of intermittent preventive treatment in pregnancy (IPTp), seasonal malaria chemoprevention (SMC), and intermittent preventive treatment in infants (IPTi) should be maintained provided that best practices for protecting health workers – and other front-line workers – from COVID-19 are followed. Ensuring access to these and other core malaria prevention tools saves lives and is an important strategy for reducing the strain on health systems in the context of the COVID-19 response.New guidance from WHO describes the rights, roles and responsibilities of health workers in the context of COVID-19. WHO has also developed guidance for countries to safely maintain essential health services during the pandemic.
WHO guidance remains the same. Early diagnosis and treatment are critical to prevent a mild case of malaria from progressing to severe illness or death. Countries should not scale back efforts to detect and treat malaria; doing so would seriously undermine the health and well-being of millions of people infected with a potentially life-threatening disease.
In addition to routine approaches to malaria control, there may be a case for special measures in the context of the COVID-19 pandemic – such as a temporary return to presumptive malaria treatment, or the use of mass drug administration – which have proved useful in some previous emergencies.
Presumptive malaria treatment refers to treatment of a suspected malaria case without the benefit of diagnostic confirmation (e.g. through a rapid diagnostic test). This approach is typically reserved for extreme circumstances, such as disease in settings where prompt diagnosis is no longer available.
Mass drug administration (MDA) is a WHO-recommended approach for rapidly reducing malaria mortality and morbidity during epidemics and in complex emergency settings. Through MDA, all individuals in a targeted population are given antimalarial medicines – often at repeated intervals – regardless of whether or not they show symptoms of the disease. Such special measures should only be adopted after careful consideration of 2 key aims: lowering malaria-related mortality and keeping health workers safe. WHO is exploring concrete proposals for when and how to activate such measures; guidance will be published in due course.
Experience from previous disease outbreaks has shown the disruptive effect on health service delivery and the consequences for diseases such as malaria. The 2014-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone, for example, undermined malaria control efforts and led to a massive increase in malaria-related illness and death in the 3 countries.
In recent weeks, the COVID-19 pandemic has tested the resilience of robust health systems around the world. Recognizing the heavy toll that malaria exacts on vulnerable populations in countries with fragile health systems, WHO underlines the critical importance of sustaining efforts to prevent, detect and treat malaria. In all regions, protective measures should be utilized to minimize the risk of COVID-19 transmission between patients, communities and health providers. WHO has developed detailed guidance for health workers in the context of the COVID-19 outbreak response, as well as operational guidance for safely maintaining essential health services.
What are the key considerations for countries that are working to eliminate malaria or prevent re-establishment of transmission?
All of the considerations described above apply to malaria-eliminating countries and those preventing re-establishment of the disease: efforts must be sustained to prevent, detect and treat malaria cases while preventing the spread of COVID-19 and ensuring the safety of those who deliver the services. Countries that are nearing malaria elimination must protect their important gains and avoid malaria resurgences. Countries that have eliminated malaria must remain vigilant for any imported cases of malaria that may be occurring to prevent reintroduction of the disease.
Have there been disruptions in the global supply of key malaria-related commodities as a result of the COVID-19 pandemic?
Yes. In recent days, there have been reports of disruptions in the supply chains of essential malaria commodities – such as long-lasting insecticidal nets, rapid diagnostic tests and antimalarial medicines – resulting from lockdowns and from a suspension of the importation and exportation of goods in response to COVID-19. Coordinated action is required to ensure the availability of key malaria control tools, particularly in countries with a high burden of the disease, and that efforts to limit the spread of COVID-19 do not compromise access to malaria prevention, diagnosis and treatment services.
WHO is working across the 3 levels of the Organization (country, region and headquarters) to ensure that any advice intended to prevent the spread of the coronavirus and to guide COVID-19 disease management is appropriate in malaria-affected settings. Together with partners, WHO has also identified a set of inter-related actions that are needed to mitigate the impact of COVID-19 in countries where malaria strikes hardest. The Organization recently convened partners to discuss areas of collaboration and coordination, with the aim of:
- generating, using and disseminating accurate information;
- mitigating against health systems disruptions; and
- ensuring the continuity of routine malaria-specific services while also providing, in some settings, additional special measures.
WHO stands ready to work with countries and other stakeholders to mitigate the negative impact of the coronavirus on malaria responses worldwide and, where possible, contribute towards a successful COVID-19 response.
What is WHO’s position on the use of chloroquine and hydroxychloroquine in the context of the COVID-19 response?
WHO is actively following the ongoing clinical trials that are being conducted in response to COVID-19, including studies looking at the use of chloroquine and its derivative, hydroxychloroquine, for treatment and/or prevention. Currently, there is insufficient data to assess the efficacy of either of these medicines in treating patients with COVID-19, or in preventing them from contracting the coronavirus.
Chloroquine is currently recommended by WHO for the treatment of P. vivax malaria. In the context of the COVID-19 response, the dosage and treatment schedules for chloroquine and hydroxychloroquine that are currently under consideration do not reflect those used for treating patients with malaria. The ingestion of high doses of these medicines may be associated with adverse or seriously adverse health outcomes. For public health emergencies, WHO has a systematic and transparent process for research and development (R&D), including for clinical trials of drugs. The WHO “R&D Blueprint” for COVID-19, initiated on 7 January 2020, aims to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large-scale crises. WHO has also designed a set of procedures to assess the performance, quality and safety of medical technologies during emergency situations.
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