Malaria elimination is possible but SA again on ‘table of shame’
IF ALGERIA, Cape Verde and China can report zero indigenous cases of human malaria at the end of 2020, why couldn’t South Africa?
As the world marked World Malaria Day yesterday (April 25), the country continues to have the dubious distinction of featuring in yet another Global Health League Table of Shame.
Dr Tedros Ghebreyesus, World Health Organization (WHO) director-general, commending eight countries declared free from indigenous malaria, said: “Many of these countries at one time had a high burden of malaria. Their successes were hardwon and came only after decades of concerted action.
“Together, they have shown that malaria elimination is a viable goal for all countries.”
This was a remarkable achievement in view of the ongoing global Covid-19 pandemic.
South Africa’s reality, the stark health inequality especially in the poorer rural provinces apart, is that it has the single highest incidence of HIV/AIDS in the world.
It is well entrenched in the Top 30 High Burden TB countries, which account for 85% of new TB cases annually.
It has the highest number of Covid-19 infections in Africa, at over 1.56 million as of April 20, which resulted in the highest number of deaths, at 53 887.
South Africa is burdened by other statistics of social dysfunction including one of the highest incidences of violence against women and of socio-economic inequality, high youth unemployment and crime, according to the IMF.
Globally, malaria, a debilitating life-threatening disease, continues to stamp its footprint predominantly in Sub-Saharan Africa (SSA).
In 2019, says the WHO, there were an estimated 229 million cases of malaria, resulting in 409 000 malaria-related deaths in 87 countries.
Nearly half of the world’s population were at risk. Children under the age of 5 in Sub-Saharan Africa continued to account for two-thirds of global deaths from malaria.
The WHO African Region accounted for a scandalously 94% of all malaria cases and deaths worldwide.
South Africa participated in WHO’s E-2020 initiative, aimed at eliminating malaria for the three years up to 2020.
Based on WHO data, in the final report of the initiative published on April 21, South Africa had between 2018 and 2020 dismally failed in reaching this target, reporting 17 099 cases of indigenous malaria, second only to Comoros in the 21-strong group.
In 2018, the Department of Health reported 9 540 cases of indigenous malaria, which dropped to 3 096 in 2019 only to spike at 4 463 in 2020, partly due to the impact of Covid-19.
Dr Pedro Alonso, director of the WHO Global Malaria Programme, maintains that malaria diagnosis and treatment services were interrupted during the pandemic in most countries as many people were unable – or unwilling – to seek care in healthcare facilities.
A recent WHO survey confirmed that a third of countries reported experiencing disruptions in the delivery of malaria services in Q1 2021. Many people refused to seek care due to the fear of contracting Covid-19.
Migration from urban to rural areas in anticipation of lockdowns also resulted in increased transmission.
Covid-19 is a double edged sword – restrictions on movement did lead to lower rates of imported malaria cases, reducing the risk of local transmission of the disease.
South Africa’s National Malaria Programme reported a 59% drop in imported cases of malaria in 2020.
Other countries maintained and even strengthened their malaria elimination efforts during the pandemic.
World Malaria Day also saw the birth of a new initiative, the E-2025 to which South Africa has again been co-opted with 24 other countries.
The aim is to eliminate malaria within the next five years. Each country’s elimination journey is unique, but there are common drivers of success across all regions.
With commendable advancements in diagnosis and treatments including anti-malarial drugs and RTS-S vaccine, prevention and surveillance programmes, the use of insecticide-treated mosquito nets, why does this wily pathogen so pervasively persist?
“Success,” says WHO’s Dr Alonso, “is driven by political commitment to end the disease.
“This translates into domestic funding that is often sustained over many decades, even after a country is malaria-free.”
Most countries that reach zero malaria, he adds, “have strong primary healthcare systems that ensure access to prevention, diagnosis and treatment services, without financial hardship, for everyone living within their borders – regardless of nationality or legal status”.
Robust data systems are also key to success, together with strong community engagement.
Many countries that eliminate malaria had dedicated networks of volunteer health workers to detect and treat the disease in remote and hard-to-reach areas.
Any imported cases of the disease must be identified and treated rapidly.
Countries should maintain up-todate malaria surveillance systems and ensure that healthcare workers at all levels are continuously trained in how to prevent, detect and treat the disease.
President Cyril Ramaphosa’s government has received many plaudits for its quick and decisive response to Covid-19, albeit this was later compromised by reports of pandemic procurement corruption, indecision over timing and relaxing of lockdowns, and vaccination strategy and roll-out.
But at what cost to managing the impact of other pathogens such as HIV, TB and malaria? That resources have been diverted from these to fight Covid is clear.
For South Africa to succeed in the E-2050 malaria elimination initiative it has to learn the 10 lessons of its E-2020 “failure”.
In general, says WHO, these include country ownership, domestic financing, robust surveillance, leaving no one behind, cross-border collaboration, quality-assured diagnostics, multisectoral collaboration, tailored malaria responses, integrated responses, and innovative approaches and best practices.
The message to Minister of Health Dr Zweli Mkhize is loud and clear. Malaria elimination is possible, even in the face of extreme challenges.
For the sake of South Africa’s children, get it right for 2025!