London - The narrative has hardly moved on, as if it is perpetually stuck amid the seemingly never-ending impacts of pandemics ranging from Covid-19 to macro and socio-economic disruptions.

A world beset by crises and multiple uncertainties.

Covid-19 bears testimony to the devastation caused in mortality, hospitalisation, health system failures, pandemic unpreparedness, vaccine inequality and insecurity, policy deficits and procurement profiteering.

The beauty of human ingenuity is reflected in the invention and production of vaccines, especially those based on mRNA technology, in record time, which no doubt prevented millions of further deaths.

The ugly side of human nature is that access to that ingenuity has been heavily skewed against the most vulnerable and marginalised of the world, of which many of those left behind are in sub-Saharan African (SSA).

As if Covid-19 was the sole pandemic in a world historically plagued by a beauty parade of pathogens tuberculosis, malaria, HIV, Ebola, etc.

We continue to bear the consequences of myopic policy-making through the reallocation of resources away from the latter towards the fight against Covid-19, which undermined progress towards achieving the targets in containing, if not eradicating, preventable diseases such as TB, malaria and HIV.

The latest World Malaria Report 2022 released on Thursday by the World Health Organization (WHO) reinforces that narrative of some gains, entrenched deficits, a perpetual “work in progress” paradigm, with SSA once again disproportionately shouldering the heaviest burden of malaria.

Despite the fact that countries largely held the line against further setbacks to malaria prevention, testing and treatment services in 2021, the stark reality is that, into the third decade of the 21st century, there were still an estimated 619 000 malaria deaths globally in 2021 compared with 625 000 in 2020 and 568 000 in 2019.

The consolations are marginal.

While malaria cases continued to rise between 2020 and 2021, the rate of growth was slower than in 2019 to 2020. But globally, the total number of malaria cases increased from 232 million in 2019 and 245 million in 2020 to reach 247 million in 2021.

The trend is expected to continue in 2022-2023.

The African region continues to shoulder the heaviest burden of this highly preventable metric of shame for governments and health preparedness, accounting for 95% or 234 million of all malaria cases and 96% or 593 000 of all malaria deaths in 2021.

The tragedy is that nearly 80% of all malaria deaths were among children aged under 5 – a sad indictment of those responsible for the well-being of Africa’s children, especially in Nigeria, which accounted for 38% of such deaths.

The WHO report shows that while the case incidence and mortality rates in Africa increased between 2019 and 2020, and then declined from 2020 to 2021, the figure is still higher than pre-pandemic levels.

Unless there is better decision-making, targeted resources, more co-ordinated R&D and testing, updated vector control tools such as insecticide-treated bed nets (ITNs), seasonal malaria chemoprevention (SMC) and artemisinin-based combination therapies (ACTs), the pathway to pre-Covid progress may take longer than anticipated.

Nigeria (26.6%), DRC (12.3%), Uganda (5.1%) and Mozambique (4.1%) accounted for nearly half of all malaria cases globally. Nigeria and DRC also accounted for 31.3% and 12.6% of all malaria deaths globally, followed by Tanzania at 4.1% and Niger at 3.9%.

The Global Technical Strategy for Malaria 2016-2030 (GTS) calls for reductions in malaria case incidence and mortality of at least 40% by 2020 compared to a 2015 baseline.

The African region as a whole missed the GTS 2020 reductions milestones in 2021 by 45% and 47% respectively.

South Africa led a cohort of eight SSA countries that met the 40% case incidence GTS target in 2021.

South Africa also reduced its malaria burden by 33.7%. The number of indigenous malaria cases in the country decreased from 4 463 in 2020 to 2 958 in 2021, albeit the number of deaths from malaria increased from 38 to 56.

South Africa saw a drastic decrease in testing rates due to restrictions to movement because of lockdowns, which occurred during peak malaria transmission periods, resulting in mobile clinics being unable to carry out testing and case investigations at the community level.

WHO director-general Dr Tedros Adhanom Ghebreyesus dreams “of a malaria-free future”, but how realistic is his hope? His regional director for Africa, Dr Matshidiso Moeti, spelt out this reality: “Despite progress, the African region continues to be hardest hit by this deadly disease.

New tools – and the funding to deploy these are urgently needed to help us defeat malaria.”

Total funding for malaria in 2021 increased to $3.5 billion, up on the two previous years. But it remains well below the $7.3bn required globally to stay on track to defeat malaria.

Other barriers include the decline in the effectiveness of core malaria control tools, most crucially ITNs, insecticide resistance; insufficient access; loss of ITNs due to the stresses of day-to-day use outpacing replacement; changing behaviour of mosquitoes, which appear to be biting early before people go to bed, and resting outdoors, thereby avoiding exposure to insecticides; parasite mutations affecting the performance of rapid diagnostic tests; growing parasite resistance to malaria drugs; and the invasion in Africa of an urban-adapted mosquito (Anopheles stephensi) malaria vector that is resistant to many of the insecticides used today.

WHO recently launched a new African malaria strategy to curb antimalarial drug resistance; to stop the spread of the Anopheles stephensi and a global framework jointly with UN-Habitat to respond to malaria in urban areas.

WHO and its partners are also banking on “a robust research and development pipeline” to bring a new generation of malaria control tools, including long-lasting bed nets with new insecticide combinations and other innovations in vector control such as targeted baits that attract mosquitoes, spatial repellents and genetic engineering of mosquitoes.

New diagnostic tests are also under development, as are next-generation life-saving medicines to respond to antimalarial drug resistance, including from 2023 the world’s first malaria vaccine, RTS,S.

The mosquito in the room is that without strong national- and international-level commitment and improved local health systems to ensure access to quality services for all in need, Africa’s malaria narrative despite the progress may remain a perpetual work in progress.

Parker is a writer based in London.

Cape Times

** The views expressed do not necessarily reflect the views of Independent Media or IOL.

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