More cases of malaria and deaths in 2020 are associated with COVID-19-related disorders

According to the latest WHO data World Malaria Report, it is estimated that in 2020 there were 241 million cases of malaria and 627,000 deaths from malaria worldwide. This represents about 14 million more cases in 2020 compared to 2019 and 69,000 more deaths. Approximately two-thirds of these additional deaths (47,000) were related to disruptions in the prevention, diagnosis, and treatment of malaria during the pandemic.

However, the situation could have been far worse. In the early days of the pandemic, the WHO predicted that – with serious service disruptions – malaria deaths in sub-Saharan Africa could potentially double 2020. But many countries have taken urgent action to support their malaria programs, preventing this worst-case scenario.

Sub-Saharan Africa still bears the greatest burden of malaria, accounting for about 95% of all malaria cases and 96% of all deaths in 2020. About 80% of deaths in the region are among children under 5 years of age.

The pandemic came at a time when global progress in the fight against malaria was already on the plateau. Around 2017, there were signs that the phenomenal gains made since 2000 – including a 27% reduction in the global incidence of malaria cases and a nearly 51% reduction in the malaria death rate – were delayed.

“Even before the COVID-19 pandemic broke out, global gains in the fight against malaria have leveled off,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Thanks to the hard work of public health agencies in malaria-affected countries, the worst projections of COVID’s impact have not materialized. We now need to harness that same energy and commitment to reverse the stalemate caused by the pandemic and accelerate the pace of progress against this disease. ”

Since 2015, the base date for the WHO Global Malaria Strategy, 24 countries have seen an increase in malaria mortality. In the 11 countries carrying the largest malaria burden in the world, the number of cases increased from 150 million in 2015 to 163 million cases in 2020, and malaria deaths rose from 390,000 to 444,600 in the same period.

To get back on track, the WHO and its partners recognize the need to ensure better and fairer access to all health services – including malaria prevention, diagnosis and treatment – by strengthening primary health care and increasing domestic and international investment.

Innovation in new tools is also a key strategy to accelerate progress. One important new prevention tool is RTS, S / AS01 (RTS, S), the first vaccine ever recommended by the WHO against the human parasite. In October 2021, the WHO recommended RTS, S for children living in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission.

Providing anti-malaria services against the odds

Despite the challenges imposed by COVID-19, about three-quarters (72%) of insecticide-treated mosquito nets were distributed in endemic malaria countries by the end of 2020. Thirteen countries in the African sub-region of the Sahel have reached 11.8 million more children with malaria prevention drugs during the rainy season of high transmission in 2020 compared to 2019.

Some countries, especially those with low malaria burdens and relatively strong health systems, have even made progress in fighting malaria during a pandemic. China and El Salvador were certified by the WHO as malaria-free in 2021, and the Islamic Republic of Iran achieved zero consecutive indigenous cases in 2020 for 3 consecutive years.

Six countries of the Greater Mekong subregion continue to experience an impressive decline in malaria cases. By the end of 2020, there were approximately 82,000 cases of malaria in the subregion, down from a peak of 650,000 cases in 2012 and about 100,000 cases in 2019.

Despite these achievements, the African region of the World Health Organization recorded an increase of 12% in malaria deaths in 2020 compared to the previous year, highlighting the consequences of even moderate service disruptions in the population at risk of malaria.

“While African countries have accepted the challenge and avoided the worst predictions of the consequences of COVID-19, the impact of the pandemic still means thousands of lives lost due to malaria,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “African governments and their partners must intensify their efforts so that we do not lose more ground under the control of this preventable disease.”

According to the report, 15 countries with a high malaria burden reported a reduction in malaria testing of more than 20% in April and June 2020 compared to the same period in 2019. National malaria programs distributed about 48 million fewer treatment courses in 2020 compared to to the previous year. And of the 11 countries with the highest workloads in the world, only India has made progress in fighting malaria. The other 10 countries, all in Africa, reported an increase in cases and deaths.

Meeting global goals

According to the report, progress towards the milestones of the WHO global strategy for malaria by 2020 has significantly strayed from the path. In 2020, the global malaria incidence rate was 59 cases per 1,000 people at risk compared to the 35 target, which delayed it by 40%. The global mortality rate was 15.3 deaths per 100,000 people at risk compared to the 8.9 target, up 42%.

Achieving the goals of the WHO Malaria Strategy for 2030, including reducing the global incidence and mortality rate by 90% by 2030, will require new approaches, new tools and better implementation of existing ones.

The WHO Malaria Strategy emphasizes the need to carefully adapt existing approaches to prevention, diagnosis and treatment to local contexts, and to strengthen health systems as a whole, with the aim of achieving general health coverage.

Meeting global goals will also require strong funding. According to the report, current levels of funding (estimated at $ 3.3 billion in 2020) will need to more than triple, reaching $ 10.3 billion a year by 2030.

Application of a new methodology

This year’s report applied a new WHO-wide statistical method to estimate the cause of death among children under five for all major diseases, including malaria. The methodology has been applied to 32 countries in sub-Saharan Africa that cover about 93% of all malaria deaths in the world. This has revealed a higher number of estimated deaths among young children each year since 2000.

Even after the application of the new methodology, the malaria mortality rate has maintained a general downward trend since 2000; globally, the malaria death rate (deaths per 100,000 vulnerable population) fell by 49% between 2000 and 2020. Between 2019 and 2020, the death rate rose for the first time since 2000 as a result of disturbances during the COVID-19 pandemic.

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Note to editors

WHO work on malaria has been guided Global Technical Strategy for Malaria 2016-2030 Record (GTS), approved by the World Health Assembly in May 2015 and updated in 2021 to reflect the lessons learned in the global malaria response from 2016 to 2020. This year, the number of countries that have achieved the milestones of the 2020 strategy is derived from the official burden estimates, instead of using projections as done in Malaria World Report 2020. Despite significant progress since 2000, the GTS 2020 milestones for morbidity and mortality have not been achieved globally.

• Frequency of cases: In 2020, the global malaria incidence rate was 59 cases per 1,000 people at risk compared to the 35 target, which delayed it by 40%.
• Mortality rate: In 2020, the global mortality rate was 15.3 deaths per 100,000 people at risk against the 8.9 target – which put it 42% off the road.

Changes in methodology

There are two new and significant considerations in this year’s report in assessing malaria and death cases. First, a new proportion of causes of malaria deaths were applied, affecting 32 countries in sub-Saharan Africa. The new methodology resulted in higher estimates of malaria mortality in children under 5 years of age over the entire period 2000–2020 compared to previous analyzes. For example, the new methodology showed that in 2019, there were 558,000 malaria deaths worldwide, compared to a previous estimate of 409,000 deaths. More information on WHO-level methodology can be found in an article recently published in Lancet health of children and adolescents.

Second, estimates for both cases and deaths reflect the impact of disturbances during the COVID-19 pandemic, leading to an increase in malaria burden in 2020 compared to 2019 in most moderate and high transmission countries, particularly in sub-Saharan Africa. In 2020, the change in methodology accounts for 32% of additional deaths (22,000 deaths) compared to 2019. However, the 68% increase (47,000 deaths) is related to disturbances during the COVID-19 pandemic.

African region of the World Health Organization

Between 2019 and 2020, the estimated number of malaria cases increased from 213 million to 228 million and deaths from 534,000 to 602,000. The World Health Organization’s African region accounted for about 95% of cases and 96% of deaths worldwide. About 80% of all malaria deaths in the African region are among children under 5 years of age. Since 2015, the progress rate in both cases and deaths has stalled in many countries with moderate or high malaria transmission; the situation has worsened, especially in sub-Saharan Africa, disruptions during the COVID-19 pandemic and other humanitarian emergencies.

Elimination of malaria

Between 2000 and 2020, 23 countries achieved zero consecutive cases of indigenous malaria for 3 consecutive years. WHO has certified 12 of these countries malaria-free (including 2 certificates in 2021): United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Kyrgyzstan (2016), Sri Lanka (2016), Uzbekistan (2018), Paraguay (2018), Argentina (2019) and Algeria (2019), China (2021) and El Salvador (2021). El Salvador was the first country in Central America to receive WHO certification without malaria. China was the first country in the Western Pacific region of the World Health Organization to be certified malaria-free in more than 30 years. Azerbaijan and Tajikistan have officially requested a certificate of malaria-free status from the WHO, and the process is ongoing. In April 2021, the WHO launched Initiative E-2025 to support 25 countries with the potential to halt malaria transmission by 2025.