Letter to partners for malaria (September 2020)

Dear friends and partners,

My last “Letter to partners“They came to you in December 2019, after launch World Malaria ReportSince then, the world has changed in ways we could never have imagined. I hope you and your loved ones have managed to avoid the COVID-19 infection or recover from it quickly. For those who have lost family members or friends, I express my deepest condolences.

This letter will focus mainly on WHO’s efforts to address the dual challenge of malaria and COVID-19. Our work in recent months has been carried out in close collaboration with experts from the country and global partners. We are very grateful to all our partners for their continued commitment and contribution.

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Topics covered in this letter

• Malaria & COVID-19
• Virtual forums
• Improving the way we develop and share policy guidelines
• New rule routing application
• Artemisinin resistance in Rwanda

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Malaria & COVID-19

As COVID-19 began to spread rapidly earlier this year from China to Italy and beyond, alarm bells began to ring throughout the malaria community. Having taken such a disastrous toll on countries with robust health systems, how will African countries overcome the malaria endemic? Among colleagues at the WHO, there is deep concern about the possibility that the coronavirus could drive years — perhaps decades — of progress in malaria control.

In March, before COVID-19 provided a strong foundation in Africa, the WHO established an inter-partner mechanism aimed at mitigating the impact of the pandemic in malaria-affected areas. Since then, leaders and experts from more than 30 partner organizations have borrowed their expertise in 7 workflows focused on a range of issues – from disruptions in the supply of key goods from malaria to surveillance and clinical trials of medicines.

Our first business order was to issue a clear statement calling for continuity of services for malaria. We have been plagued by reports that some countries in sub-Saharan Africa have suspended mass online campaigns treated with insecticides, major strongholds in malaria prevention in the region for almost 2 decades. Our statement, released on March 26, stressed the crucial importance of ensuring the safety of communities and health professionals in the first place.

A few weeks later, the WHO and partners provided two key documents that helped shape national malaria responses during the pandemic:

• New guideline describes how to safely maintain basic malaria services in the context of COVID-19. It makes it clear that countries should not choose between or protecting their populations from COVID-19 or malaria; they can – and should – do both. These malaria guidelines are aligned with broader WHO guidelines on the maintenance of basic services in the COVID-19 settings. It also complements guidelines WHO, UNICEF and IFRC on the role of community health care.
• modeling analysis, released just before World Malaria Day, reinforces our urgent call to maintain anti-malarial services. Under the worst-case scenario, we predicted a doubling of the number of deaths in sub-Saharan Africa only in 2020 if access to online campaigns and antimalarial treatment was severely limited during the pandemic.

We are encouraged to see online campaigns moving in many countries across Africa. Benin, the Democratic Republic of the Congo, Sierra Leone and Chad paved the way this spring, and many others have followed in their footsteps. In line with WHO guidelines, all countries have adjusted their distribution strategies to ensure that households receive networks as quickly and securely as possible.

However, we have not been able to effectively monitor or use other preventive approaches, such as IPTp for pregnant women, an intervention that is usually carried out through prenatal care facilities. The full impact of a pandemic on the diagnosis and treatment of malaria – which can usually be accessed through primary care facilities – is also unknown. Many of the reports we received were incomplete or anecdotal.

Paradoxically, there are reports of malaria reduction in some areas, probably reflecting the fact that fewer and fewer people are seeking care in health facilities; if a person with malarial fever does not seek care, they will not be diagnosed, treated, or reported. We expect a clearer picture to emerge as more data becomes available.

We will continue to keep you informed of our ongoing efforts to combat malaria and COVID-19. Our Q&A provides additional background and is updated periodically.

Virtual forums

Later this week, WHO and RBM Partnership to End Malaria will co-organize live interactive forums twice in a row under the theme: “Responding to the Double Challenge of Malaria and COVID-19”. On the first day, we will hear from experts from the country about the challenges they face on the first line of reactions to these urgent health threats. Their shared reflections will inform Day 2 discussions with global health leaders, including our WHO Director-General.

Discussions are conducted in English, with simultaneous translation into French and Spanish. We encourage you to register in advance; the agenda and registration details can be found here,,

Improving the way we develop and share policy guidelines

As you may recall, in 2018, the Global Malaria Program (GMP) undertook a comprehensive review of our malaria policy-making processes. Following the recommendations derived from this exercise, our path towards malaria policy is now structured around 3 steps at a high level:

• better anticipate
• develop policy
• optimize adoption

To better anticipate unmet public health needs (Step 1), GMP requested proposals in 2019, including online consultations, for topics requiring new or updated malaria policy recommendations. Based on the received feedback, we form individual groups for the development of guidelines (GDG) for each of the identified technical areas: chemoprevention, vector control, elimination, treatment, diagnosis, Plasmodium vivaxand anemia.

To increase the transparency of our processes, GMP will publish the names and brief biographies of individuals considered for participation in each GDG. Everyone is welcome to comment on any conflict of interest observed.

We are currently inviting comments to September 8th, on the proposed GDG members on malaria elimination. For details visit this connection, If you’d like to receive regular updates on GDGs – including alerts about other upcoming “comment calls” – email us at: [email protected],,

New rule routing application

Step 3 in our new policy path calls for optimizing the adoption of WHO guidelines on malaria policy, especially in endemic countries. To this end, I am very pleased to share a new application that brings together all WHO documents on malaria – guidelines, recommendations, operational manuals and other technical documents – in one simple source.

Download the iOS app | Download the app for Android devices

The application complements Compendium of WHO Guidelines for Malaria, published in April 2018, ia a dedicated policy guidance section on the WHO website.

Artemisinin resistance in Rwanda

As you may have seen, Nature medicine recently published an article confirming the appearance of parasites in Rwanda with mutations associated with partial resistance to artemisinin. At the same time, the study found that artemisinin-based combination therapy (ACT) remained an effective drug for malaria.

This article is co-authored by the WHO and is based on data generated by the WHO monitoring systems. Most importantly, the parasites emerged independently in Rwanda and did not spread directly from the Greater Mekong subregion, as some had predicted.

Unfortunately, some newspaper articles misrepresented the key findings and implications of the study. Together with our malaria partners, we have worked to reinforce the message that ACTs – at the moment – remain an effective malaria cure in all settings around the world, including Rwanda. We encourage you to read informative note on this issue developed by Malaria Drugs as well as ours WHO Questions and Answers,,