Public health systems in Africa are coming under severe strain as the unprecedented COVID-19 pandemic persists. But as countries battle to bring the outbreak under control, efforts must also be maintained on other health emergencies and progress made against diseases such as malaria or polio preserved, the World Health Organization (WHO) urged last Friday.
Prior to the arrival of the novel coronavirus in Africa, WHO was stressing the need for countries to ensure the continuity of routine essential health services. An overburdened health system not only undermines the effectiveness of the response to COVID-19 but may also undermine the response to a whole host of preventable threats to human health. Even brief interruptions of vaccination make outbreaks more likely to occur, putting children and other vulnerable groups more at risk of life-threatening diseases.
“I urge all countries to not lose focus on their gains made in health as they adapt to tackle this new threat,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We saw with the Ebola Virus Disease outbreak in West Africa that we lost more people to malaria, for instance than, we lost to the Ebola outbreak. Let us not repeat that with COVID-19.”
Confirmed COVID-19 cases in Africa continue to rise, now exceeding 25 000. WHO is supporting countries in all aspects of the COVID-19 response and has recently published guidelines for ensuring the continuation of critical health services, including immunization and anti-malaria campaigns. The guidelines stress the need for countries to take a dynamic approach that mitigates any unavoidable pause in vaccination campaigns.
The consequences of disrupting efforts to control malaria in Africa could be particularly grave. Current estimates suggest that sub-Saharan Africa accounted for approximately 93% of all malaria cases and 94% of deaths, mainly among children under five. A new analysis by WHO and partners suggests that in a worst case scenario if malaria prevention and treatment services were severely disrupted as a result of COVID-19, the number of malaria deaths in 2020 in sub-Saharan Africa could rise to double the number in 2018.
“Africa has made significant progress over the past 20 years in stopping malaria from claiming lives. While COVID-19 is a major health threat, it’s critical to maintain malaria prevention and treatment programmes. The new modelling shows deaths could exceed 700 000 this year alone. We haven’t seen mortality levels like that in 20 years. We must not turn back the clock,” said Dr Moeti.
There are countries like Benin, the Democratic Republic of the Congo, Sierra Leone, Chad, Central African Republic, Uganda and Tanzania which are continuing with their insecticide treated bed net campaigns and other important malaria prevention activities. Countries are adapting their malaria strategies to the current complex situation.
Another essential health service is immunization. The response to COVID-19 has already disrupted vaccination efforts on the continent. Despite considerable progress on immunization, one in four African children remains under-immunized. Measles vaccination campaigns in Chad, Ethiopia, Nigeria and South Sudan have already been suspended because of COVID-19, leaving approximately 21 million children who would have otherwise been vaccinated unprotected. In response to the introduction of physical distancing measures, WHO has published guidelines on immunization in the context of COVID-19.