La malaria en los tiempos del ébola

Malaria in the Time of Ebola


[This blog is part of the #DefeatMalaria World Malaria Day blog series hosted by Roll Back Malaria, to be published between April 8 and May 1, 2015]


Every year, the global health community marks April 25th as World Malaria Day—a time to reflect on the toll of the disease, the progress we’ve made in combatting it, and the work ahead. But this year, with the Ebola crisis still hovering over West Africa, things feel a little bit different. On one hand, there’s temptation to say we shouldn’t take our eye off the ball in the Ebola fight just to mark a pre-set day on the calendar for a different disease. At the other end of the spectrum, there’s temptation to say yes Ebola’s important, but malaria has actually killed many more people in the affected countries than Ebola has—so really, we should be rebalancing the scales of where we focus our attention.

There’s merit in both of these sentiments, but I’d argue that the best way to mark World Malaria Day this year is to acknowledge the deep linkages that Ebola and malaria have with each other, and to think about how the lessons we’ve learned from either can help us more effectively tackle both.

To me, there are at least three key similarities between the two. First and foremost, it’s clear that progress is possible, but complacency in the face of that progress can lead to backsliding. In the case of malaria, we’ve made tremendous gains, reducing malaria mortality rates by 47% worldwide and delivering more than 1 billion bed nets since 2000. In the case of Ebola, we’ve pushed back on an outbreak that was raging out of control last fall with more than 1,000 cases per week; now, we see only a few dozen cases in the same amount of time. And yet with both diseases, we’ve seen concrete examples of what happens when we take our eye off the ball prematurely. Zanzibar offers a famous case for malaria, having neared malaria elimination back in the 1950s and 60s, only to have cases rebound before it could formally eliminate the disease. In Guinea, many experts thought they had controlled Ebola back in the spring of 2014, only to have it similarly come back with more cases than before—and the fight still continues today.

A second parallel between malaria and Ebola is that, while financing is critical to fighting the diseases, it’s not sufficient on its own—securing political will and meaningful community engagement are also keys to making lasting progress. Some of the gains we’ve made on malaria have come because leaders in the countries hit hardest by the disease have stepped up and made it a priority for them and their people. At the local level, community engagement around malaria has helped to improve understanding of the disease, care seeking behavior, and proper bed net usage. Similarly, efforts to engage local communities in the fight against Ebola have proven to be an invaluable weapon in combating myths and stigma, promoting behavior change (including around traditional burial practices), and encouraging individuals to recognize symptoms and seek help. In both instances, an outsider-only approach simply will not generate the rapid progress needed to combat both diseases effectively.

Finally, Ebola and malaria remind us that infectious diseases don’t exist in a vacuum—they impact each other, and also the wider development sector around them. One of the secondary casualties of the Ebola outbreak in West Africa was the region’s efforts to fight malaria. Even though partners like the Global Fund, UNICEF, MSF, and others tried creative approaches to keep programs running, a number of bed net distribution campaigns were halted or cancelled, and UNICEF estimates that in Sierra Leone alone, the number of children treated for malaria was down 39%. Diseases like Ebola and malaria also have clear, negative impacts beyond direct mortality that they each can cause, such as diminishing a pregnant woman’s likelihood of giving birth in a safe facility and surviving childbirth. And they have clear economic impacts, too; the World Bank estimates that Ebola has cost the affected countries more than $1.6 billion in forgone economic growth in 2015, and economists estimate that malaria costs the African continent $12 billion in lost productivity annually.

So on this World Malaria Day (and every other), we ignore the ongoing fight against Ebola and the lessons learned from it at our peril. At the end of the day, a death from malaria has the same devastating impact as a death from Ebola. Rather than pitting one disease against another, the world must recommit the financing and political will to tackling both diseases, and others like them, so that no man, woman, or child has to die needlessly from a preventable disease.