Malaria, Polio, and COVID-19: Lessons for Existing and Future Pandemics Infectious Diseases 26/04/2022 • Sarthak Das, Aidan O’Leary & Shekhar Mehta Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) On the occasion of World Immunization Week, influential global health figures share lessons learned in the global fight against two age-old diseases, malaria and polio – and more recently, COVID-19 – and how we should tackle existing and future pandemics. A child in Malawi gets drops to prevent polio. While COVID-19 surprised and shocked the world, it should not have. For decades, infectious disease experts have asserted that it was a matter of when and not if the next pandemic was going to strike. Global health security has unprecedented urgency. While pandemic preparedness remains atop our list of public health priorities, we cannot afford to lose sight of existing diseases that remain active threats and continue to put millions at risk. Polio and malaria are two such diseases that are strikingly similar; efforts to eradicate and contain these diseases span decades. While we have seen remarkable progress – with global malaria deaths substantially reduced and elimination achieved in 40 countries and territories, and endemic wild polio eradicated in all but two countries – significant gaps remain. The global response to COVID-19 has highlighted the tremendous power of both innovation and political will. We have witnessed first-hand the ability to pool resources across geographies and sectors to tackle challenges when a disease is truly a global priority; the result has been diagnostics, drugs, and vaccines at lightning speed. Yet simultaneously, as a recent review of lessons from polio and malaria highlighted, health delivery programs continue to be challenged in many countries – especially those where malaria and polio continue to be endemic – by the same health system weaknesses that make tackling diseases effectively challenging. Three key lessons are clear: 1. Building equitable health systems to reach even most at-risk Both polio and malaria are diseases of the most marginalized populations. Unfortunately, they endure in these pockets; the last cases are the most challenging and the hardest to reach. But real health equity means embracing these challenges head-on. Whether it is through surveillance, outbreak management, supply chain, or the use of data to plan, implement, and evaluate, both polio and malaria present opportunities to strengthen systems in key health pillars that can also be leveraged against other communicable diseases threats, be they current or future ones. For example, malaria case management begins with the recognition of acute febrile illness (AFI) in patients presenting at health facilities or to community health workers. Appropriate triaging of AFI can help identify new emerging pathogens, and thus simultaneously improve patient outcomes and strengthen surveillance systems. Likewise, the global service organization Rotary International, the catalyst behind the global polio eradication effort, is at the forefront of utilising polio-established infrastructures to help address broader public health efforts. Reaching the end game is not viable without targeting the places that are hardest to reach and building equitable health systems in those places. From tribal communities in India and Pakistan, to last-mile communities in Papua New Guinea, there is nothing more equitable than the elimination and eradication of a disease. In the case of polio, it not only protects those who are vaccinated but crucially also those who are not – the most marginalised who are persistently missed with health interventions. We will see continued transmission and/or face subsequent challenges such as the resurgence of both diseases if we leave the marginalised behind. Confirmation in February of a child paralysed by wild poliovirus in Malawi linked to a virus originating in Pakistan, for instance, underscores this risk. The current refugee movements associated with the Ukraine tragedy in addition to the ongoing humanitarian crises in Myanmar and Afghanistan further raise this spectre. 2. Innovating by listening to communities Whether it is delivering polio vaccines, insecticide-treated bed nets or antimalarials, tailored approaches are critical along with the readiness to adapt. While new tools are welcome additions to our defence strategies, at the end of the day we need to ensure that service delivery aligns with what works for communities. We need socio-behavioural informed public health interventions adapted to local systems. Health interventions must be delivered in a culturally appropriate manner, addressing the core needs of individual communities. This can only be achieved through innovation in delivery approaches and forging the right partnerships to create new delivery models and measure their impact. At the same time, research efforts continue to develop more effective, safer, easier-to-use and more affordable health solutions, to address communities’ needs in the most cost-and-humanitarian effective manner. From training youth volunteers to become health champions in their own remote and tribal communities, to mobile clinics (“Haat Bazaar Clinic”) offering routine health check-up services including tests for malaria in tribal areas in Chhattisgarh, India, to community health workers delivering house-to-house malaria services in Cambodia and Lao PDR – approaches like these have not only accelerated service delivery but have played a critical role in mobilising communities, particularly women and children. In fact, social mobilisation and India’s Social Mobilisation Network (SMNet) are often cited as instrumental to immunisation efforts for polio in hard-to-reach communities with poor immunization services, conflict, and dense populations. 3. Fostering greater political will Malaria and polio are two diseases that have already been eliminated from many parts of the world –Asia Pacific, in particular, has made significant progress, having achieved the global goal of reducing malaria cases and deaths by 40% by 2020. They are both preventable diseases. As much as we need innovation to accelerate our fight, especially among last-mile communities, we have the tools and the technology and, in many cases, the adequate resources to achieve success. What is needed is political will and leadership – the same forces we saw at work as the COVID-19 pandemic emerged – by both countries still affected by the diseases and donor governments, to fully implement and resource these proven strategies. Urgency, priority and accountability are key, as evidenced over the last two years by governments and local authorities taking ownership of evolving epidemiology, and rapidly adapting operations to the new reality to ensure a maximum number of communities can be reached with life-saving health interventions. The Global Fund to Fight AIDS, Tuberculosis and Malaria’s Seventh Replenishment later this year is a forthcoming opportunity to demonstrate this collective will. Commitment will back an ambitious $18 billion plan, of which a third will be dedicated to reinforcing systems for health and pandemic preparedness, in addition to financing over half of all malaria programs that also help to accelerate the pathway to ending the disease. Similarly, on Tuesday the GPEI is publishing a comprehensive ‘investment case’, which will outline the humanitarian and economic benefits of investing in the achievement of a polio-free world. The need for equitable health systems, innovative community-tailored approaches and greater political will to tackle both existing threats and future pandemics could not be clearer. As we rightly double down on efforts to prepare for the next pandemic, we need to also ensure all necessary resources are mobilized to overcome age-old diseases that are still with us today. Let us commit both in word and in deed to tackling malaria and polio once and for all. Dr Sarthak Das is Chief Executive Officer of the Asia Pacific Leaders Malaria Alliance (APLMA). Aidan O’Leary is Director of the Global Polio Eradication Initiative (GPEI) at the World Health Organization. Shekhar Mehta is President of Rotary International Image Credits: UNICEF Malawi. 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