ASTMH 2023: Climate Change and Malaria Elimination - Perspectives from the Ground

Climate change and its far-reaching implications are impossible toignore: it is a harsh reality that touches the lives of millions. TheIntergovernmental Panel on Climate Change (IPCC) reported that 3.6 billionpeople already live in areas highly susceptible to climate change.

Emerging evidence shows that malaria, an ancient adversary, could potentiallyfind new avenues and opportunities to spread and thrive in the face of ourchanging climate. This poses an existential threat to malaria elimination,risking reversal of decades of progress against the disease. 

It is the intersection of these two global challenges thatinfluenced the topic for our sponsored symposium, held in conjunction with the2023 The American Society of Tropical Medicine& Hygiene (ASTMH) Annual Meeting last month. Co-hosted by GLIDE, APLMAand Malaria No More, ‘ClimateChange and Malaria Elimination: Perspectives from the Ground’ featuredfive notable speakers who shared country experiences and expert perspectives onthe impacts of climate change on the global malaria response.

Climate Change & Malaria Elimination

In his framing remarks, Simon Bland, GLIDE CEO, shed light on theintricate and multifaceted interplay between climate change and malaria. Hestressed the complexity of this relationship, acknowledging the diversechallenges it poses while also highlighting potential opportunities. Blandemphasized that it is far from a simple, linear equation, with uncertaintiesand unknowns surrounding the impact of climate change on malaria elimination.He also mentioned that there is a growing recognition of the criticalimportance and a heightened enthusiasm among individuals to explore the relationshipbetween climate change and disease elimination, particularly in anticipation ofCOP28, underscoring the urgency of global collaboration and informed action.

Dr DanielNgamije, WHO Director of the Global Malaria Programme, provided the keynotetalk and noted that last year, flooding in Pakistan was one of the mostextreme climate-related disasters in living memory. At its height, more thanhalf of the country was underwater and more 33 million people were affected.When the floods eventually receded, mosquitos came out en masse, driving theworst malaria outbreak the country had seen since 1973. The floods took theheaviest tool on the districts that were already hardest hit by malaria, a morethan four-fold increase in 2022 compared to the previous year, with poor andvulnerable populations living in hard-to-reach areas bearing the brunt of theoutbreak. There are many unknowns around how a changing climate will impactmalaria transmission, but one thing is clear: the consequences will be feltmost by people living in low-income countries, who contribute least to theproblem.

There are many different pathways to howclimate change might affect malaria transmission and burden. However, availableevidence on the longer-term impacts of climate change on malaria transmissionis sparse, and projections come with uncertainties. What is certain is that climate change willhave indirect effects on malaria. 

The WHO is at the forefront of highlightingthe consequences of climate change on health. This year, for the first time,WHO will include a dedicated chapter focused on the climate and malaria nexusin the World Malaria Report. In 2024,WHO will convene an expert group to review available evidence and come to acommon position. We need to hear first and foremost from voices in the field aswe shape and refine our narrative. 

Dr Ngamije closed his remarks with reflections onrecent flooding in Madagascar, Malawi and Mozambique - three countries batteredearlier this year by Cyclone Freddy. Inthe wake of the longest lasting tropical cyclone in recorded history, more than300 health centres were destroyed, leaving vulnerable populations withoutmedical services. As seen in Pakistan,heavy rains were followed by a surge of cases in malaria and otherdiseases. He closed with a stirring callto action to build environmentally sustainable health systems, as well as foraction at the individual level.

CountryPerspectives

On-the-groundperspectives provide a nuanced understanding of the contextual realities andunique challenges faced by each country. This insight is crucial in tailoringeffective interventions that resonate with the specific needs of the localpopulation. As the Director of Mozambique's National Malaria Control Program(NMCP) since 2015, Dr Baltazar Candrinho provided a firsthand account ofnavigating the challenges of malaria elimination post-Cyclone Idai and CycloneFreddy. His close-up view unveiled the complexities faced by Mozambique insustaining malaria control efforts in the aftermath of devastating cyclones. DrCandrinho shed light on the impact of climate change on the seasonality ofmalaria in the country, emphasizing how this dynamic factor influences thetiming and effectiveness of interventions and the need for adaptiveinterventions that align with shifting patterns.

Dr Farah Qamar, an Associate Professor at Aga Khan University in Pakistan, discussed the challenges regarding malaria resurgence posed by the catastrophic flooding in Pakistan in 2022, the worst flooding in its history, which resulted in at least a four-fold increase in the reported number of malaria cases in Pakistan. Dr Qamar offered practical insights on the implications for disease control strategies. She highlighted the need for rapid diagnostic tests and additional resources directed towards local entomologists to explore and communicate potential solutions. Addressing the complexities of climate change and disease control requires not only strategic interventions but also a continuous dialogue that incorporates real-world experiences from the ground.

Civil SocietyPerspective

Understanding the intricaterelationship between climate change and health emphasizes the need to amplifythe voices and insights of communities and individuals affected by thesechallenges. Olivia Ngou, Founder and Executive Director, Impact Santé Afrique sharedinsights from the civil society perspective and highlights that the destructiveimpact of climate change extends to dismantling the essential tools communitiesrely on to protect themselves from malaria. This setback not only exacerbateshealth challenges but also disrupts the hard-earned progress in malaria controlefforts. Recognizing and incorporating these perspectives is crucial forfostering a holistic and effective approach to address the complexities at theintersection of health, climate change, and community resilience.

Climate modelling and Malaria Elimination

Kelly Willis, Managing Director of Strategic Initiatives at Forecasting Healthy Futures, discussed early-warning tools, emphasizing the challenge of importance of developing capacity to efficiently utilize the information produced by innovative models. In addition to her insights, Willis stressed the pivotal role of knowledge and advanced predictive tools in bolstering climate resilience, emphasizing the need for ongoing innovation to predict and address the evolving effects of climate change.

This symposium effectively united diverse malaria viewpoints from around the world to showcase the issues and steps being taken to ensure that emerging challenges like climate change will not impede the global goal of eliminating malaria by 2030. In his closing remarks, Dr Sarthak Das, CEO of the Asia Pacific Leaders Malaria Alliance (APLMA) thanked all the speakers for their invaluable contributions and stressed that the challenge of climate change only further highlights the necessity and moral responsibility for collaborative efforts in ending this ancient disease.

This blog has been co-published by GLIDE. Read their version here.