Cape Town — The J.C. Flowers Foundation and Friends of the Global Fight Against AIDS, Tuberculosis and Malaria ('Friends') are focusing attention on how faith leaders, philanthropists and community partners are uniting against the scourge of malaria, despite the disruptions of Covid-19.
The two organizations hosted a digital convening on the topic in the lead up to this week's release of the World Malaria Report from the World Health Organization. Participants discussed how to maintain progress towards malaria elimination and how to mitigate the negative effect of Covid-19 on efforts to reduce malaria cases and deaths.
Representatives of both convening groups and their local partners emphasized the essential role of religious leaders in reaching 'the last mile' – communities far from health services and with limited educational opportunities.
Discussion moderator Mark P. Lagon is Chief Policy Officer for Friends, founded to support the The Global Fund, a Geneva-based partnership launched in 2002 to speed the end of Aids, TB and malaria as epidemics. Friends advocates for the Fund and educates and facilitates discussions about its work.
"Last year the two billionth bed net was distributed", Lagon said. In less than two decades, the Fund contributed over U.S.$13 billion to malaria control, and "the malaria-related annual mortality rate has been reduced by 50 percent".
But Covid-19, Lagon lamented, has interrupted the distribution of insecticide-treated bednets and access to antimalarial medicines, due to national lockdowns and measures to contain the pandemic. "The Global Fund took a survey on 1 November, and over half the countries they work with have partners reporting that they're experiencing disruptions to malaria service delivery, including 13 percent claiming high levels of disruption," Lagon said.
More than 50% of malaria-affected countries report disruptions from Covid.
The Global Fund's Covid-19 Response Mechanism, Lagon said, has assisted 106 countries around the world, spending almost U.S.$16 to blunt the effects of Covid. The group deploys personal protective equipment (PPE), shores up health systems and mitigates the impact of the virus on Aids, tuberculosis and malaria programmes.
J. Christopher Flowers, philanthropist and CEO of private equity investment firm J.C. Flowers & Co, explained why his organisation became involved in the fight against malaria. "From its beginnings many years ago, the Anne and Chris Flowers Foundation has partnered with faith communities in Africa … We felt that while some problems don't have solutions, this one does," said Flowers, an active Anglican.
He pointed to the church as a primary partner in the battle against malaria. "We could not do what we do without each other," he said.
Committed both to regional solutions and to working collaboratively, the foundation launched the Isdell:Flowers Cross Border Malaria Initiative with Irish businessman and philanthropist E. Neville Isdell. The initiative began its work in hard-to-reach border areas of Angola, Namibia, Zambia and Zimbabwe in southern Africa.
Isdell, a former CEO and board chair of the Coca-Cola Company, told participants that he joined with Flowers to launch the cross-border initiative as someone who knows malaria personally. "I have had malaria," he said. "I was brought up in Zambia. I always thought it pretty scandalous that here is a disease that we know how to eliminate. We don't need to discover anything magical."
Malaria experts say that engaging border-spanning rural communities, as the Isdell:Flowers initiative does, is an important tool for ending malaria. Northern Namibia, for example, has reduced malaria disease and death substantially, but it cannot eliminate malaria from the area until more progress is made in neighboring Angola to the north. Mosquitoes, scientists point out, recognize no national boundaries.
"In these areas", Flowers said, "we have become convinced of the role of faith leaders who understand local realities and speak with moral authority". He cited faith leaders who include malaria teaching in their weekly services.
"Because of the trust they have, these faith leaders and other community leaders have been able to convince parents to continue to seek malaria testing and treatment for their febrile children," Flowers said. This has helped save lives, especially among children whose parents have been wary to seek medical help as Covid-19 spread".
Combined efforts of entomologists, drug developers, supply chain managers and future funders, such as the Global Fund and the U.S. President's Malaria Initiative are needed, Flowers said, but their success will be limited without the assistance of faith leaders and the local engagement they can encourage. Community and religious networks have powerful motivations, in addition to looking out for their communities. "The health of their own families is at stake," Flowers said.
Mosquitoes need no passports to travel from country to country.
Dr. Mapanga reported that malaria cases from the border areas of Namibia and Angola have experienced strain from Covid-19, which has set back anti-malaria efforts. "We have seen a redirection of funds, which is why we are grateful to Global Fund for their continued support," she said.
The symptom of fever is common to both malaria and Covid-19 patients, leading to reduced diagnoses, especially where resources for testing are scarce, and has pushed up the death rate. "Unfortunately, our mortality rate has gone up this year," Mapanga said. The lockdowns reduced availability of medication for malaria treatment and restricted the movements of healthcare workers, who are "critical in going out to communities", she said. "They haven't been able to do that this year…We have lost a lot of ground."
Other antimalarial programmes also have been suspended, Mapanga said, because transport was repurposed for Covid-19 responses. Controlling the population of biting mosquitoes, using a low-toxicity spray on indoor walls , was one of the tactics that was discontinued, due to pandemic restrictions.
But Mapanga is hopeful that those in the faith community who have played a central role in reaching underserved communities will spur a new intensification of efforts. "I think faith has provided the platform to treat and see people with the right lens, and that is appreciating the value in everybody and understanding that everybody has the right to healthcare," she said.
"It's been really crucial where I work, which is a rural area", she said. "What we've found is that when [people] hear it from all fronts - the medical front and their faith leaders - they are more willing to understand the importance of completing their medication, using mosquito nets and allowing community healthcare workers to go into communities to spray their homes."
The paediatrician experienced the importance of faith leaders in the Covid-19 response as well the malaria crisis. "In the beginning, Covid-19 required you to have access to the internet or to be able to read, because it's such a new virus. The ability to access people in remote villages was very difficult for us, because they don't have cell phones. They don't have internet access. The role of faith leaders was really crucial, because they were able to go into those communities and disperse information," she said.
Bishop David Njovu of the Anglican Diocese of Zambia is a 'firebrand', said moderator Lagon. As a church leader and member of the country's End Malaria Council of Zambia, he has helped draw unprecedented attention to the opportunity to end malaria.
"As Dr. Kundai mentioned, Covid-19 has had a major impact on the fight against malaria", Njovu told the convening, "especially during the months of March and April, when we were under lockdown". While encouraging observance of World Health Organization recommendations of frequent sanitising, social distancing and the use of PPEs, "we were able to go out into communities to do two things: while sensitising people about Covid-19, we were also reminding people that malaria was still present," Njovu said.
In June, Zambian health workers were able to visit communities to test, treat and track Covid-19 patients. "Covid-19 taught us to use platforms like WhatsApp, Facebook and YouTube in order to communicate to our members," Njovu said, voicing hope that those adaptations will contribute to future malaria elimination programmes.
Global health funds and programmes have cut malaria deaths in half in 57 countries.
The Bishop reinforced other discussants' message that malaria education is included in faith leaders' social media communications about Covid-19. "We had to explain to the people why we closed places of worship. In explaining that, we reminded them that malaria was still present and was even more dangerous than Covid-19. More people were dying during this period than those who died of Covid-19 here in Zambia," Njovu said.
Participants agreed that interfaith partnerships have had useful previous experience in cooperating against disease threats. "We had some lessons prior to this," Njovu said. "HIV and AIDS helped us to come together as faith leaders and see how we could help people who were bedridden. We took that knowledge and experience and brought it to the issues of Covid-19 and malaria."
Sheikh Dr. Shaban Phiri, a Muslim scholar, said that as a faith leader, working to eliminate malaria and other diseases that cause human suffering is "a calling". He serves alongside Bishop Njovu on Zambia's End Malaria Council, and said that interfaith collaboration is an element of religious belief. "In Islam, teachings talk about helping one another. Malaria is a problem that does not only affect one particular faith or one particular race but, indeed, it affects everyone," Phiri said.
Njovu agreed, saying religious leaders share a creed of helping those in need, and interfaith unity is a powerful weapon against disease. "Unity - speaking with one voice - it didn't matter which faith you followed - it had impact. For instance, recently in one of Zambia's rural areas, different faith leaders came together to train up other faith leaders in the community. It gave a good picture because all of us - different faiths - were there to talk about malaria and how we can eliminate it."
Njovu said that in addition to mobilizing communities, this religious common front is a political tool to hold policy makers accountable for their actions. "This lets us carry a voice for advocacy when we approach government officials because we do so with one voice. That is working very well for us," Njovu said.
A few weeks earlier, the bishop said, "we had a workshop, and the one who came to officiate was the Permanent Secretary [a senior civil servant in the parliamentary system]. During lunch I was able to engage him and ask for continued support for our antimalarial work, despite the fight against Covid-19".
Njovu said that he gave the government official statistics for Zambia's malaria-related fatalities from January to July this year, which numbered nearly 1,200 – in comparison to 300 deaths attributed to Covid-19. " Unless the government itself showed everybody it had the political will to eliminate malaria, nobody would take them seriously," Njovu told the politician.
Sheikh Phiri said that Zambia's Interfaith Networking Group gained prominence in responding to the spread of HIV/Aids in southern Africa. "From that point, as religious leaders, irrespective of our beliefs or backgrounds, we needed to come together," he said. The dual crises of malaria and Covid-19 has furthered religious cooperation, he said.
Dr. Jenny Dyer, founder of the 2030 Collaborative, an organisation that promotes awareness, provides education, and encourages advocacy for the United Nations Sustainable Development Goals, echoed the view that faith leaders are important agents of advocacy, and that their role in reducing malaria should be held up as an example and an inspiration.
"I don't think anybody has said this yet," she noted, "but it bears repeating: global health investments worldwide have halved the number of deaths caused by malaria in 57 countries. With the advent of Covid-19, we don't want to see a reversal of this incredible progress."
Supporting Phiri and Njovu, Dyer said the role of religious figures in the fights against infectious diseases has grown more important with time.
Ending malaria, as well as Covid-19, is not only a smart security, health and economic investment – it is the right thing.
"That is the unique voice of faith leaders," she said. "They remind our elected leaders that this is not only the smart thing to do in terms of national security, economics and public health, but funding not only Covid-19 relief but also funding the fight against malaria is the right thing to do."
Dyer pointed to the United Methodist Church as an example of service. Over the past decade, the church donated more than U.S.$23 million to the Global Fund for antimalarial efforts. "Their life saving activities and distribution of insecticide-treated nets, indoor residual spraying and rapid diagnostic tools have proven them to be a significant non-governmental partner for the Global Fund," she said.
Never waste a crisis.
Isdell said that the success of the anti-malaria campaign shows what can be accomplished, but that the momentum must be sustained to protect those gains. "Never waste a crisis," he urged. "I think today is a very good day to think about what happens after Covid-19. In the last week we've had quite a lot of news about vaccines, and there's a post-Covid world coming."
If the global community comes together to eliminate malaria, he said, "the funding comes together."
Lagon asked Isdell why faith leaders play a valuable role in his collaborative work with Chris Flowers. "I think they're not just valuable", he replied. "I think they're essential."
"It's about trust. We live in a world of falsehoods being spread everywhere, and here you've got people who are trusted - leaders who are trusted - who are connected to people at ground level. Then, within that, there's the multiplier effect of all the people are part of that particular faith".
Isdell said the crises facing the world today must be approached holistically. "We work in the health silo; we work in the climate change silo; we work in nature conservation silos. But Covid-19 is a zoonotic disease (spread from animals to humans.) We've got to think of everything as connected."
Comments of speakers, as of interviews published on AllAfrica, are condensed and ordered for clarity, length and flow.