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New Delhi, August 26, 2020 :
WHO is actively following the ongoing clinical trials that are being conducted in response to COVID-19, including the more than 80 studies looking at the use of chloroquine and its derivative, hydroxychloroquine, for treatment and/or prevention.
To date, 3 large randomized controlled trials, including the WHO Solidarity trial, have failed to show that the use of hydroxychloroquine among hospitalized patients infected with COVID-19 can prevent death or disease progression. Additionally, 3 trials of patients with mild or moderate disease failed to show a significant benefit in prevention of respiratory failure through the use of hydroxychloroquine. Thus, there is now growing evidence that hydroxychloroquine is not an effective treatment for COVID-19. This evidence will inform the next update of WHO guidance on therapeutics.
Studies on the use of chloroquine or hydroxychloroquine to prevent individuals, particularly those at high risk such as health care workers, from contracting COVID-19 are ongoing. Currently, there is insufficient evidence to assess the protective efficacy of either of these medicines for the prevention of COVID-19 infection or disease.
WHO cautions physicians against administering these unproven treatments to patients with COVID-19 outside the context of a clinical trial. Individuals are also advised against self-medicating with these drugs.
For public health emergencies, WHO has a systematic and transparent process for research and development (R&D), including for clinical trials of drugs. The WHO “R&D Blueprint” for COVID-19, initiated on 7 January 2020, aims to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large-scale crises.
Malaria-endemic countries in all WHO have regions have reported cases of COVID-19. In the WHO African Region, which carries more than 90% of the global malaria burden, there have been more than 1 million confirmed cases of COVID-19 since the beginning of the pandemic. The latest situation reports on the COVID-19 pandemic are available on the WHO website.
WHO guidance remains the same. Countries should not scale back efforts to detect and treat malaria; doing so would seriously undermine the health and well-being of millions of people infected with a potentially life-threatening disease.
As signs and symptoms of malaria and COVID-19 can overlap (such as a fever), public health messages will need to be adapted in malaria-endemic settings so that people who have a fever are encouraged to seek immediate treatment rather than stay at home; without prompt treatment, a mild case of malaria can rapidly progress to severe illness and death.
As of March 2020, there have been reports of the suspension of insecticide-treated net (ITN) and indoor residual spraying (IRS) campaigns in several African countries due to concerns around exposure to COVID-19. Suspending such campaigns will leave many vulnerable populations at greater risk of malaria, particularly young children and pregnant women.
WHO strongly encourages countries not to suspend the planning for – or implementation of – vector control activities, including ITN and IRS campaigns, while ensuring these services are delivered using best practices to protect health workers and communities from COVID-19 infection. Modifications of planned distribution strategies may be needed to minimize exposure to the coronavirus.
WHO commends the leaders of Benin, Chad, the Central African Republic, the Democratic Republic of the Congo, Mali, Niger, Sierra Leone and Uganda for committing to move forward with ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.
Together with partners, WHO has developed guidance to ensure that those suffering from malaria can safely receive the care they need in COVID-19 settings. Tailoring malaria interventions in the COVID-19 response includes guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities. The document is consistent with broader WHO guidance on how to maintain essential health services during the pandemic.
In addition to routine approaches to malaria control, there may be a case for special measures in the context of the COVID-19 pandemic – such as a temporary return to presumptive malaria treatment, or the use of mass drug administration – which have proved useful in some previous emergencies.
Presumptive malaria treatment refers to treatment of a suspected malaria case without the benefit of diagnostic confirmation (e.g. through a rapid diagnostic test). This approach is typically reserved for extreme circumstances, such as disease in settings where prompt diagnosis is no longer possible.
Mass drug administration (MDA) is a WHO-recommended approach for rapidly reducing malaria mortality and morbidity during epidemics and in complex emergency settings. Through MDA, all individuals in a targeted population are given antimalarial medicines – often at repeated intervals – regardless of whether or not they show symptoms of the disease.
Such special measures should only be adopted after careful consideration of 2 key aims: lowering malaria-related mortality and keeping health workers and communities safe. WHO is exploring concrete proposals for when and how to activate such measures; guidance will be published in due course.
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