Effects of COVID-19 Control Policies on Malaria Surveillance: A Comparative Analysis of North and South Korea.

PURPOSE: Both South and North Korea are identified by the World Health Organization (WHO) as having the potential to eliminate malaria. However, the increase in malaria cases during the COVID-19 response has prompted an investigation into the reasons behind this unexpected rise.

MATERIALS AND

METHODS

Epidemiological, entomological, and meteorological data from national and international surveillance systems were analyzed. Using the WHO's analytical framework, which can be effectively applied during the elimination phase, we assessed drivers of malaria resurgence in North and South Korea.

RESULTS

In North Korea, border closures caused a severe shortage of rapid diagnostic test kits, reducing malaria testing by over 90% by 2021. Microscopy use increased but remained insufficient, while confirmed cases rose from 1819 in 2020 to 3160 in 2023. In South Korea, public health resources were diverted to COVID-19, weakening malaria control activities. The response time for epidemiological investigations increased from 1.3 days in 2019 to 4.3 days in 2021. Relapse cases, which were zero in 2021, increased to eight in 2023, and confirmed cases rose from 274 in 2021 to 673 in 2023. There were no meaningful changes in the drivers of malaria resurgence, including importation of malaria parasites or human susceptibility. With no notable shifts in vector density, variations in temperature and precipitation did not explain the rise in either country, and there were no reports of emerging resistance to insecticides or antimalarial drugs.

CONCLUSION

These COVID-19-related disruptions, including supply chain failures and the diversion of human resources, impaired malaria control in countries on the Korean Peninsula.