Malaria remains a primary cause of childhood illness and death in Africa.
Data from World Health Organization denotes that over 476,000 child deaths are recorded every year.
World’s first malaria vaccine, RTS,S/AS01 (commercial name Mosquirix), has, however, flashed a light of hope to communities in Kenya, Ghana, and Malawi, where the vaccine is already in use.
The vaccine promises a 30 percent reduction in severe malaria in fully vaccinated children.
RTS,S vaccine, developed by PATH Malaria Vaccine Initiative (MVI) and GlaxoSmithKline (GSK) with support from the Bill and Melinda Gates Foundation, could save tens of thousands of lives each year if implemented broadly.
In October 2021, WHO recommended expanding the use of the RTS,S malaria vaccine for the prevention of Plasmodium falciparum malaria in children living in moderate to high transmission areas.
Kenya is expanding the use of the vaccine in 25 additional sub-counties across the eight counties using it in response to the recommendation.
Similar expansions took effect in Malawi in November 2022 and Ghana in February 2023.
PATH has received a grant from the US-based Open Philanthropy for the initial expansion of the vaccine in the three countries’ pilot areas through 2023, using vaccine doses donated by GSK, the manufacturer.
“In 2021, more than half a million African children died from malaria; this is equal to 1 child dying of malaria every minute. Even one of these deaths is too many. Thanks to the evidence generated here in Kenya and other pilot countries; more children throughout Africa will have access to this lifesaving tool,” said Scott Gordon, Director, Malaria Vaccine Implementation Program, in a briefing on March 6, 2023.
Steps made so far
Speaking during a stakeholder forum ahead of the expansion launch of the malaria vaccine, Gordon indicated that The RTS,S malaria vaccine has been estimated to save 1 child’s life for every 200 children vaccinated.
“And when the vaccine is implemented together with other recommended malaria interventions – as it is here in Kenya – it has been shown to reduce the number of children that become sick with malaria, those needing to be hospitalized with malaria, those requiring blood transfusions for malaria, and most importantly, those who die from malaria,” he added.
Kenya has so far distributed more than one million doses of the four-dose malaria vaccine to children in eight counties, with nearly 400,000 receiving at least one dose.
The pilot program has been made possible by a collaboration involving in-country and international partners, including the Ministries of Health of Ghana, Kenya and Malawi; in-country evaluation partners; and PATH, GSK, and UNICEF.
Since September 2019, Kenya’s National Vaccines and Immunization Programme (NVIP), working collaboratively with the Division of National Malaria Program (DNMP), has provided the malaria vaccine as part of routine immunization in 26 sub-counties across eight counties in Western Kenya: Homabay, Kisumu, Migori, Siaya, Busia, Bungoma, Vihiga, and Kakamega.
Why Kenya, Ghana and Malawi
In December 2015, WHO called for expressions of interest from African ministries of health to collaborate on the malaria vaccine implementation program.
Three of the ten countries that responded positively were chosen for the program based on pre-specified criteria.
Among these was the ministry of health’s expressed desire to participate in the Malaria Vaccine Implementation Programme (MVIP) as well as well-functioning malaria and immunization programs.
“The experience of Kenya and the other pilot countries has also shown us the widespread acceptance and demand for the vaccine in the communities. Over the past three and a half years, more than 1.3 million children have begun receiving the vaccine across the three countries.
Lessons drawn from the experience in these three countries have served as critical evidence for the World Health Organization’s recommendation for the widespread use of the vaccine throughout Africa,” Gordon asserted.
In-country research partners are leading the evaluation of the RTS,S vaccine pilot implementation.
This includes a consortium of partners in each pilot country led by the Kintampo Health Research Centre in Ghana, the CDC Foundation in Kenya, and the University of Malawi College of Medicine in Malawi.
Health utilization studies are being led by the University of Health and Allied Services in Ghana, the Liverpool School of Tropical Medicine in Kenya, and the Malawi-Liverpool Wellcome Trust in Malawi.
The program is expected to continue through 2023.
The pilot will generate data on the feasibility of delivering the vaccine in childhood vaccination clinics, the vaccine’s potential role in reducing childhood deaths, and its safety in routine use.
Results will inform future decisions on the potential wider-scale deployment of the vaccine.
Impact felt
The program had reached more than 800,000 children by October 2021.
By the end of December 2022, a total of 1,052,826 doses had been administered in Kenya, with 367,360 children having received the first dose through a routine immunization program under the leadership of the Ministry of Health.
Phased introduction in additional countries will begin in late 2023.
Twelve countries in Africa have already applied for funding from Gavi to introduce the vaccine.
The three countries (Kenya, Ghana and Malawi) have seen a decreased number of malaria cases since the commencement of the program.
According to data from the Kenya Malaria Indicator Survey (KMIS), when the malaria vaccine was launched in Homabay county in 2019, the lake-endemic malaria region had a malaria prevalence of 27%, which has now dropped to 19%.
The elephant in the room
“While we welcome this new additional tool to fight malaria and the recommendation to reach many more communities and children, we are also alive to the global limitation in vaccine supply,” said Dr. Abdourahmane Diallo, WHO Country Representative, Kenya.
“To address this, WHO has developed an allocation framework to ensure equity and fairness for access to limited vaccine supply while working with manufacturers to increase capacity to meet global demands for the vaccine.
The vaccine allocation will not be provided to all areas simultaneously, but more areas will be covered as global vaccine availability increases,” he added.
In his keynote remarks, Dr. Diallo indicated that GAVI has approved funding for malaria vaccine introduction into routine immunization and will support the continuation of vaccination beyond the pilot period that will end this year.
While efforts to sustain and expand existing interventions must continue, new complementary tools and strategies are required in some areas to accelerate the fight against malaria and reduce the disease burden.
Rubbing salt to the wound, on 22 February 2023, Researchers in Kenya detected an invasive mosquito that can transmit malaria in different climates, threatening progress in fighting the parasitic disease.
The new carrier, the Anopheles stephensi mosquito, transmits plasmodium vivax, the parasite that causes the deadliest type of malaria.
Concerns for urban residents have been felt, given that the new carrier may feed on poor environmental management systems.
Game changer
However, with the vaccine expansion program, there’s light at the end of the tunnel.
The 2021 WHO recommendation for broader use of the vaccine among children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission will help save Sahel and sub-Sahel regions from this life-threatening disease.
African countries have so far made tremendous progress in the fight against malaria using core WHO-recommended tools such as insecticide-treated mosquito nets, indoor spraying with insecticides, and antimalarial medicines.
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The malaria vaccine is prospected to be the game changer in containing and controlling malaria in the country and in Africa at large.
The launch of the malaria vaccine with additional protection for better results will be on March 7, 2023, in Vihiga county, Kenya.
