Health in Africa

World Malaria Day: How Africa plans to fight the disease

Malawi becomes the first African nation to roll out landmark vaccine, Ghana and Kenya to join the league soon; Uganda adopts a new mass action strategy

By Kiran Pandey
Published: Thursday 25 April 2019

Around 90 per cent of the 435,000 global deaths due to malaria were in Africa, and a majority of them — 250,000 — were children under five. 

However, the World Health Organization (WHO) recently announced that Malawi has become the first country in the world to begin immunising children against malaria under a landmark pilot programme.

A vaccine known as RTS,S/AS01 (RTS,S) will be made available to children up to two years. Ghana and Kenya, too, will be introducing the vaccine in the coming weeks, according to the WHO.  

This vaccine which took almost 30 years to be developed by GlaxoSmithKline, provides partial protection against malaria among young children. It will only protect about one-third of the children who are immunised, while those who get the shots are likely to have less severe cases of malaria.

During clinical trials, the vaccine was found to prevent approximately four in 10 malaria cases, including three in 10 cases of life-threatening severe malaria. It acts against Plasmodium falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. It is the first, and to date, the only vaccine to show a protective effect against malaria among young children in a trial conducted between 2009 and 2014.

Collaborative venture on childhood vaccination

Even though the public health potential of the RTS,S vaccine was recognised by the WHO, a further evaluation of RTS,S/AS01 was required to address several gaps in knowledge before considering wider country-level introduction. Hence, WHO has selected three out of 10 African countries — Ghana, Kenya and Malawi.

The ministries of health in Ghana, Kenya and Malawi will focus on areas with moderate-to-high malaria transmission to ensure maximum impact of the vaccine. In selected areas in the three countries, the vaccine will be given in four doses: three doses to those between five and nine months of age, and the fourth dose provided around the second birthday.

This malaria vaccine implementation programme (MVIP) has been structured by WHO to address several outstanding questions related to the public health use of the vaccine. The programme aims to reach about 360,000 children per year across the three countries.

“Malaria is a constant threat in the African communities where this vaccine will be given. We know the power of vaccines to prevent killer diseases and reach children. This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination,” said Matshidiso Moeti, WHO regional director for Africa.

Future of the vaccine after three years

This programme is expected to continue till 2022. In the next three years it is expected to provide data on feasibility, the safety profile of RTS,S in the context of routine use, and the vaccine’s impact on child survival. Success of the programme in the three African countries will decide the wider-scale deployment of the vaccine in the future. 

A word of caution

According to the European Medicines Agency — the benefits of the vaccine outweigh the risks. However, the WHO does not recommend the use of the RTS,S vaccine in the younger (6–12 weeks) age category, as the vaccine’s efficacy has been found to be low in this age category so far. Even as the pilot takes off in Malawi, the vaccine, costing $5 per dose, can have maximum public health impact and can be cost-effective too if it is considered as a package of preventive interventions along with high usage of long lasting insecticidal nets (LLINs), and high coverage of seasonal malaria chemoprevention (in places with high seasonal malaria transmission as suggested by WHO in 2013).

Uganda too has a new strategy to fight malaria

Even as Malawi, Ghana and Kenya are working with WHO, Uganda has decided to develop a new Mass Action Against Malaria (MAAM) strategy. The country accounts for four per cent of global malaria cases and is also among the top five countries responsible for nearly half of all malaria cases worldwide, along with Nigeria, Democratic Republic of Congo, Mozambique and India.

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