A map by the International Association for Medical Assistance to Travelers shows where the risk of contracting Malaria is greatest.
Malawi has become the first country in the world to roll out a malaria vaccine, with two other African countries set to follow in its footsteps in coming weeks. The vaccine was launched just ahead of World Malaria Day, which is observed on April 25 annually. Despite concentrated efforts to lessen the impact of the disease in Africa and globally, malaria remains one of the world’s leading causes of death, with one child dying from the disease every two minutes.
The World Health Organisation (WHO) has welcomed the Malawian government’s launch of the pilot project where the vaccine, known as RTS,S, will be made available to children up to the age of two. In coming weeks the malaria vaccinations will also be rolled out to children in Ghana and Kenya.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2017, there were an estimated 219 million cases of malaria in 87 countries. Despite being one of the leading causes of death internationally, it is both preventable and curable.
Malaria is a life-threatening disease transmitted through the bites of infected mosquitoes. Pic: Stock
Most malaria-related deaths occur in Africa, where more than 250 000 children die annually. Children under the age of five are at greatest risk of life-threatening complications after contracting the disease, which kills 435 000 people worldwide each year. The vaccine is administered in four doses - three of them between five and nine months of age, and the final dose around the child’s second birthday.
The WHO Director-General Tedros Adhanom Ghebreyesus says there have been massive strides made in malaria prevention in the past 15 years, but that these are not enough. “We have seen tremendous gains from bed nets and other measures to control malaria, but progress has stalled and even reversed in some areas.”
He says new solutions and innovations are needed to ensure that the response to this disease gets back on track. “This vaccine gives us a promising tool to get there. The malaria vaccine has the potential to save tens of thousands of children’s lives.”
Innovation thirty years in the making
After three decades of development, the RTS,S vaccine is the first and only vaccine that has been shown to significantly reduce malaria in children. During clinical trials the vaccine was found to prevent about four out of every ten malaria cases, and three in ten cases of life-threatening severe malaria. Six in ten cases of severe malaria anaemia, which is the most common malaria-related cause of death in children, were prevented. A significant decrease in hospital admissions and the need for blood transfusions, which are needed to treat severe malaria anaemia, was also noted.
“Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes.” She says this is a day to celebrate as the medical and developmental communities learn more about how this vaccine can be used to change the trajectory of the disease through early interventions and childhood vaccinations.
The vaccine has been in development for thirty years and is the first of its kind to show any successes.
The WHO will use the pilot programme to generate evidence and experience in order to inform policy recommendations on the broader use of the malaria vaccine, looking at reductions in child deaths, as well as the vaccine uptake. Other considerations are whether parents will bring their children on time for the four required doses and vaccine safety in the context of routine use. The WHO says the vaccine is not recommended as a stand-alone treatment, but is rather a complementary malaria control tool to be added to the core package of recommended prevention measures like the routine use of insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment.
Public-private partnerships at work
The pilot programme, coordinated by the WHO, is done in collaboration with the ministries of health of the three countries where the vaccine will be rolled out, as well as a number of other local and international corporates and non-profit organisations. The vaccine developer and manufacturer, GSK, will be donating up to 10 million vaccine doses for the project.
Steve Davis is president and CEO of PATH, a non-profit organisation that has partnered on the pilot. “We salute WHO and Malawi for their leadership in realizing this historic milestone,” he said. “ We look forward to the start of vaccination in Ghana, and then Kenya later this year. A vaccine for malaria is among many innovations needed to bring an end to this disease, and we proudly stand with all countries and our many partners in progressing towards a malaria-free world.”
Unitaid is another organisation with close ties to the pilot project. Executive Director of Unitaid, Lelio Marmora says the vaccine roll-out is an important step in the fight towards a malaria-free world. “The vaccine is an exciting innovation that complements the global health community's efforts to end the malaria epidemic. It is also a shining example of the kind of inter-agency coordination that we need.”
According to WHO, the vaccine pilot aims to reach about 360 000 children each year across the three selected countries. The local ministries of health will determine where the vaccine will be given, focusing on areas with a high number of transmissions where they believe the vaccine can have the greatest impact. According to WHO Kenya, Malawi and Ghana were selected from ten African countries, looking at other key criteria like well-functioning malaria and immunisation programmes, couples with moderate to high malaria transmission risks.
Chief Medical Officer of GSK Vaccines says they look forward to seeing the results of their development in action. “Delivering the world’s first malaria vaccine will help reduce the burden of one of the most pressing health challenges globally,” he said. He added that in parallel to the pilot project, they are continuing to work with WHO and PATH to secure the sustained global impact of the vaccine.