2023-11-22 19:07:29
by Health Editorial Staff
After the pilot project which led to a 13% drop in mortality and the green light from the WHO, the large-scale immunization program begins in the areas at highest risk
Shipments of RTS,S, the first WHO-recommended malaria vaccine, have begun, with 331,200 doses arriving last night in Yaound, Cameroon. The delivery is the first to a country not previously involved in the malaria vaccine pilot program and indicates that malaria vaccination in the highest risk areas of the African continent will begin shortly. Almost every minute, a child under 5 dies from malaria. In 2021, there were 247 million cases of malaria globally, resulting in 619,000 deaths. Of these deaths, 77% involved children under 5, mostly in Africa.
Immunization in routine programs soon
Malaria burden is highest on the African continent, accounting for approximately 95% of global malaria cases and 96% of malaria-related deaths in 2021. Another 1.7 million doses of RTS vaccine are expected to arrive in the coming weeks,S in Burkina Faso, Liberia, Niger and Sierra Leone, while other African countries will receive doses in the coming months. This means that several countries are now in the final stage of preparations for the introduction of the malaria vaccine into routine vaccination programmes, which are expected to see the first doses administered in the first quarter of 2024.
Introducing any new vaccine into essential vaccination programs requires complex preparations, such as training of health workers, investment in infrastructure, technical capacity, vaccine storage, community involvement and demand, planning and integrating the vaccine rollout alongside the provision of other vaccines and health interventions.
Four-dose schedule
Malaria vaccine distribution presents the added challenge of a four-dose schedule that requires careful planning for effective distribution. Since 2019, Ghana, Kenya and Malawi have administered the vaccine on a 4-dose schedule starting at approximately 5 months of age in selected districts as part of the pilot program, known as the Malaria Vaccine Implementation Program (MVIP).
Mortality reduced by 13%
Over 2 million children have received malaria vaccination in three African countries through the MVIP, with a notable 13% decline in all-cause mortality among children of age eligible to receive the vaccine and a substantial reduction in severe disease from malaria and hospital admissions. Other key findings from the pilot program show high vaccine uptake, with no reduction in the use of other malaria prevention measures or the administration of other vaccines.
An international coalition
The MVIP is coordinated by the World Health Organization (WHO) in collaboration with UNICEF and other partners and financed by Gavi, the Global Fund and UNITAID, with doses donated by GSK, the manufacturer of the RTS,S vaccine. The world needs good news, and this is good news, said David Marlow, CEO of Gavi, the Vaccine Alliance. Gavi is proud that our Stakeholder Alliance, with African countries at the forefront, has decided to invest in the malaria vaccine as a public health priority and that this support has contributed to the availability of a new tool that can save the lives of thousands of children every year. We are excited to roll out this historic vaccine through Gavi programs and work with partners to ensure it is delivered alongside other vital measures.
This could be a real turning point in our fight against malaria, said UNICEF Director General Catherine Russell. The introduction of vaccines like adding a star player on the pitch. With this long-overdue step, led by African leaders, we are entering a new era in malaria vaccination and control, with the hope of saving the lives of hundreds of thousands of children every year.
This is another watershed moment for malaria vaccines and malaria control, and a ray of light in a dark time for so many vulnerable children around the world. The delivery of malaria vaccines to new countries in Africa will offer life-saving protection to millions of children at risk of malaria, WHO Director-General Tedros Adhanom Ghebreyesus said. But we shouldn’t stop here. Together we must find the will and resources to bring malaria vaccines to scale, so that more children can live longer, healthier lives.
The developments
Data from the pilot demonstrated the impact and safety of the RTS,S vaccine and provided important evidence on the acceptability and uptake of the vaccine which contributed to the recent WHO recommendation of a second malaria vaccine, R21, produced by the Serum Institute of India (SII). Results from a phase 3 study for R21 showed that the vaccine has a good safety profile in clinical trials and reduces malaria in children. It is expected that, like RTS,S, when R21 is implemented it will have a similar impact on public health. The choice of vaccine to use in a country must be based on the characteristics of the program, availability of the vaccine and economic accessibility. The R21 vaccine is currently under review by WHO for prequalification.
Not just vaccines
The availability of two malaria vaccines is expected to increase supply to meet high demand in African countries and lead to sufficient vaccine doses for all children living in areas where malaria is a public health risk. In preparation for large-scale vaccination, Gavi, WHO, UNICEF and partners are working with countries that have expressed interest and/or confirmed rollout plans on subsequent phases. These developments demonstrate that widespread application of malaria vaccination in malaria-endemic regions has the potential to be a game-changer for malaria control and could save tens of thousands of lives each year.
However, malaria vaccines are not a one-size-fits-all solution. They should be introduced in the context of the WHO-recommended package of malaria control measures, which includes insecticide-treated bed nets, internal residual spraying, intermittent preventive treatment in pregnant women, antimalarials, effective management and case treatment, all of which have contributed to reducing malaria-related deaths since 2000. Importantly, the MVIP has shown that the administration of vaccines together with non-vaccination interventions can strengthen the uptake of other vaccines and the use of insecticide-treated bed nets, and generally increase access to malaria prevention measures.
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November 22, 2023 (modified November 22, 2023 | 6:06 pm)
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