Through the groundbreaking pilot program of the RTS,S Malaria vaccine has incredibly reached over 650,000 children in Kenya, Ghana and Malawi.
By Constance Ndeleko
This pilot program was launched two years ago with more than 1.7 million doses of world’s first malaria vaccine having been administered. Malaria control interventions, has the potential to save tens of thousands of lives per year.
The number of children reached in this relatively short period indicates strong community demand for the vaccine as well as the capacity of the countries’ child immunization programs to deliver the vaccine on a novel schedule (4 doses up to about age 2 years) says the Mirage online paper.
Extensive testing in clinical trials (including a large-scale Phase 3 trial) in sub-Saharan Africa have confirmed that the RTS,S malaria vaccine reduces malaria significantly, including life-threatening severe malaria in young children.
“Over the last 2 decades, we have achieved remarkable results with existing malaria control tools, averting more than 7 million deaths and 1.5 billion cases of the disease,” says Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “However, progress towards key targets of our global malaria strategy remains off course. To get back on track, new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit.”
Insights generated by the pilot implementation will inform a WHO recommendation on broader use of the vaccine across sub-Saharan Africa. Global advisory bodies for immunization and malaria are expected to convene in October 2021 to review RTS,S data and consider whether to recommend wider use of the vaccine.
“In some ways malaria is the child health emergency of a lifetime – or many lifetimes – in Africa. We applaud the work of participating countries that has resulted in malaria vaccine pilots with strong vaccination coverage that will add to our understanding of the RTS,S vaccine’s potential to improve child health and strengthen malaria control – and, potentially, reverse trends,” says Dr Akpaka Kalu, Team Leader for Tropical and Vector-borne Diseases in the WHO African Region.
In 2019, there were 229 million malaria cases globally that led to 409,000 deaths. Of these deaths, 67 per cent (274,000) were children under 5 years of age. This translates into a daily toll of nearly 750 children under age 5. Many of these deaths are preventable and treatable.
Statistics show that sub-Saharan African countries are with high malaria transmission where pregnant women are highly vulnerable to malaria infection due to reduced immunity. When infected with malaria during pregnancy, they are more likely to become anemic and give birth to low-birthweight or stillborn babies. Approximately 90 per cent of all malaria deaths currently occur in sub-Saharan Africa.
In 2019, there were an estimated 33 million pregnancies, of which 35% (12 million) were exposed to malaria infection during pregnancy. Central Africa had the highest prevalence of exposure to malaria during pregnancy (40%), closely followed by West Africa (39%), while prevalence was 24% in East and Southern Africa. It is estimated that malaria infection during pregnancy in these 33 countries resulted in 822 000 children with low birthweigh.
RTS,S is the first and, to date, the only vaccine that has been shown to reduce malaria in children, including life-threatening severe malaria, related hospital admissions and the need for blood transfusions. The vaccine is currently being piloted in areas of moderate to high malaria transmission where malaria can account for up to 60% of childhood outpatient visits to health facilities.
The Malaria Vaccine Implementation Programme supports the country-led introduction of the RTS,S vaccine in childhood immunization; and, separately, the evaluation of how best to reach children with the recommended four-dose regimen, the impact on severe malaria and on lives saved, and vaccine safety in routine use.
Crucially, efforts to combat malaria must be integrated with broader efforts to build strong health systems based on people-centered primary health care, as part of every country’s journey towards universal health coverage