Thousands of children are benefiting from the added protection provided by the world’s first malaria vaccine (RTS,S) one year after it was introduced in three African countries.

The pilot vaccine implementation programme which was introduced in April last year is taking place in Ghana, Kenya and Malawi.

At a webinar to provide updates on the achievement of the vaccine and how it had responded to COVID-19, the Lead for the Malaria Vaccine Implementation Programme at the World Health Organisation (WHO), Dr Mary Hamel, said vaccines were powerful public health tools and the introduction of a malaria vaccine was a major step forward in malaria control.

The webinar was a collaboration between the Roll Back Malaria Partnership to End Malaria and the African Media and Malaria Research Network (AMMREN).

Malaria, COVID-19

Dr Hamel said the prevention of malaria was particularly important around this time of COVID-19 when access to clinics were disrupted.

She said in the era of COVID-19, malaria prevention was strategically important because the symptoms of COVID-19 overlapped quite a bit with the symptoms of malaria in children.

She said there had been little or no impact on vaccine distribution or uptake in the pilot countries during the COVID-19 period and the evaluation component of the implementation programme was continuing.

“But we are being very vigilant and watching closely because we expect that COVID-19 will peak in sub-Saharan Africa probably in the next one or two months, so we are monitoring the situation,” she said.

Malaria vaccine

Dr Hamel said the malaria vaccine did not prevent all malaria cases but reduced the number of malaria episodes a child would experience and reduced the chance of getting severe malaria.

She said in order to get the most benefits from the vaccine, it had to be supported with other malaria prevention tools such as sleeping under insecticide-treated bed nets (ITNs) in order to save tens of thousands of lives.

She said evaluation from all three countries that were piloting the malaria vaccine would help inform how best the vaccine could be introduced into the routine immunisation system.

Dr Hamel recalled that there was tremendous progress in malaria control between 2000 and 2015 with a dramatic decline in malaria cases and halving of malaria deaths.

However in 2015, the progress stalled and about 240,000 children died of malaria in 2018, adding that the incidence of malaria was still increasing in some high-burden countries.

“So we need new tools to get malaria control back on track to change that trajectory and further reduce malaria, and the RTS,S vaccine may be the next new tool,” she added.

She commended the network of African scientists who played a major role in the development of the vaccine, including leading the phase 3 trial, which was the largest clinical trial across Africa.

Furthermore, she said the pilot of the malaria vaccine could also not have happened without the strong commitment from the Ministries of Health of the three countries.

Next step

Dr Hamel said while the pilots continued, it was expected that thousands of more children would be vaccinated in the coming year or two, and information that would be gathered would feed and inform policy recommendation for the broader use of the vaccine.

Ghana’s situation

For his part, the Africa Lead at the PATH Malaria Vaccine Initiative, Mr John Bawa, said as of now, about 106,000 children in Ghana had received the first dose of the malaria vaccine and by October this year, the first set of children who started last year would be due for their fourth dose of the malaria vaccine.

He said that was a great accomplishment, especially within the context of COVID-19.

He said during the early times of COVID-19, the partners involved in the malaria vaccine anticipated that there could be some impact on the uptake so they worked effectively with the Ministries of Health of the pilot countries to be able to put in place measures to ensure that the impact of COVID-19 was minimised.

He explained that the main strategy the ministry took was to be proactive and to come up with appropriate guidelines that ensured that session sizes were reduced as much as possible, social and physical distancing were maintained and also made sure that the necessary logistics in terms of PPEs that the teams needed were made available.

Additionally, he said the massive public education also helped maintain the level of coverage of the malaria vaccine even within the COVID-19 period.

“While COVID-19 is still a critical issue in Ghana, the Health Ministry has also prioritised the need to sustain malaria and other services, especially the ones that affect the health of women and children in the country,” he said.

The ministry has been able to leverage the ongoing communication on COVID-19 to provide additional information on caregivers and community members to continue immunisation services.

Mr Bawa said the country had also benefited immensely from the rollout of other malaria intervention programmes, especially ITNs, effective case management and indoor residual spraying, and Seasonal Malaria Chemoprevention (SMC) in other parts of the country.

Those, he said, had reduced the burden of malaria significantly in the country although some parts of the country had recorded significant numbers of malaria. He was, therefore, hopeful that the malaria vaccine, which was an additional tool, would be able to minimise or control malaria towards the goal of elimination that the country had set.

He said the community and caregivers in the pilot areas had been ecstatic about the malaria vaccine, adding that so far, the uptake had been good.

A recent malaria cluster survey report by the Ghana Statistical Service indicated that when community members were asked about their knowledge of the malaria vaccine, most of them said “yes they had heard and close to 90 per cent of them said they will be ready to present their children for the malaria vaccine if it becomes available and if their children are due for it”.

Mr Bawa commended the Ministry of Health and the teams on the ground for the great work they were doing, adding that, “There is a lot of potential and good news as we continue to roll out the malaria vaccine.”

RTS,S

The RTS,S is the first and to date the only vaccine that has demonstrated some effectiveness in reducing malaria in young African children. The vaccine is being delivered by the Ministries of Health as part of the Expanded Programme on Immunisation (EPI).

About 360,000 children per year across the three pilot countries will receive the vaccine.

When used together with effective interventions such as bed nets, insecticide spraying, diagnostics and drugs, the vaccine has the potential to protect thousands of African children who die from malaria every year.