In a press release on October 6, 2021, the World Health Organization (WHO) approved the use of the malaria vaccine RTS,S/AS01. This landmark achievement is based on the success of the pilot vaccination programs in three countries in the WHO African Region (WHO/AFRO) that are Ghana, Kenya and Malawi. Since 2019, more than 2.3 million doses have already been administered in these countries, proving that this vaccine is an effective additional tool in the fight against malaria.
Malaria, a scourge in the African region
A real scourge in the African region, malaria kills thousands of children every year. In 2019, for example, 257,950 children under the age of 5 died as a result of the disease according to the latest Integrated African Health Observatory (iAHO) regional malaria fact sheet. Indeed, by the end of 2019, an estimated 215 million people in the WHO/AFRO region had been infected with malaria. Equally important, the COVID-19 pandemic has disrupted access to health services for malaria. According to data from the pulse survey on continuity of essential health services during the COVID-19 pandemic, 36% of countries surveyed in the region reported disruptions in malaria treatment and diagnostic services.
As highlighted by Dr. Matshidiso Moeti, Regional Director of WHO/AFRO,
New opportunity for the fight against malaria
The result of 30 years of research, this vaccine presents a real opportunity for the region for several reasons. While there are several types of malaria parasites, the most widespread and deadly in the world and the one with the highest prevalence in Africa is Plasmodium falciparum. The RTS,S vaccine, also known as Mosquirix, specifically targets this parasite.
In addition, pilot programs in Kenya, Ghana, and Malawi have demonstrated several benefits that this vaccine can offer. First, the vaccine is a “promising additional tool for malaria prevention” (Dr. Matshidiso Moeti, WHO/AFRO Regional Director), since in the three countries where it was administered, no decrease in the use of insecticide-treated nets was recorded. In this regard, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphasized that "the use of this vaccine alongside existing tools to prevent malaria could save tens of thousands of young lives each year. According to a study published in late August in the New England Journal ofMedicine, led by Brian Greenwoord, a combination of vaccine and preventive treatment could reduce hospitalizations and deaths from the disease by 70% in young children.
The pilot program also demonstrated that the vaccine would be highly cost-effective, especially in countries with moderate to high transmission, which is the case for the WHO/AFRO region. In addition to being cost-effective, the malaria vaccine extends the equity of malaria control and thus offers an alternative to vulnerable populations who do not have access to other malaria control methods.
Finally, the vaccine reduces severe and fatal malaria cases by 30% in children aged 5-17 months who have received all four doses of the vaccine, bringing the African region closer to the global goal of reducing malaria cases and deaths by 90% by 2030.
Next steps
Now that the vaccine is available and approved, a key next step will be its massive rollout in the region, with financial support from the global community, and the inclusion of the malaria vaccine in national disease control strategies.
In a joint statement, the various technical and financial partners Gavi, Unitaid and the Global Fund stated that they were evaluating "the possibility and the way to finance a new malaria vaccination programme". In this sense, a first financing agreement between Gavi, MedAccess and GSK was adopted. This agreement guarantees the production of the RTS,S antigen needed for the malaria vaccine. Should Gavi support the malaria vaccine programme, this agreement will anticipate supply problems and facilitate the deployment of the vaccine in the countries of the region.
However, the availability of a vaccine does not necessarily mean its acceptance, as is the case with the COVID-19 vaccine. The issue of vaccine hesitancy is therefore also important to consider. However, the pilot study showed that in two years the vaccine reached more than 800,000 children in Ghana, Malawi and Kenya and was received with great enthusiasm.
According to Dr. Rose Jalang'o, the principal investigator of the malaria vaccine pilot program in Kenya:
The next few months will therefore be critical for the rollout of the vaccine in the African region and its introduction into countries' immunization schedules.