What to know about malaria vaccine for children

On Wednesday the World Health Organisation (WHO) announced its approval of the first malaria vaccine for children. It recommended the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission.  The organisation said the recommendation was based on results from […]

On Wednesday the World Health Organisation (WHO) announced its approval of the first malaria vaccine for children.

It recommended the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission.

 The organisation said the recommendation was based on results from an ongoing pilot programme in Ghana, Kenya and Malawi that has reached more than 800 000 children since 2019.

Malaria is a life-threatening disease caused by plasmodium parasites that are transmitted to people through the bite of female anopheles mosquitoes carrying the parasites.

Symptoms include fever, headache, vomiting, diarrhoea, profuse sweating and anaemia.

The disease is a major public health burden in Africa. In 2019, it accounted for 94 per cent of both the 229 million malaria cases and 409, 000 malaria deaths reported globally, in spite of efforts towards tackling the disease.

It also remains a primary cause of childhood illness and death in sub-Saharan Africa, according to WHO with more than 260,000 African children under the age of five dying from malaria annually.

“In recent years, WHO and its partners have been reporting a stagnation in progress against the deadly disease,” the organisation said.

WHO Director-General Dr Tedros Adhanom Ghebreyesus described the approval of the vaccine as historic.

“The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control. Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year,” he said.

Dr Matshidiso Moeti, WHO Regional Director for Africa said for centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering.

She said, “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”

 

The RTS,S malaria vaccine

The malaria vaccine, RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa.

Before now, there was no vaccine for the prevention of malaria in both adults and children.

WHO then approved the pilot of the RTS,S malaria vaccine which was developed for children in three African countries; Ghana, Kenya and Malawi.

The financing for the pilot programme was mobilized through collaboration among three key global health funding bodies: Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria and Unitaid.

The Bill & Melinda Gates Foundation provided catalytic funding for late-stage development of RTS,S between 2001 and 2015.

WHO said the RTS,S malaria vaccine is the result of 30 years of research and development by GSK and through a partnership with PATH, with support from a network of African research centres.  

According to Dr. Perpetua Uhomoibhi, National Coordinator of the National Malaria Elimination Programme (NMEP) of the Federal Ministry of Health, the pilot was concluded last year and it was done to evaluate the efficacy of its use in children, as the vaccine is them.

Dr. Uhomoibhi, said another malaria vaccine for children called R21 Matrix-M Malaria vaccine was recently announced by Oxford, but “It is still undergoing clinical trial and has not been piloted in any country yet. It has also not been approved by WHO.

WHO said the pilot programme of RTS,S will continue in the three pilot countries to understand the added value of the 4th vaccine dose and to measure the longer-term impact on child deaths.

 

WHO recommendation for the RTS,S malaria vaccine

WHO made the recommendation based on the advice of two of its global advisory bodies, one for immunization and the other for malaria.

It recommends that in the context of comprehensive malaria control the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.  

“RTS,S/AS01 malaria vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden,” it said.

Key findings of the pilots informed the recommendation based on data and insights generated from two years of vaccination in child health clinics in the three pilot countries.

They include: Reaching the unreached, being highly cost-effective and strong safety profile.

“High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment,” WHO added.

 

Burden of Malaria in Nigeria

Nigeria is one of the endemic countries in sub-Saharan African and is expected to benefit from the vaccine.

The disease is still killing many Nigerians including children and pregnant women, in spite of efforts towards reducing the burden of the disease.

Nearly 61 million malaria cases occur in Nigeria annually, according to the World Health Organization (WHO) Malaria Report 2020.

WHO Country Representative, Dr Walter Kazadi-Mulombo, said the country continues to bear the disproportionate brunt of the malaria toll accounting for 27% and 23% of global cases and deaths respectively.

“With all Nigerians at risk, it accounts for more than 60% of hospital visits, 20% of under-five mortality and 11% of maternal mortality,” he said.

Perpetua Uhomoibhi, National Coordinator, National Malaria Elimination Programme (NMEP), said malaria is one of the key health challenges that Nigeria has to deal with, and transmission is all year round in most parts of the country.

About 11 persons die from malaria-related issues every hour in Nigeria, according to NMEP.

 

‘The vaccine is not a stand-alone intervention’

Pharmacist Tope Ogunbi, a Senior Malaria Specialist, said the endorsement of the RTS,S vaccine for malaria is a welcome development.

He said the effect and efficacy of the vaccine in the three countries where it was piloted showed that it has contributed to reducing the burden of malaria in children to about 30 per cent.

He said, “You know one life saved is definitely a huge thing to celebrate, so when you consider 30 per cent morbidity reduction that is a huge one.”

However, he said the vaccine offers partial protection, not full protection.

The pharmacist said the advice is to continue to use the vaccine in addition to other protective measures, such as sleeping consistently inside Insecticide Treated bednets every night all year round.

He said, “This vaccine is not yet uhuru or a stand-alone measure for protection against malaria. It offers partial immunity which is very good. Thirty per cent reduction in those countries that have been piloting this is a huge and significant contribution in reducing the mortality and morbidity of malaria in children who are the most vulnerable.

“The vaccine is said to be almost 40 per cent efficacious which is very good but it is not to be taken as a standalone intervention or strategy, controlling or reducing the burden of malaria.

“It is supposed to be combined with other preventive measures like consistent sleeping inside Insecticide Treated Nets. With all other vaccines, science and medicines, this approach is going to continue to be refined and will eventually bring out something that will offer better protection against malaria.”

While saying that the RTS,S is definitely a breakthrough and cheering news, he added that it has also opened options available for reducing the burden of malaria particularly in sub-Saharan Africa where we have the greatest burden of malaria.

Reducing 30 per cent mortality is journey towards zero malaria for Nigeria — Expert

Ogunbi, said it is a welcome development for the country adding, “We are looking forward to when the vaccines will be available in Nigeria.”

He said a 30 per cent reduction in the malaria burden among children in the country by the vaccine is a journey towards achieving zero malaria status.

“So we need all hands on deck in promoting this vaccine because for WHO to have approved it, it means it has gone through quality assurance and the researchers have done a lot to get to this point.

“It is something we should celebrate and welcome. I mean if we can reduce the burden of malaria in Nigeria by a whopping 30 per cent among this vulnerable population, and you add that to other strategies which we are currently employing, then you know that the journey towards zero malaria is definitely closer than ever before.”