Monday, November 29, 2021
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Malaria Vaccine: Vital Addition To Toolkit For Preventing Malaria But No Magic Bullet


It is indeed a breakthrough scientific achievement that
we now have the first-ever and only malaria vaccine to
prevent malaria in children. This is an important (and
long-awaited) addition to existing range of scientifically
proven effective methods to prevent malaria. While we
celebrate this moment of yet another milestone scientific
feat we must remind ourselves that this new and only vaccine
is a complementary malaria control tool which needs to be
added to the already proven measures for malaria
prevention.

Malaria vaccine is a vital addition to
malaria prevention options such as routine use of
insecticide-treated bed nets, indoor spraying with
insecticides, and the timely use of malaria testing and
treatment. But we have to also acknowledge that access to
these proven methods to save lives from malaria has been far
from satisfactory, as a result of which, as per the latest
data, 229 million people got malaria in 2019 (compared to
228 million in 2018), and 409,000 died of malaria in 2019
– most of them children (compared to 411,000 deaths in
2018). Children under 5 are at greatest risk of its
life-threatening malaria complications. Despite
unprecedented progress in in the recent two decades in the
fight against this ancient disease, malaria remains one of
the world’s leading killers, claiming the life of one
child every two minutes; and most of these deaths are in
Africa.

Let us celebrate this turning point – as
there is no doubt that malaria vaccine is going to be one of
the blessings in the global fight to end malaria by 2030.
Clock is ticking! As 110 months are left to end malaria
worldwide, let us also make doubly sure we scale up the
rollout and access to all the science-backed methods to save
lives from malaria.

DYK about first-ever
malaria vaccine?

The United Nations health
agency, World Health Organization (WHO), has recommended the
first-ever malaria vaccine for children, in regions with
moderate to high transmission of deadliest malaria parasite
(Plasmodium falciparum). This vaccine acts against this
malaria parasite which not only causes the most lethal
malaria globally, but also is most prevalent in Africa. The
WHO recommendation of this vaccine is based on results from
an ongoing pilot programme in Ghana, Kenya and Malawi that
has reached more than 800,000 children since
2019.

This malaria vaccine (RTS,S/AS01) is the first,
and to date the only, vaccine that has demonstrated it can
significantly reduce malaria in children.

The
scientific research for this malaria vaccine has been going
on since past 30 years. Phase-3 clinical studies were
conducted between 2009 and 2014 in African nations. Children
receiving 4 doses of this vaccine, experienced significant
reductions in malaria and malaria-related complications in
comparison to those who did not receive the
vaccine.

In clinical studies, the vaccine was found to
prevent 4 in 10 malaria cases, including 3 in 10 cases of
life-threatening severe malaria. In addition, the vaccine
also prevented 6 in 10 cases of severe malaria anaemia, the
most common reason children die from malaria. Significant
reductions were also seen in overall hospital admissions and
the need for blood transfusions, which are required to treat
severe malaria anaemia. These and other benefits were in
addition to those already seen through the use of
insecticide-treated bed nets, prompt diagnosis, and
effective antimalarial treatment.

This malaria vaccine
(RTS,S/AS01) is to be provided in 4 doses to children from 5
months of age up to 2 years. First 3 doses are given between
6 to 9 months of age, and 4th dose is given at 2 years of
age.

The pilot of this malaria vaccine has been going
on in Ghana, Kenya and Malawi since 2019. This malaria
vaccine pilot began first in Malawi in April 2019, then in
Ghana in May 2019, and finally in Kenya in September 2019.
This Malaria Vaccine Implementation Programme generated
evidence and experience on the feasibility, impact and
safety of the RTS,S malaria vaccine in real-life, routine
settings in selected areas of these three African nations:
Ghana, Kenya and Malawi.

The pilot has proven
that:

  • Feasible to deliver: Vaccine
    introduction is feasible, improves health and saves lives,
    with good and equitable coverage of RTS,S seen through
    routine immunization systems. This occurred even in the
    context of the COVID-19 pandemic.
  • Reaching the
    unreached: RTS,S increases equity in access to malaria
    prevention. Data from the pilot programme showed that more
    than two-thirds of children in the 3 countries who are not
    sleeping under a bed net are benefitting from the RTS,S
    vaccine.
  • Layering the tools results in over 90% of
    children benefitting from at least one preventive
    intervention (insecticide treated bed nets or the malaria
    vaccine).
  • Strong safety profile: To date, more than
    2.3 million doses of the vaccine have been administered in 3
    African countries – the vaccine has a favourable safety
    profile.
  • No negative impact on uptake of bed nets,
    other childhood vaccinations, or health seeking behaviour
    for febrile illness. In areas where the vaccine has been
    introduced, there has been no decrease in the use of
    insecticide-treated bed nets, uptake of other childhood
    vaccinations or health seeking behaviour for febrile
    illness.
  • 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.

No
one-size fits all

Let us hope this malaria
vaccine along with all proven methods to save lives of
malaria will be fully rolled out without any delay in every
part of the world, driven by the local needs, contexts, and
national/ subnational strategies to end malaria. Financial
crunch or inequitable rollout or other forms of unjust
programming will not be an obstacle in ensuring universal
access to all range of healthcare services.

Bobby
Ramakant is a World Health Organization (WHO) Director
General’s WNTD Awardee 2008 and part of CNS (Citizen News
Service) and Asha Parivar teams. Follow him on Twitter
@BobbyRamakant or read
www.bit.ly/BobbyRamakant

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