More than 330,000 doses of WHO-recommended RTS,S malaria vaccine went to Cameroon, with an additional 1.7 million doses set for delivery to Burkina Faso, Liberia, Niger and Sierra Leone in the coming weeks.
Shipments of the world’s first WHO-recommended malaria vaccine, RTS,S, have begun with 331,200 doses landing last night in Yaoundé, Cameroon. The delivery is the first to a country not previously involved in the malaria vaccine pilot programme and signals that scale-up of vaccination against malaria across the highest-risk areas on the African continent will begin shortly.
Nearly every minute, a child under five dies of malaria. In 2021, there were 247 million malaria cases globally, which led to 619,000 deaths. Of these deaths, 77 percent were children under 5 years of age, mostly in Africa. Malaria burden is the highest on the African continent, which accounts for approximately 95% of global malaria cases and 96% of related deaths in 2021.
A further 1.7 million doses of the RTS,S vaccine are expected to arrive in Burkina Faso, Liberia, Niger and Sierra Leone in the coming weeks, with additional African countries set to receive doses in the months ahead. This reflects the fact that several countries are now in the final stage of preparations for malaria vaccine introduction into routine immunization programmes, which should see first doses administered in Q1 2024.
Comprehensive preparations are needed to introduce any new vaccine into essential immunization programmes – such as training of health care workers, investing in infrastructure, technical capacity, vaccine storage, community engagement and demand; and sequencing and integrating roll-out alongside the delivery of other vaccines and health interventions. Delivering the malaria vaccine has the added challenge of a four-dose schedule which requires careful planning to effectively deliver.
The Pilot Program
Since 2019, Ghana, Kenya and Malawi have been administering the vaccine in a schedule of four doses from around 5 months of age in selected districts as part of the pilot programme, known as the Malaria Vaccine Implementation Programme (MVIP). More than 2 million children have been reached with the malaria vaccine in the three African countries through MVIP, resulting in a remarkable 13% drop in all-cause mortality in children age-eligible to receive the vaccine; and substantial reductions in severe malaria illness and hospitalizations.
Other key findings from the pilot programme show that vaccine uptake is high, with no reduction in use of other malaria prevention measures or uptake of other vaccines. MVIP is coordinated by WHO in collaboration with UNICEF and other partners; and funded by Gavi, the Global Fund and UNITAID, with donated doses from GSK, the manufacturer of the RTS,S vaccine.
A Second Vaccine
The data from the pilot have shown the impact and safety of the RTS,S vaccine and provided important evidence on vaccine acceptability and uptake that helped inform the recent WHO recommendation of a second malaria vaccine – R21, manufactured by the Serum Institute of India (SII). Results of a phase 3 trial for R21 showed that the vaccine has a good safety profile in the clinical trial setting and reduces malaria in children. It is expected that, like RTS,S, when R21 is implemented it will have similar high public health impact. The choice of which vaccine to be used in a country should be based on programmatic characteristics, vaccine supply and affordability.
The R21 vaccine is currently under review by WHO for prequalification. The availability of two malaria vaccines is expected to increase supply to meet the high demand from African countries and result in sufficient vaccine doses to benefit all children living in areas where malaria is a public health risk. In preparation for scaled-up vaccination, Gavi, WHO, UNICEF and partners are working with countries that have expressed interest and/or have confirmed roll-out plans on the next steps.
These developments mean that broad implementation of malaria vaccination in endemic regions has the potential to be a gamechanger for malaria control efforts, and could save tens of thousands of lives each year. However, malaria vaccines are not a standalone solution. They should be introduced in the context of the WHO-recommended package of malaria control measures which include insecticide-treated nets, indoor residual spraying, intermittent preventive treatment in pregnant women, antimalarials, effective case management, and treatment – all of which have helped to reduce malaria-related deaths since 2000. Importantly, the MVIP showed that delivering vaccines alongside non-vaccine interventions can reinforce the uptake of other vaccines and the use of insecticide treated nets, and overall boost access to malaria prevention measures.
Source : Angels in Medicine