By Alicia Barron
In Kenya (where approximately 10,700 people die from malaria every year) new mothers are sent home from the hospital with bed nets and told that their best weapon against a disease that kills 260,000 children under the age of five every year in sub-Saharan Africa alone, is some mesh netting and increasingly ineffective insecticide. Malaria is a primary cause of childhood illness and death in sub-Saharan Africa. Mathews Ajwala, a community health worker in Kenya stated that “Malaria is our number one health problem.” In Tanzania, 90% of the population is at risk and the country records 11 million clinical cases a year. People can also contract malaria several times in a year or a lifetime which leads to delayed development, especially in children. Although there has been a decrease in malaria deaths since 2000, a worrying trend is emerging with the various strains growing resistant to existing medicines and prevention strategies. It’s easy to compress death and infection rates into pure statistics and forget the human element behind it, but for those on the ground in high-risk areas, the reality is like watching your loved ones in a slow-motion car crash and being helpless to stop it. This is why a recent announcement from the World Health Organisation (WHO) has been described as “an historic moment” and is being met with celebrations around the world.
On the 6th of October WHO, in an unprecedented decision, recommended the use of a new malaria vaccine. WHO’s Director-General Dr Tedros Adhanom Ghebreyesus touted the new development as “a breakthrough for science.” The new vaccine, known as RTS,S/AS01 or Mosquirix, targets the parasite Plasmodium falciparum which is the most prevalent and deadliest strain of malaria in Africa. The timing couldn’t be better, with the parasite developing a resistance to existing anti-malarial medication and many health centres in affected areas overrun by COVID-19, the news has been welcomed by stakeholders across the globe as a “glimmer of hope”. However, the vaccine is not a ‘hail mary’ solution and there are important efficacy and policy considerations that need to be addressed before affected communities will see a decrease in cases and deaths.
This vaccine has been a long time coming, with development taking 30 years. Malaria has posed such a problem for scientists due to the parasite being able to reside in both mosquitoes and humans, making it difficult to formulate a vaccine that is effective against both hosts. Malaria is most prevalent in some of the world’s poorest countries, meaning there was previously little financial incentive for pharmaceutical companies to put resources towards developing a vaccine. This new vaccine was jointly developed by the company GlaxoSmithKline (GSK) and the non-profit PATH Malaria Vaccine Initiative (MVI) with pivotal funding from the Bill and Melinda Gates Foundation. It is recommended that children with a moderate to high risk of becoming infected receive four doses starting from when they are five months old. Since 2019, a pilot program, wherein more than 800,000 children have been vaccinated, has been running in Ghana, Kenya and Malawi, testing the effectiveness of the vaccine itself and rollout and distribution strategies. This pilot program along with clinical trials show that the vaccine decreases the risk of contracting severe malaria by 30% in the first year after it’s administered. However, the vaccine’s protective immunity decreases over time, indicating that multiple booster shots will be needed throughout one’s life. Comparing this to recently developed vaccines against COVID-19, many of which decrease the chance of contracting the disease into the 90th percentile, it’s easy to see why many in the community don’t want to get their hopes up. Dr Githinji Gitahi, CEO of the NGO Amref Health Africa stated that “the vaccine saves lives, but it will not be a silver bullet.” WHO and other health organisations have emphasised that having a vaccine does not mean the existing preventative measures can be discarded - it is simply an added layer of protection.
In addition to this, there are questions surrounding how the vaccine should be distributed and how it should fit into a child’s vaccination schedule. These are questions of policy, and as each country is responsible for their own rollout of the vaccine, it remains to be seen if there will be any sort of uniformity or consistency. There is worry that governments do not have a plan in place for distribution which could see the vaccine sitting in a warehouse indefinitely. In particular, there are concerns surrounding how to effectively distribute the vaccine to rural areas where access to health care is limited. Further questions arise when considering conflict zones where malaria is often rife. These concerns are all inherently tied to funding and at the moment it is unclear whether affected countries will need to fund the rollout themselves or will receive aid from the global health community. The world has also seen an increase in misinformation via the internet and an increase in anti-vaccine sentiment. This is intertwined with a mistrust of government and WHO, evidenced by teacher, Mamadou Tounkara, in Senegal’s capital Dakar who questioned why WHO did not instead fund better sanitation systems and didn’t think a vaccine was necessary to protect against malaria. A study focusing on Tanzania found that lack of community support for vaccines is generally due to poor knowledge and perceptions. However, it would be remiss to assume that poor uptake of vaccines is always due to personal choice. Many people in affected countries cannot get certain vaccines due to the cost and lack of accessibility. Governments must also figure out how best to balance this vaccination campaign with other vaccination campaigns currently ongoing with COVID-19 and the measles.
These issues might not be resolved for years as the vaccine rollout slowly gets underway. However, it is expected that this vaccine is merely a necessary starting point and will spur the development of next-generation vaccines in the coming decades. It is anticipated that if successful rollout occurs, there will be a major positive impact on socioeconomic growth and welfare.
Abdi Latif Dahir, ‘Africans Welcome New Malaria Vaccine. But is it a ‘Game Changer’?’, The New York Times (online, 7 October 2021).
Danielle Stanisic and Michael Good, ‘World’s first mass malaria vaccine rollout could prevent thousands of children dying’, The Conversation (online, 8 October 2021).
Melinda Moree and Sarah Ewart, ‘Policy Challenges in Malaria Vaccine Introduction’ (2004) 71(2) The American Journal of Tropical Medicine and Hygiene 248.
Rebecca Voelker, ‘As Trials Advance for a Malaria Vaccine, Policy Makers Urged to Plan for its Use’, JAMA (online, 1 December 2010).
Sally Mtenga et al, ‘Stakeholders’ opinions and questions regarding the anticipated malaria vaccine in Tanzania’ (2016) 15(1) Malaria Journal 189.
World Health Organisation, ‘WHO recommends groundbreaking malaria vaccine for children at risk’ (News Release, 6 October 2021).