Malaria is a mosquito-borne infectious disease. One develops malaria after being bitten by an infected female Anopheles mosquito, known to spread the plasmodium parasites to humans. Malaria has been defined as a life-threatening disease by the World Health Organisation (WHO), hence the need to apply various strategies to combat the disease. In 2022, almost 249 million cases and 608,000 mortalities were recorded in 85 countries. The global burden was more in the WHO African Region which had 94% of cases (233 million) and 95% of mortalities (580 000), with 80% of the malaria deaths in the African region being children under the age of five.
Vaccines have become a very important tool in the broader malaria control strategy. It is expected to complement other interventions which include Insecticide-Treated Nets (ITN), indoor residual spraying, environmental control measures, and antimalarial medications.
The RTS, S/AS01 vaccine (Mosquirix) is the first vaccine found to provide partial protection against malaria in young children who are the most vulnerable. The roll-out of the vaccine is a landmark in the global fight against one of the deadliest diseases especially in Sub-Saharan Africa. The result has been promising since roll-out with a significant reduction in the number of cases and mortalities, amid various challenges.
The vaccine was first released for a pilot in three African countries: Ghana, Kenya, and Malawi in 2019. This initiative was led by WHO to assess the feasibility, safety, and effectiveness of being part of the routine immunisation schedules for children.
The early results from the pilot programmes were promising as there was a significant reduction in the number of cases of severe malaria that are responsible for mortalities. The safety profile aligned with what was observed in earlier clinical trials and showed no new safety concerns. In terms of feasibility, the vaccine was successfully integrated into the existing immunisation programmes, meaning it could be successfully rolled out with other vaccines. The long-term efficacy of the RTS, S/AS01 vaccine is being monitored because, from studies, the initial efficacy goes down over time hence, the need for booster doses after 18 months of completing the primary series to ensure protection.
Although it was not difficult to integrate the vaccine into the national immunisation programmes of the countries that piloted it, some complex issues were however associated with the process. These issues are those related to the Supply Chain, Healthcare Infrastructure, and Community Acceptance. To address these issues: a consistent supply of vaccines to remote and hard-to-reach areas has to be ensured, and healthcare systems have to be strengthened to support the additional burden of administering the vaccines, as well as the need to address the crucial aspect of building trust and community acceptance of the vaccine.
Vaccine Accessibility
Being able to distribute the malaria vaccine appropriately to reach those who need it may be a big challenge. WHO is working towards making more vaccines available by scaling up production and proper distribution to more children in endemic regions. A call has been made for partnerships between governments, international organisations, and pharmaceutical companies to support this initiative.
Research and Development
Being able to distribute the malaria vaccine appropriately to reach those who need it may be a big challenge. WHO is working towards making more vaccines available by scaling up production and proper distribution to more children in endemic regions. A call has been made for partnerships between governments, international organisations, and pharmaceutical companies to support this initiative.
Policy and Funding
Being able to distribute the malaria vaccine appropriately to reach those who need it may be a big challenge. WHO is working towards making more vaccines available by scaling up production and proper distribution to more children in endemic regions. A call has been made for partnerships between governments, international organisations, and pharmaceutical companies to support this initiative.
Knowledge, Attitude and Perception of Nigeria Toward Malaria Vaccine
The Federal government is scaling up the deployment of seasonal chemo-preventive (use of medicines) treatments to endemic areas to further reduce the spread of malaria by 10% by 2025. Nigeria has seen a significant reduction in prevalence and mortalities from the use of antimalarial medicines and the use of ITN. From a recent study, some policy actors do not believe that the malaria vaccine can reduce the burden of the disease. Community buy-in (emphasis on safety) and the cost of the vaccine also pose a big challenge. This underscores the vital need to increase the knowledge of Nigerians through education and, support towards adopting the use of vaccines, emphasising its safety and potential benefits in complementing other tools already available. The Government has a huge role to play in developing the best way to improve the knowledge of the populace on the benefits of the vaccine to enhance usability through acceptance and scalability when it is rolled out.
Presently, Nigeria has not started the pilot programme, but it has been projected to start with two states very soon. These states are Kebbi and Bayelsa. Nigeria was not listed as a beneficiary in the distribution of the 18 million doses of RTS, SAS01 for the 2023-2025 period due to a failure to meet the deadline on the application process. However, being on a waiting list considering the urgent need of the country to combat the disease. The Malaria Vaccine Implementation Programme has allocated additional doses to Ghana, Kenya, and Malawi to continue vaccinations in pilot areas. In addition, allocations have been made for new introductions of the use of the vaccines in Benin, Burkina Faso, Burundi, Cameroon, DRC, Liberia, Niger, Sierra Leone and Uganda.
The second vaccine R21/Matrix-M has been added to the list of prequalified vaccines by the WHO, but it has not yet been fully approved as more data are expected to come in from the phase 3 clinical trial. Although Ghana and Nigeria have authorised its use because it has been proven to be more effective in preventing malaria, it is more cost-effective and more likely to be available in large quantities. This decision has provided the opportunity to carry out the phase 4 trial of the vaccine in Nigeria.
In conclusion, years after roll-out, the RTS, S/AS01 malaria vaccine approved by the WHO has proven to be a dependable tool in combating malaria, especially in the endemic regions. Although challenges remain, through continued efforts in funding, research, intensive government effort, international organisation support, and healthcare systems strengthening, this tool will complement existing tools towards the eradication of Malaria. The second vaccine, the R21 vaccine has been added to the list of prequalified vaccines by the WHO and two countries, Ghana and Nigeria have keyed into using it allowing for phase 4 clinical trial to be implemented.
