Shipments to African countries herald final steps toward broader malaria vaccination

by MMC
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Shipments of the first WHO-recommended malaria vaccine, RTS,S, began with 331,200 doses arriving yesterday evening in Yaoundé, Cameroon. This delivery is the first to a country that has not yet participated in the malaria vaccine pilot program and indicates that the scale-up of malaria vaccination in the highest risk areas of the African continent will soon begin.

Almost every minute, a child under five dies from malaria. In 2021, there were 247 million cases of malaria worldwide, resulting in 619,000 deaths. Of these deaths, 77 percent involved children under the age of 5, mainly in Africa. The burden of malaria is the highest on the African continent, accounting for approximately 95% of global malaria cases and 96% of associated deaths in 2021.

An additional 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 other African countries expected to receive doses in the coming months. This reflects the fact that several countries are now in the final stages of preparations for the introduction of the malaria vaccine into routine immunization programs, which are expected to see the first doses administered in the first quarter of 2024.

Comprehensive preparations are needed to introduce any new vaccine into essential immunization programs – such as training of health workers, investment in infrastructure, technical capacity, vaccine storage, community engagement and demand, as well as sequencing and integrating the rollout alongside the delivery of other vaccines and health interventions. . Malaria vaccine distribution presents the added challenge of a four-dose schedule that requires careful planning for effective distribution.

Since 2019, Ghana, Kenya and Malawi have been administering the vaccine on a 4-dose schedule starting at around 5 months of age in selected districts under the pilot program, known as the Implementation Program. Malaria Vaccine Implementation (MVIP). More than 2 million children were vaccinated against malaria in the three African countries through MVIP, resulting in a remarkable 13% decline in all-cause mortality among children of age eligible to receive the vaccine, as well as a substantial reduction in severe malaria cases and hospitalizations.

Other key results from the pilot show that the vaccination rate is high, with no reduction in the use of other malaria prevention measures or the use 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 doses donated by GSK, the manufacturer of the RTS,S vaccine.

Data from the pilot showed 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 for a second vaccine against malaria – R21, manufactured by the Serum Institute of India (SII). ).

Results from a phase 3 trial for R21 showed that the vaccine has a good safety profile in clinical trials and reduces malaria in children. It is expected that, like RTS,S, when R21 is implemented, it will have a similar impact on public health. The choice of which vaccine to use in a country should be based on program characteristics, vaccine supply and affordability.

The R21 vaccine is currently being reviewed by WHO for prequalification. The availability of two malaria vaccines is expected to increase supply to meet high demand from African countries and result in sufficient vaccine doses to benefit all children living in areas where malaria poses a public health risk . In preparation for scaling up vaccination, Gavi, WHO, UNICEF and partners are working with countries that have expressed interest and/or confirmed their deployment plans on next steps.

These developments mean that large-scale implementation of malaria vaccination in endemic regions could potentially be a game-changer in malaria control efforts and could save tens of thousands of lives each year. However, malaria vaccines are not a stand-alone solution.

They should be introduced in the context of the WHO-recommended package of malaria control measures, which include insecticide-treated bed nets, indoor residual spraying, intermittent preventive treatment in pregnant women, antimalarials, effective case management and treatment, all of which have contributed to reducing malaria-related deaths since 2000. Importantly, the MVIP has shown that providing vaccines alongside non-vaccine interventions can strengthen the adoption of other vaccines and the use of insecticide-treated bed nets, and generally improve access to malaria prevention measures.

“The world needs good news – and this is good news,” said David Marlow, CEO of Gavi, the Vaccine Alliance. “Gavi is proud that our Stakeholder Alliance, with African countries on the front lines, made the decision to invest in the malaria vaccine as a public health priority, and that this support played a role in availability of a new tool that can save lives. the lives of thousands of children every year. We are excited to roll out this landmark vaccine through Gavi’s programs and work with our partners to ensure it is distributed alongside other lifesaving measures.

“This could be a real game-changer in our fight against malaria,” said UNICEF Executive Director Catherine Russell. “Introducing vaccines is like adding a star player to the field. With this long-awaited measure, led by African leaders, we are entering a new era in vaccination and the fight against malaria, and we hope to save the lives of hundreds of thousands of children every year.

“This is another watershed moment for malaria vaccines and the fight against malaria, and a ray of light in a dark time for so many vulnerable children around the world. Delivering malaria vaccines to new countries in Africa will provide lifesaving protection to millions of children at risk of malaria,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “But we must not stop there. Together, we must find the will and resources to scale up malaria vaccines, so more children can live longer, healthier lives.

“This is a significant step forward towards scaling up malaria vaccination in the region. The vaccine, which protects children against severe forms of the disease, is an essential addition to the existing set of malaria prevention tools and will help strengthen our efforts to reverse the trend of increasing cases and further reduce deaths,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

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