Alinafe Tsitsi, a mother of two, arrived at the Mitundu
Community Hospital, Malawi early Tuesday morning. Cradling her youngest child
close to her chest, she joined a forming line. Like many other mothers gathered
at the hospital, Tsitsi had learned from a community healthcare worker that the
world’s first malaria vaccine would be introduced today.
Having experienced the high personal toll taken by malaria, she wanted to make sure her youngest child is protected.
“My husband was diagnosed with malaria, but there was no medication available at the hospital,” Tsitsi said. “I was scared for his life. He is the breadwinner of the family. We had to borrow money to get treatment at a private clinic. When I found out about the malaria vaccine, I wanted my child to have it.”
Malaria remains a major killer worldwide and particularly in Sub-Saharan Africa where more than 250 000 children under five-years-old die every year. They are the most vulnerable group that accounts for over 60% of all malaria deaths worldwide.
Dr Mary Hamel, Lead for Malaria Vaccine Implementation Programme at WHO said that there has been a lot of progress made in controlling malaria in the past 15 years.
“There has been a steady decline in malaria cases and deaths, mostly from insecticide treated bednets, indoor residual spraying and highly effective treatment when children do get sick,” Dr Hamel said. “But we have come to a point where progress has stalled, and we know this is a time when we desperately need a new tool. We hope that the new malaria vaccine will be that tool.”
RTS,S is the first and, to date, the only vaccine to show partial protection against malaria in young children. It acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria and 3 in 10 cases of severe malaria over a four-year period.
“This vaccine has a somewhat unusual schedule,” Dr Hamel said. It’s given at 5, 6 and 7 months of age and then at around 2 years of age. A key question is whether the parents will bring their children for these visits.
Malawi is the first country to pilot the vaccine in their routine immunization programme across 11 districts in the country.
It is one of the countries worst affected by malaria, with over 4 million cases and 7000 deaths in 2017. Local doctors and nurses hope that the vaccine, along with other malaria prevention measures, will reduce the number of life-threatening infections due to the disease.
“People have received the introduction of the vaccine very well,” Haneefa Likaka, Senior Nursing Officer at Mitundu Community Hospital said. “A lot of mothers with 5-months-old babies turned up, which gives us a clue that mothers also want to end malaria.”
Dr Michael Kayange, Deputy Director of Malaria, Ministry of Health of Malawi said that work with the communities will continue to support malaria prevention, with continued promotion of bed nets to protect families against infection.
“We have communication teams on the ground to make sure that women get the correct messages,” Dr Kayange said. “They should not think that when their children get the malaria vaccine, they are fully protected. They can still pick up malaria if other preventive measures are not being used.”
As for Tsitsi, she is fully committed to comply with the full malaria vaccination schedule and to make sure other women at her community are informed.
“When I will go home, I will talk to friends and to other women in the community about the malaria vaccine,” she said. “I will tell them to come vaccinate their children.”
The next step in the Malaria Vaccine Implementation Programme is to start piloting the vaccine in Kenya and Ghana, the two remaining countries selected for malaria vaccine introduction.
“The pilots will take four years to complete,” Dr Hamel said. “If there is a policy for wider use of the vaccine, which could come earlier, we will learn a lot to help other countries implement successful programmes in the future.”
Led by the Ministries in Health in Ghana, Kenya and Malawi, the RTS,S pilot programme is being funded by Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid. WHO, PATH and GSK are providing additional contributions, with GSK donating up to 10 million doses of the vaccine.