Malaria vaccine: Vital addition to toolkit for preventing malaria but no magic bullet

Bobby Ramakant *

Rights-based access to comprehensive health services remains centrestage

It is indeed a breakthrough scientific achievement that we now have the first-ever and only malaria vaccine to prevent malaria in children. This is an important (and long-awaited) addition to existing range of scientifically proven effective methods to prevent malaria. While we celebrate this moment of yet another milestone scientific feat we must remind ourselves that this new and only vaccine is a complementary malaria control tool which needs to be added to the already proven measures for malaria prevention.

Malaria vaccine is a vital addition to malaria prevention options such as routine use of insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment. But we have to also acknowledge that access to these proven methods to save lives from malaria has been far from satisfactory, as a result of which, as per the latest data, 229 million people got malaria in 2019 (compared to 228 million in 2018), and 409,000 died of malaria in 2019 – most of them children (compared to 411,000 deaths in 2018).

Children under 5 are at greatest risk of its life-threatening malaria complications. Despite unprecedented progress in in the recent two decades in the fight against this ancient disease, malaria remains one of the world’s leading killers, claiming the life of one child every two minutes; and most of these deaths are in Africa.

Let us celebrate this turning point – as there is no doubt that malaria vaccine is going to be one of the blessings in the global fight to end malaria by 2030. Clock is ticking! As 110 months are left to end malaria worldwide, let us also make doubly sure we scale up the rollout and access to all the science-backed methods to save lives from malaria.

DYK about first-ever malaria vaccine?

The United Nations health agency, World Health Organization (WHO), has recommended the first-ever malaria vaccine for children, in regions with moderate to high transmission of deadliest malaria parasite (Plasmodium falciparum). This vaccine acts against this malaria parasite which not only causes the most lethal malaria globally, but also is most prevalent in Africa. The WHO recommendation of this vaccine is based on results from an ongoing pilot programme in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019.

This malaria vaccine (RTS,S/AS01) is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children.

The scientific research for this malaria vaccine has been going on since past 30 years. Phase-3 clinical studies were conducted between 2009 and 2014 in African nations. Children receiving 4 doses of this vaccine, experienced significant reductions in malaria and malaria-related complications in comparison to those who did not receive the vaccine.

In clinical studies, the vaccine was found to prevent 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria. In addition, the vaccine also prevented 6 in 10 cases of severe malaria anaemia, the most common reason children die from malaria. Significant reductions were also seen in overall hospital admissions and the need for blood transfusions, which are required to treat severe malaria anaemia. These and other benefits were in addition to those already seen through the use of insecticide-treated bed nets, prompt diagnosis, and effective antimalarial treatment.

This malaria vaccine (RTS,S/AS01) is to be provided in 4 doses to children from 5 months of age up to 2 years. First 3 doses are given between 6 to 9 months of age, and 4th dose is given at 2 years of age.

The pilot of this malaria vaccine has been going on in Ghana, Kenya and Malawi since 2019. This malaria vaccine pilot began first in Malawi in April 2019, then in Ghana in May 2019, and finally in Kenya in September 2019. This Malaria Vaccine Implementation Programme generated evidence and experience on the feasibility, impact and safety of the RTS,S malaria vaccine in real-life, routine settings in selected areas of these three African nations: Ghana, Kenya and Malawi.

The pilot has proven that:

- Feasible to deliver: Vaccine introduction is feasible, improves health and saves lives, with good and equitable coverage of RTS,S seen through routine immunization systems. This occurred even in the context of the COVID-19 pandemic.

- Reaching the unreached: RTS,S increases equity in access to malaria prevention. Data from the pilot programme showed that more than two-thirds of children in the 3 countries who are not sleeping under a bed net are benefitting from the RTS,S vaccine.

- Layering the tools results in over 90% of children benefitting from at least one preventive intervention (insecticide treated bed nets or the malaria vaccine).

- Strong safety profile: To date, more than 2.3 million doses of the vaccine have been administered in 3 African countries – the vaccine has a favourable safety profile.

- No negative impact on uptake of bed nets, other childhood vaccinations, or health seeking behaviour for febrile illness. In areas where the vaccine has been introduced, there has been no decrease in the use of insecticide-treated bed nets, uptake of other childhood vaccinations or health seeking behaviour for febrile illness.

- High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.

No one-size fits all

Let us hope this malaria vaccine along with all proven methods to save lives of malaria will be fully rolled out without any delay in every part of the world, driven by the local needs, contexts, and national/ subnational strategies to end malaria. Financial crunch or inequitable rollout or other forms of unjust programming will not be an obstacle in ensuring universal access to all range of healthcare services.