Keeping children alive past age five: Malaria vaccine programme offers hope in sub-Saharan Africa
Out of all children worldwide who die under the age of 5 years, half are in Africa. The World Health Organization (WHO), UNICEF and partners are working to reduce the number of childhood deaths and the agony that goes with them.
Clara Magalasi lives in a rural village near Lilongwe, the capital of Malawi. One morning not long ago she woke up to a grey sky that was threatening rain. But that did not stop her from walking four kilometers to Chileka Health Centre. Her daughter Grace Butawo, who just turned 22 months, was due for her fourth and final dose of the RTS,S malaria vaccine.
“I understand that if my child gets all four doses, the vaccine will give her the most protection against malaria and severe malaria,” says Clara. “Ever since Grace was born, she has never suffered from malaria, unlike my other children who experienced a lot of malaria episodes when they were the same age as Grace.”
When added to other malaria control measures, the RTS,S malaria vaccine can reduce episodes of malaria in children by 40 per cent and reduce life-threatening severe malaria by around 30 per cent.
Malaria vaccine pilot progress: two years on
Grace is one of 220,000 children in Malawi who have received at least one dose of the RTS,S malaria vaccine through routine immunization as part of a landmark pilot project sub-Saharan Africa — led by the Ministries of Health in Malawi, Ghana, and Kenya, coordinated by the United Nations, through WHO, and supported by health partners in those countries and worldwide.
In Malawi, malaria is among the three most deadly diseases among children under five years old, alongside pneumonia and diarrhea. WHO and UNICEF have been working together with health authorities to combat the disease as it is preventable and easily treatable if caught early. Worldwide, there are more than 200 million new cases of this parasitic disease every year, and it claims the lives of more than 400,000 people, mainly young children in Africa.
When the moment came two years ago to introduce the malaria vaccine into childhood immunization programmes around the world, Malawi was the first country to get on board, followed by Ghana and then Kenya. The vaccine was introduced in a phased approach that targeted 11 districts in Malawi with moderate-to-high parasite transmission.
“To reduce childhood deaths, we can look to the potential of interventions like the malaria vaccine,” says Dr. Nonhlanhla Dlamini, WHO Representative in Malawi. “It is an additional tool alongside insecticide-treated nets,” also known as ITNs or bed nets.
The Malawi Ministry of Health also uses measures such as bed nets and spraying households with insecticide, supported by UNICEF and WHO. However, some households in hard-to-reach areas do not yet benefit from such interventions.
Other potential benefits: reduced hospital admissions, more preventive health care visits
Hospital visits for malaria put a financial burden on the vulnerable. In Malawi, almost 60 per cent of childhood outpatient health facility visits are due to malaria. Data from Chileka Health Centre in Lilongwe shows a decrease in hospital admissions for malaria among children under age five years since the vaccine was introduced.
There are other spillover benefits, too. Madalitso Chadewa is a Senior Health Surveillance Assistant at Chileka Health Centre. She says the pilot has meant more mothers come for more health care for their children. Before the pilot, most mothers would quit under-five clinic visits when their children get their last jab for measles at 15 months. But now with the draw of the malaria vaccine, that period has extended to 22 months.
“When children come at 22 months, aside from giving them the RTS,S fourth dose, we also do growth monitoring and general health checks,” she says. “These health checks are essential because they help to detect preventable health threats in the under-five children.”
Keeping up with malaria prevention, even in a pandemic
Data and experience from the malaria vaccine pilot will reveal how best to reach children with the four-dose vaccine regimen, and the vaccine’s impact and safety in routine use. So far, the data is promising, and the WHO may recommend the vaccine for wider use in sub-Saharan Africa as early as October 2021.
The UN has been supporting the Malawi Ministry of Health to ensure the continuity of essential immunization and malaria services during the pandemic, including malaria vaccination in pilot districts. The malaria vaccine pilot has continued without major disruptions.
“We understand how COVID-19 has put pressure on our health system,” says Dr. Randy Mungwira, the WHO technical officer for the malaria vaccine pilot programme in Malawi. “It is important for us to ensure that child vaccination services, including the malaria vaccine programme, continue during this time because immunizations reduce child illnesses, save lives, and help relieve the strain on the health system.”
Learn more about the malaria vaccine implementation programme.
Written by Veronica Mukhuna, WHO Malawi. Editorial support by Paul VanDeCarr, Development Coordination Office. To learn more about the work of the United Nations Country Team in Malawi please visit: Malawi.UN.org.
