The World Health Organization (WHO) has just recommended the large-scale deployment of the first vaccine against malaria in children in sub-Saharan Africa.

This news has been widely celebrated, but scientists warn that there could be obstacles in the acquisition and distribution of this vaccine in endemic countries.

Indeed, the WHO last Wednesday approved widespread use of the RTS, S vaccine in children in sub-Saharan Africa and other areas where malaria transmission is moderate or high.

The vaccine works against the deadliest malaria-transmitting parasite, Plasmodium falciparum, which is widespread in Africa.

But Simon Kariuki, director of research at the Kenya Medical Research Institute, who participated in the trials of this vaccine, fears that the main obstacles now are the financing of mechanisms allowing malaria-endemic countries to acquire the necessary doses and to distribute them in these countries.

“This is a golden opportunity for countries to have this vaccine, as mosquitoes are becoming increasingly resistant to insecticides and could render mosquito nets ineffective, leading to an increase in malaria cases”

Simon Kariuki, Kenya Medical Research Institute

“The researchers have done their part. It is now up to governments to quickly review their malaria control programs to adopt the vaccine, ”he said.

The vaccine was developed by British pharmaceutical giant GSK which said it would provide doses at the cost of manufacture plus 5%, but did not say how much that is.

According to the latest Global Malaria Report, an estimated 229 million cases of malaria were recorded worldwide in 2019; the WHO African region accounting for 94% of all cases and deaths.A child under five dies of malaria every two minutes, according to estimates by UNICEF (United Nations Children’s Fund), while the WHO says malaria is responsible for 260,000 deaths each year in children under five in Africa.

Matshidiso Moeti, WHO Regional Director for Africa, said the WHO recommendation was an important step in Africa’s long wait for an effective malaria vaccine.

It “offers a glimmer of hope for the continent, which bears the heaviest burden of disease and we expect many more African children to be protected from malaria and grow into healthy adults,” she said. -she adds.

The WHO recommendation, announced by Director-General Tedros Adhanom Ghebreyesus, stems from the results of an ongoing malaria vaccine pilot program in Ghana, Kenya and Malawi that started in 2019 and has already affected nearly 800 000 children.

Equity

Describing it as a “historic moment,” Tedros Adhanom Ghebreyesus said the vaccine would increase equity in access to malaria prevention, was reasonably priced and could help those who cannot access. existing prevention measures such as mosquito nets.

However, other interventions remain vital, health experts stressed, as the vaccine is only 30% effective in reducing severe cases of malaria.

Brian Greenwood, Professor of Clinical Tropical Medicine at the London School of Hygiene and Tropical Medicine who played a key role in vaccine research, says that RTS, S did not offer complete protection but had “great potential to reduce death and disease in high burden areas, particularly when they are combined with other interventions such as seasonal malaria chemoprevention and mosquito nets ”.

Don Mathanga, director of Malaria Alert Center at the University of Malawi, says “this vaccine is welcome in this region where the decline in malaria has reached its peak and in countries like Malawi where cases are increasing. This vaccine will reduce the devastating effects of malaria in the region and support its economic growth. “

However, the latter argues that the speed of vaccine deployment will depend on how quickly countries adopt the vaccine and the availability of resources to support that deployment.

Simon Kariuki therefore urges the countries of sub-Saharan Africa to start negotiations with the WHO to access vaccines as soon as possible. “This is a golden opportunity for countries to have this vaccine, as mosquitoes are becoming more and more more resistant to insecticides and could render mosquito nets ineffective, leading to an increase in malaria cases, ”he added.

Simon Kariuki, who is also the head of the malaria research program au Center for Global Health Research, in Kisumu, Kenya, says countries like Kenya have the capacity to stock vaccines and could easily increase their distribution.

He argues that the third phase of clinical trials found the vaccine to be 50% effective in preventing malaria in children aged five to 17 months. It is given in three doses between these ages, with a fourth dose about 18 months later.

This four-dose regimen has raised concerns about its administration in endemic countries where health facilities may be limited.

However, Simon Kariuki said its adoption in pilot countries is promising and he does not expect it to be difficult to deliver the required number of doses more widely.

The original version of this article was produced by the English language edition SciDev.Net for Sub-Saharan Africa.

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