It is heartening to see progress in the fight against malaria. Over the past thirty years and with hundreds of millions of dollars invested thus far, the RTS,S malaria vaccine was officially rolled out yesterday in Malawi. In 2017, I wrote about the vaccine trials that began in 2009 and the announcement of the three countries that had been chosen for the vaccine rollout: Kenya, Malawi, and Ghana. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria. Now two years later the vaccine is officially in use to curb the unnecessary deaths of hundreds of thousands of African children under the age of five. The Malaria Vaccine Implementation Program will continue through 2022.
For decades, there has been consistent chatter, research, and hope for a potential malaria vaccine. Now, all three are finally coming to fruition to roll out the world’s first clinical malaria vaccine trials. The World Health Organization Regional Office for Africa (WHO/AFRO) announced today that Ghana, Kenya, and Malawi have been chosen for the WHO-coordinated pilot implementation program that will make the world’s first malaria vaccine available in 2018.
“The prospect of a malaria vaccine is great news. Information gathered in the pilot will help us make decisions on the wider use of this vaccine,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, in a statement. “Combined with existing malaria interventions, such a vaccine would have the potential to save tens of thousands of lives in Africa,” she added.
Sub-Saharan Africa records 90% of all global malaria cases. Even though the number of cases and deaths have dropped dramatically since 2001, the rate is still astronomically high. In fact, malaria still remains one of the deadliest killers on the African continent, especially for children under the age of five.
To date, the most effective way to curb malaria cases is via the use of bed nets and indoor residual spraying. Unfortunately, 43% of sub-Saharan Africans are not protected against either and 429,000 people died from malaria in 2015. After spending time with mothers in Tanzania with Malaria No More, I saw this to be true. I met moms standing in long lines to receive new nets, but the ones they had used for years had holes throughout, rendering them virtually worthless.
There is now new hope to curb child deaths with the injectible malaria vaccine targeted to children within five to 17 months called RTS,S. The vaccine developed by GlaxoSmithKline. Malawi, Kenya, and Ghana were chosen for the following reasons according to the World Health Organization:
- high coverage of long-lasting insecticidal treated nets (LLINs)
- well-functioning malaria and immunization programs
- a high malaria burden even after scale-up of LLINs,
- and participation in the Phase III RTS,S malaria vaccine trial
The countries themselves will determine the areas in their country where the trials will ultimately take place. The $49.2 million cost of the trials will be taken up by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNITAID. The World Health Organization and GlaxoSmithKline will additionally provide complimentary funds for the malaria trial efforts.
Photo: UN Photo/Marie Frechon
Sub-Saharan Africa has the highest burden of malaria sickness and death. In fact, 90 percent of all malaria deaths occur in Africa according to the World Health Organization. Children under the age of five are particularly susceptible of dying from malaria and adults can be completely debilitated by the infectious disease as it zaps their energy little by little for weeks. It is important, then, that those who live in malaria prone areas have the medicinal options needed to fight off the disease.
Researchers at the University of California, Berkeley and New York University business schools have written a recent paper showing that more donor funding from U.S. multilateral agencies such as the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as from foundations like the Clinton Foundation and the Bill and Melinda Gates Foundation are critical to keeping the price of malaria drugs low for poor people to afford. Buying these Artemisinin Combination Therapies (ACTs) is literally a matter between life and death.
I have been told enough harrowing personal stories and have read enough reports to understand contracting malaria isn’t a cakewalk. And for children (especially those under the age of five) and expectant mothers malaria can be deadly. Fortunately with rapid diagnosis and malaria treatments children as well as adults can experience speedy recoveries from a disease that is both debilitating and potentially fatal.
While in Zambia last month I visited the Chongwe District Hospital in Lusaka province with Malaria No More to see how robust malaria control efforts funded by the Zambian government, USAID, the Global Fund and other NGOs and private foundations have helped drastically reduced the number of child deaths in the country. Zambia has effectively reduced the number of malaria deaths to 8000 annually through prevention measures including mass distributions of mosquito nets, indoor residual spraying, fogging, and spraying of mosquito-infected areas like bogs and dambos (shallow wetlands). The annual deaths have also been reduced because of the mass test and treatment programs that are being administered by frontline health workers around the country. Unfortunately, the vast majority of these deaths are children under the age of five because their immune systems cannot fight off the disease without the help of a positive diagnosis and follow-up medications.
In Zambia 50% of children are admitted to hospitals due to malaria according to UNICEF. You must also understand that being admitted to a hospital means that frontline health care didn’t work and that hospital care is necessary. In Zambia as well as in most developing countries, most healthcare is done on the local level. Most severe cases are referred to hospitals as was the case of these three children I met in the Chongwe District Hospital located about an hour outside of Lusaka.
While malaria is wholly preventable and treatable some children still struggle getting better when they contract the infectious disease. This little boy was extremely sick, but was steadily getting better. I took his picture as he slept with the permission of his mother who was sitting lovingly at his side.
This little boy played with his mother’s hands and reached to breastfeed as he laid beside her. He had one of the sweetest faces I’ve ever seen and was quickly on the mend from his bout of malaria.
This little boy, who was snuggled with his mother, was also feeling better than before, but was quite lethargic. There are stages children have to go through to get better. Doctors had a positive prognosis for his eventual improvement.
By 2015, Zambia has a goal of having 100% of malaria cases are diagnosed and treated with Coartem on the community and health post level. While that goal hasn’t been achieved yet, Zambia with the expertise of Path’s MACEPA program and countrywide campaigns such as Power of One is helping Zambia steadily stand behind its commitment.
In Zambia there is one central location where over 600 medicines are stored for distribution throughout the country. I was recently in Zambia as a guest of Malaria No More and its new campaign, Power of One that ensures that with a small $1 donation a Zambian child will receive a full course of malaria treatment and a diagnostic test. While in Zambia I visited the Central Medical Store located in Lusaka where I saw Coartem, the life-saving medicine that prevents children from dying from malaria.
While there, I couldn’t help looking around at many of the medicines stacked to the rafters in the warehouse and also noticed the donors that provided various medicines and even equipment like the Global Fund, for example, that provides Lamivudine that treats Hepatitis B. The UNFPA provides male latex condoms to Zambia and also donated forklifts to the warehouse as well as USAID that provides family planning commodities for Zambian women. These are just a few examples of some of the medicines I saw. Additionally, USAID provided trucks that transports the medicines throughout the country. These are just a few of the observations I made.
In Zambia the Ministry of Health along with many of its NGO partners are looking at new and innovative ways to distribute medicines more efficiently throughout the country. In many remote areas like Zambia’s northwestern and northern provinces it becomes increasingly difficult to transport medicines, especially when the rainy season begins. Getting life-saving medicines and medical supplies becomes critical for the health and wellness of entire communities.
Now, the Central Medical Store is rolling out temporary hubs where medicines and medical supplies can be housed in each province instead of solely stored in Lusaka. The first of these hubs has been opened in Choma, a nearby major city center south of Lusaka. In Zambia, each of its 650 health posts must have one to two months of medical supplies on hand whereas hospitals must have a three month supply of medicines. In addition to introducing hub warehouses throughout the country the medical distribution supply chain is becoming more cloud-based which will ensure health posts and hospitals are able to order medicines and supplies from their mobile phones.
It was fascinating to see the Central Medical Store in Lusaka. It’s a huge operation that receives five containers of medicines a day and is effectively the most important component of the entire country’s medical supply chain.