World Malaria Day 2022: Inside Nigeria’s plan ahead of vaccine distribution

The hope of ending malaria, a disease that kills thousands of people annually, received a boost in late 2021 when the World Health Organisation (WHO) approved the use of the first-ever malaria vaccine.

The vaccine, RTS,S or mosquirix, is not just the first for malaria, but also the first developed for any parasitic disease. Parasites are much more complex than viruses or bacteria, and the quest for a malaria vaccine had been underway for many years.

This vaccine was found to surpass the 75 per cent efficacy goal set by the WHO for a malaria vaccine to receive a nod.

Health experts, caregivers, and government officials describe the development as a breakthrough in the fight against the scourge that has plagued humans for decades.

“The long-awaited malaria vaccine is a breakthrough for science, child health, and malaria control,” WHO director-general, Tedros Ghebreyesus, said following the vaccine endorsement.

Malaria burden

Malaria, although preventable and treatable, continues to have a devastating impact on the health and livelihood of people around the world.

In 2020, there were estimated 241 million new cases of malaria and 627,000 malaria-related deaths in 85 countries. More than two-thirds of deaths were among children under the age of five living in the WHO African region.

“Children under five are one of the most vulnerable groups affected by the disease, accounting for 67 per cent of all malaria deaths worldwide,” said Matshidiso Moeti, WHO Regional Director for Africa.

Ms Moeti said for centuries, malaria has stalked sub-Saharan Africa, “causing immense personal suffering”.

Nigeria, Africa’s most populous nation accounts for the highest malaria burden in the region and also contributes to 23 per cent of malaria deaths worldwide.

Although WHO said the vaccines “could save tens of thousands of young lives each year”, there are concerns it may not get to children who are most vulnerable to the disease.

Health experts say children mostly miss out on vaccination due to inaccessibility of vaccines and poor awareness about their importance.

“There are lots of communities unaware of free health services provided by the government. This is an issue of human rights because access to quality health is a right issue,” Ayo Ipinmoye, the national coordinator, Civil Society on Malaria Immunisation and Nutrition (ACOMIN), told PREMIUM TIMES in an interview.

Missing out

A mixture of stench from several pools of stagnant water; flying insects and smoke from burning firewood, was the atmosphere at Dape area of Gwarimpa, a district in Nigeria’s Federal Capital Territory when our reporter visited recently while researching for this report.

Shanties erected with wood and cement sacks are what residents of the community call home. No proper drainage to channel away water from the makeshift bathroom next to the living area or from washing and other chores.

Sweating from the heat of the afternoon and her own cooking area, Amina Isah, a resident of the community, smiled as she wiped her face with her arm.

Asked if she was aware of any vaccination programme and if she ever allowed her children to take vaccines, Ms Isah said; “I do not know anything about immunisation and I have never taken my children to the hospital.”

Speaking in Hausa language, the middle-aged mother of four, who is popularly called Mama Aisha in the neighbourhood, said her children were delivered in her living room with the help of a friend and neighbour.

Memunat Gamboa, a resident of Naibawa area of Kano State, said she knew there are hospitals where she could be delivered of her babies, but said she could not withstand the stress of “being ordered around” by hospital officials. Thus like Ms Isah, she had all her babies at home.

On her part, Hannatu Usman, a resident of Baran-Goni, a community in Bwari area of the FCT, said in her village in Borno State, where she had all her children before insurgency forced her to relocate to Abuja, there was no public healthcare facility.

“For you to see a health centre, you will walk several kilometres or take a bike when you see one,” she said.

The cases of these three women who had babies either delivered by traditional birth attendants or by their relations and neighbours are common across the 774 local government areas in the country. By having their children outside accredited health facilities, these children miss out on key national immunisation programmes of the government.

Over the years, immunisation has proven to save millions of lives globally. Vaccines reduce risks of getting a disease by working with the body’s natural defences to build protection, WHO said.

However, despite its numerous benefits, far too many people around the world– including nearly 20 million infants each year, are said to have insufficient access to vaccines.

The 2018 Nigeria Demographic Health Survey (NDHS) states that the country’s immunisation coverage rate is very low.

According to the survey, only 31 per cent of children between the ages 12 to 23 months received all basic vaccinations at the time before the survey, while 28 per cent received the basic vaccination by the appropriate age of 12 months and 19 per cent received no vaccination at all.

Possible game changer

The WHO’s endorsement of the vaccine was based on the results of more than 2.3 million doses administered since 2019 to about 800,000 children in Kenya, Malawi, and Ghana.

The vaccine, developed by GlaxoSmithKline is said to reduce cases of clinical malaria by 40 per cent and severe cases of malaria by 30 per cent. It is given in three doses between ages five and 17 months, and a fourth dose is given 18 months later.

“To have a malaria vaccine that is safe, moderately effective and ready for distribution is a historic event,” said Pedro Alonso, director of the WHO’s global malaria programme.

Health experts across the globe said the introduction of the RTS,S vaccine to existing malaria control interventions could help drive down child mortality in Africa- a continent that bears the brunt of the disease.

Vaccines roll-out, funding

It is unclear how soon the vaccine will be widely available in Africa, said John Nkengasong, the director of the Africa Centers for Disease Control and Prevention, at a news conference.

Mr Nkengasong said the vaccine roll-out may take a while as the pilot programme is still ongoing.

GSK, the vaccine developer, said it has donated 10 million doses for the study and so far only a quarter of those have been used.

The company also committed itself to providing 15 million doses a year but health authorities said this may be insufficient to cover malaria-endemic countries.

“What we know for now is that the vaccines that will be available in the near future will not be sufficient to go round, so there has to be some prioritisation,” national coordinator of NMEP, Perpetual Uhomoibhi, said.

Ms Uhomoibhi said there are plans to ensure Nigeria, being a high burden country, gets prioritised when distribution begins.

On funding, she said the government will purchase the vaccines at the right time with support from development partners.

“If there is a funding gap, the government will come in.”

The director, disease control and immunisation at NPHCDA, Bassey Okposen, said there is a process to follow before any new vaccine can be introduced into the country.

Mr Okposen said countries are also expected to make decisions and express interest on whether to adopt the vaccine as part of national malaria control strategies.

He said the immunisation agency is working with the NMEP team and others to develop a proposal for submission to GAVI for consideration when allocations commence.

Gavi, the vaccine alliance, in late 2021 announced that it will invest $155.7 million to help roll out the RTS,S vaccine in sub-Saharan Africa between 2022 and 2025.

It said this is an initial investment to support the vaccine introduction, procurement and delivery for Gavi eligible countries, which includes Nigeria.

Mr Ipinmoye, the national coordinator of ACOMIN said the government must invest its funds in the vaccines which will serve as a useful tool in protecting children from dying of malaria.

He said malaria is endemic in Nigeria and for pregnant women and children to be in a community with no access to vaccination could be saddening.

He said persons especially those in rural communities need to be enlightened on the importance of childhood vaccinations.

“The malaria vaccine has the potential to be a game-changer in the fight against malaria but those at the grassroots must have access to it,” he said.

“We are hopeful that the new vaccines, when fully implemented, will help reduce deaths and malaria cases,” Tim Obot, the Deputy Director National Malaria Elimination Programme (NMEP), said.

Mr Obot said the vaccines are meant for children under five, “so other persons above this age will continue to make use of alternative interventions available for malaria”.

Before the vaccine breakthrough, insecticide-treated bednet was considered the most widespread preventive measure for malaria and that it reduces deaths in children under five by about 20 per cent.

Unfortunately, every household visited by PREMIUM TIMES in the course of this report, including that of Ms Isah lacks an insecticide-treated net.

While some residents at Baran-Goni, a community in Bwari said they have never seen a mosquito net, others claim it’s too expensive.

“I wanted to buy sometime in 2020 but I was told it’s N5,000. I don’t have that much and even if I have, it won’t be for an ordinary net,” Hannatu Usman said.

Equitable distribution

The main challenge that may face the vaccine will be how to achieve equitable distribution, not just to regions with high transmission, but also to conflict zones where malaria is endemic, said Gbemiga Aina, head, Centre for Research in Traditional Complementary and Alternative Medicine, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos.

Mr Aina said there should be a distribution plan in place before the vaccines get into the country.

Ms Uhomoibi of NMEP said the agency is in discussion with partners to achieve a decent distribution of the vaccines when they are available.

According to her, the government is considering taking the vaccines to various households instead of integrating it into the routine immunisation schedule.

“We have to work with partners to identify where the few doses of vaccines we would get are more needed within the country,” she said.

World Malaria Day

In commemoration of 2022 World Malaria Day, the WHO estimates that the vaccine could save the lives of an additional 40,000 to 80,000 African children each year.

WAD is marked on April 25 every year to highlight global efforts to control malaria and celebrate the gains that have been made.

Themed, “Harness Innovation to Reduce the Malaria Disease Burden and Save Lives”, this year’s activities aim to draw attention to the critical role innovation plays in helping to achieve global elimination goals.

Therefore, Nigerians are expectant of the massive contributions of vaccines against the country’s most common albatross.