On Tuesday, April 23, 2019, Malawi became the first country in the world to begin the use of RTS,S, the world’s first malaria vaccine, also known as Mosquirix as part of routine childhood immunization programs. The country is the first of three in Africa in which the vaccine will be made available to children up to 2 years of age; Ghana and Kenya are expected to start large-scale vaccinations in the coming weeks.
Malaria is one of the world’s leading causes of death, killing 435 000 people a year, most of them children, according to the World Health Organization. Malaria kills one child every two minutes, particularly in Africa, where more than 250 000 children die from the disease every year.
“We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination,” she added.
Manufactured by British pharmaceutical giant GlaxoSmithKline (GSK), RTS,S triggers the immune system to defend against the first stages of malaria shortly after the malaria parasite enters the bloodstream through a mosquito bite. The vaccine which has been under development for thirty years is the first, and to date, the only vaccine that has demonstrated it can significantly reduce malaria in children.
In the most extensive clinical trial in Africa conducted between 2009 and 2014 involving about 15,000 infants, the vaccine prevented approximately 40 percent of malaria infections, 30 percent of severe cases, and 60 percent of severe malaria anaemia, the most common reason children die from malaria. The vaccine also reduced the need for blood transfusions, which are required to treat life-threatening malaria anaemia by about 30 percent.
As part of a large-scale pilot implementation programme coordinated by the WHO, RTS,S will be made available through a four-dose routine immunization to young children under the age of two in specific areas in the pilot countries. The first three doses will be given between five to nine months of age and the fourth dose when the child is almost two. This schedule could prove difficult as it doesn’t necessarily coincide with other vaccinations and will require extra effort on the part of health workers to ensure that children get the four required dosages.
The implementation programme which will run until 2022, aims to reach about 360,000 children a year across the three pilot countries. It is designed to generate evidence and experience to inform WHO policy recommendations on the broader use of the vaccine. Ministries of health in the pilot countries will determine where the vaccine will be given with a focus on areas with moderate-to-high malaria transmission, where it can have the most impact. And it will be administered from health facilities where children receive their routine childhood vaccinations.
The implementation programme is a collaborative effort between the WHO, ministries of health in the three pilot countries and international partners including a non-profit organization, PATH, and vaccine developer and manufacturer, GSK, which is donating up to 10 million vaccine doses for the pilot programme. It is funded with a total investment of almost $1 billion by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.