Cameroon Becomes the First of 20 African Countries to Roll Out Routine Malaria Vaccination in 2024
Up to 20 African countries are gearing up to rollout WHO-recommended malaria vaccines in 2024.

The Central African country of Cameroon became the first country globally to implement routine malaria vaccinations on Monday, marking a significant stride in the fight against the deadly disease that claims over half a million lives annually, primarily affecting children under five in Africa.

According to Aurélia Nguyen, Chief Programme Officer of Gavi the Vaccine Alliance, the RTS,S vaccine will be administered in 42 districts across the nation, targeting children over the age of 5 months, in areas with the highest risk of malaria.

The moment marks the historic start of routine malaria vaccinations in African countries for the first time ever, said WHO and Gavi, the Vaccine Alliance in simultaneous announcements on Monday.  Over 30 African countries have expressed interest in introducing the vaccine, with 20 aiming to introduce it in 2024, said Gavi in an press briefing last Friday, which was embargoed until Monday.  The aim is to reach approximately 6.6 million children with the malaria vaccine through 2024 and 2025.

Cameroon, the first country to participate in the rollout, has been grappling with rising malaria cases and deaths since 2017, with nearly 30% of all hospital consultations attributed to the mosquito-borne illness. The vaccine rollout is expected to bring about a substantial reduction in both cases and fatalities, providing relief to affected families and alleviating strain on the country’s healthcare system.

More than 331, 000 doses of malaria vaccine landed in Yaoundé on Tuesday 22nd November, to support the kick-off of the vaccination campaign.

Several other countries have already received shipments of vaccine doses as well, and are gearing up for launch. Others are waiting for delivery a second WHO-approved malaria vaccine, the R21/Matrix-M,  which is to be produced by the Serum Institute of India in even larger quantities than the RTS,S, WHO and Gavi said in the press briefing.

Why it matters

Gavi emphasised the historical significance of this moment. Having invested in studies and urged manufacturers to expedite the vaccine’s development, the vaccine alliance said it is now delivering approved vaccines to those in need. It also described collaborations with partners to ensure that vaccination is integrated into essential interventions like the distribution of bed nets.

Dr Mohammed Abdulaziz, Head of Disease Control and Prevention at Africa Centres for Disease Control and Prevention, noted that the vaccine has been validated through trials in several African countries to have a significant impact on reducing clinical cases, particularly in high-burden areas.

He described the integration of the malaria vaccine into routine immunisation in African countries as a strategic shift to address insecticide and drug resistance, as well as the effects of climate change on malaria.

Beyond medical benefits, he said the vaccine has the potential to improve educational outcomes and cognitive abilities, breaking the cycle of adversity for future generations. He added that the partnerships involved in the vaccine implementation suggest that there would be equitable distribution of doses which in return could result in a decrease in malaria morbidity and mortality among children. Beyond adopting strategies, he urged all African Union member states to take up the vaccine for better health outcomes.

A vaccine that is already saving lives

The vaccine has already reached more than two million children and Kate O’Brien, the World Health Organization’s (WHO) Director of Immunisation, Vaccines and Biologicals, said the vaccine’s safety and life-saving efficacy, demonstrated in successful pilot programs, have prompted a broader rollout across Africa as part of routine services.

It has already been implemented in large-scale programs in Ghana, Kenya, and Malawi, reaching over two million children, leading to a 13% reduction in deaths among eligible children and a significant decrease in severe malaria hospitalizations, said O’Brien, speaking at Friday’s press briefing.

“The malaria vaccines have been shown to reduce clinical malaria cases by more than half in the year after vaccination. And that level of efficacy goes up when the vaccine is provided seasonally,” said O’Brien.

“In that case, that prevents about three quarters or 75% of malaria cases. So if we think about the 250 million in malaria cases that occur every year, a childhood vaccine with this level of efficacy can result in major reductions in malaria illness and death.”

She added that the coordinated pilot programs demonstrated high demand for the malaria vaccine without compromising other preventive measures, and expressed gratitude to scientists, African researchers, health workers, international partners, and donors for their collaborative efforts in achieving this progress, marking a significant step toward improving child health in Africa.

While acknowledging the long road of development for malaria vaccines, Andrew Jones, Principal Advisor for UNICEF’s Supply Division’s Vaccine Centre, described the imminent mass introductions as a reflection of progress in ensuring every child at risk of malaria receives the vaccine.

This, he said, is a giant step forward in collective efforts to save children’s lives and reduce the malaria burden. While celebrating the achievement, he anticipated ongoing innovation, and said he is looking forward to the development and rollout of even more effective and user-friendly next-generation vaccines.

The four-dose quagmire

To achieve the best outcomes from the vaccine, every child should receive four doses, which Jones described as unusual for routine childhood immunisation vaccines and noted that it could pose an additional challenge to some countries.

Dr Dorothy Achu, malaria adviser for WHO’s African Regional Office, noted that it will be important to communicate to parents that getting all the doses gives their children a higher chance of celebrating lots of birthdays. She also expressed WHO Africa’s preparedness to support countries to roll out the vaccine.

Dr Dorothy Achu, regional malaria adviser for WHO Africa

“We want to congratulate countries that have taken this bold step after the pilot phase and we encourage all endemic countries, and especially the high-burden countries to this vaccine and to deploy them. We are also committed to supporting them as we have been doing already – preparing the countries to roll out the vaccine,” she said.

Working with local partners

One of the lessons from the COVID-19 vaccination experience in Africa has been the need to involve local partners and for the malaria vaccination rollout in Cameroon, said Mbianke Livancliff, Senior Immunization Officer, Value Health Africa, an NGO improving community health in Cameroon, is one of the local partners involved in the rollout.

Livancliff said the timing of the vaccine arrival in the country is timely and highlighted the excitement within communities in Cameroon, recalling the positive response to the first vaccine shipment.

He said the organisation has been actively engaging with communities to understand dynamics, expectations, and concerns, addressing potential rumours and dispelling myths. He added that discussions are being held with community leaders, religious leaders, and various groups to educate them on the vaccine’s effectiveness. He said feedback from these engagements will inform the national policy for the vaccine introduction.

“The communities understand that this is not something that is just happening now. This has been in development over the years, going through rigorous processes to ensure the vaccines are safe and effective for children. Like with every vaccine, there are conspiracies, rumours, and myths. Understanding those dynamics within communities will help in the acceptance of these vaccines,” he said.

Image Credits: WHO.

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