Twenty-two months after the world’s first malaria vaccine RTS,S was approved by the World Health Organization (WHO), 12 countries in Africa will soon receive 18 million doses. A second, arguably more efficient, vaccine against malaria is currently in the queue for WHO approval. 

Meanwhile, distribution of the 18 million RTS,S doses is to be carried out jointly by WHO, Gavi and UNICEF, according to WHO Director-General Dr Tedros Adhanom Ghebreyesus, speaking at a media briefing Wednesday from WHO’s Geneva headquarters.  

“At least 28 African countries have expressed interest in receiving the RTS,S vaccine,” Tedros said. “The second vaccine is currently under review for prequalification, and if successful, provides additional supply in the short term.”

At the briefing, the WHO Director General also condemned the rising incidents of gender-based violence in Sudan, including conflict-related sexual violence against women and girls who have been internally displaced due to the clashes. 

“I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros said. 

His comments coincided with a joint statement, several UN agencies called for an immediate end to the use of such instances of gender-based violence as tactics to terrorize people.

The malaria vaccine race

Tedros said that the RTS,S vaccine has already been administered to over 1.6 million children in Ghana, Kenya, and Malawi and has proven to be safe and effective. The initial shipment of RTS,S vaccines will go to Benin, Burkina Faso, Burundi, Cameroon, Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, in addition to Ghana, Kenya, and Malawi, according to a WHO statement.

Developed by GlaxoSmithKline (GSK), the vaccine was initially tested between 2019-2021 in a pilot study in Ghana, Kenya, and Malawi, in which 800,000 children aged 5-17 months received the vaccine. The study found that severe malaria infections were reduced by 30% and hospitalizations 21%, while mortality declined by 10% among children receiving the vaccine. 

The other vaccine, R21/MM, developed by Oxford University, has achieved much higher rates of efficacy – as much as 75%. But that was in smaller Phase 2B trials, while a larger Phase 3 trial is still underway. 

Even so, the vaccine was recently approved by Ghana and Nigeria, which hope to begin manufacturing the vaccine soon. However, it has not yet been approved by WHO under its “Prequalification programme” insofar as the trials performed so far were notably smaller in comparison to the massive real-world trials conducted on the GSK vaccine. 

Already, more than 1.5 million children in these countries have received over 4.5 million doses of the GSK vaccine, according to Dr Kate O’Brien, head of WHO’s Immunization Department. 

She flagged the lack of adequate supply of the GSK vaccine, however, saying that the time is ripe for a second malaria vaccine. 

“We’re very much looking forward to the review of the second malaria vaccine through both our regulatory processes and our policy processes,” O’Brien said. “And, if that review of the evidence leads to recommendations, we would expect a significant increase in the supply in the short term.”

Sudan conflict: increase in sexual violence

Since April 2023, the UN Human Rights office in Sudan has received credible reports of 21 incidents of conflict-related sexual violence against at least 57 women and girls. The victims include at least 10 girls. In one case, as many as 20 women were reportedly raped in the same attack, the statement revealed. 

The office added that Sudan’s ministry of social development also has received at least 42 alleged cases of conflict-related sexual violence in the capital Khartoum, and 46 such cases in the Darfur region. Given that sexual violence is severely underreported, it is feared that the actual number of cases is much higher.

“I’m appalled by attacks on healthcare as well as increasing gender-based violence in the country,” Tedros remarked, adding that the ongoing violence is preventing survivors of gender-based violence from accessing much-needed healthcare services. 

“Women and girls must have unhindered access to the care they need, particularly survivors of sexual violence and women that need support through pregnancy and birth health.”

There have been 50 attacks on healthcare infrastructure in Sudan, in which 10 people were killed and 21 injured since April 2023, when clashes erupted in Khartoum. 

The current conflict in Sudan has internally displaced over 800,000 people, and over 220,000 more have fled the country. 

On Monday, violence escalated in Sudan’s Darfur region, where a group of armed forces and the Rapid Support Forces (RSF) clashed with each other. The region borders Chad, and the recent clashes have resulted in thousands of people fleeing to Sudan’s western neighbor seeking refuge in camps. 

This situation has made providing health support to the affected persons difficult, according to Dr Olivier le Polain, WHO’s incident manager for Sudan. He said that the flow of information from the region to the WHO is limited due to the security situation currently in place. 

“We are very concerned about the situation in Darfur which, by all accounts, is very dire. We also have very limited information in Darfur given the security situation at the moment… We know that conflict is intensifying, some of which is along ethnic lines,” he said, adding that the agency along with its partners is trying to provide the necessary medical and healthcare support to people on either side of the border – Chad and Darfur. 

Image Credits: Peter Mgongo.