• As Jab Passes Safety, Efficacy Test In Clinical Trials
• ‘COVID-19, Rising Drug Resistance Threaten Disease Elimination
• Slowing Down On Fight May Increase Child Mortality, Mokuolu Warns
As nations celebrate World Malaria Day (WMD) today, Nigeria and other African countries worse hit by the disease may get more relief and inch near the global zero malaria target with mass deployment of malaria vaccine by October this year.
The cheery news came with indications that the malaria vaccine jab, RTS, S has passed safety and efficacy tests in clinical trials and may be globally approved for mass deployment and adoption in national immunisation programmes.
Again, another malaria vaccine was reported by the University of Oxford team to have proven to be 77 per cent effective in early trials and could be a major breakthrough against the disease. The said vaccine was found to be safe and showed “high-level efficacy” over 12 months of follow-up.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through mosquito bites and kill more than hundreds of thousands of people yearly, mostly children in sub-Saharan Africa.
Director for the malaria vaccine implementation programme at PATH (formerly known as Programme for Appropriate Technology in Health), an international nonprofit global health organisation, Scott Gordon, speaking during the second instalment of the Combat Malaria in Africa virtual discussion, noted, “The RTS,S vaccine has been tested in Jos and Enugu in 2010 and 2012. The trial demonstrated efficacy. As of today, Ghana, Kenya and Malawi are conducting clinical trials on the vaccine. Over 1.7 million doses have been administered to over 650,000 children across Africa.”
The online meeting, titled ‘Combat Malaria in Africa: Lessons and Opportunities’ was organised by GBCHealth’s Corporate Alliance on Malaria in Africa (CAMA). GBCHealth is a network of more than 300 companies and development organisations, leading business action for improved global health, while CAMA is a GBCHealth-led initiative to drive partnerships for malaria control and elimination.
Gordon said: “We are gathering evidence on the feasibility of providing the vaccine through routine immunisation. We expect to have a meeting with WHO and other stakeholders to make the decision. We have data from the clinical trails. On the pilot, the safety of the vaccine has been priority. The researchers found that data on safety is positive. Feedback on survey in the three countries is encouraging. There is potential for the recommendation for the vaccine to be used routinely across Africa to end malaria.”
The theme of this year’s World Malaria Day is ‘Reaching the zero malaria target.’ In Nigeria, the adopted slogan for World Malaria Day 2021 is ‘Stand up and Take Action.’
ACCORDING to the World Health Organisation (WHO), RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria and life-threatening severe malaria in young African children. It acts against Plasmodium falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received four doses in large-scale clinical trials, the vaccine prevented approximately four in 10 cases of malaria over a four-year period.
In view of its public health potential, WHO’s top advisory bodies for malaria and immunisation have jointly recommended phased introduction of the vaccine in selected countries in sub-Saharan Africa. As such, three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019, with vaccinations being provided through each country’s routine immunisation programme.
The pilot programme is to address several outstanding questions related to the public health use of the vaccine. Critical among those questions how best to deliver the recommended four doses of RTS,S, the vaccine’s potential role in reducing childhood deaths, and its safety in the context of routine use.
The WHO-coordinated programme is a collaborative effort with ministries of Health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organisation, and GSK, the vaccine developer and manufacturer.
Gordon, however, cautioned that regardless of the optimism being generated by the vaccine, there is a need to continue to use other interventions, strengthening strategies and programme linkage in the war against malaria.
“There is a need for continued investment in new tools such as vaccines, in addition to Research and Development (R&D). What we have learnt is that there is no single solution both for malaria and COVID-19.”
Financing for the vaccine programme has been mobilised through collaboration among three major global health funding bodies – Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid, a global health initiative working with partners to bring about innovations to prevent, diagnose and treat major diseases in low and middle-income countries, with an emphasis on tuberculosis, malaria, and Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and its deadly co-infections.
MEANWHILE, the reported rise in resistance to insecticides and malaria drugs, and the ongoing COVID-19 pandemic are said to be threatening plans to eliminate malaria by 2030.
National Coordinator, National Malaria Elimination Programme (NMEP), Dr. Perpetua Uhomoibhi, at the second installment of the ‘Combat Malaria in Africa’ virtual discussion, also acknowledged the growing cases of insecticide and malaria drug resistance in Nigeria.
According to the latest World malaria report, 73 countries reported mosquito resistance to at least one of the four commonly used insecticide classes in the period 2010-2019. In 28 countries, mosquito resistance was reported to all of the main insecticide classes.
However, despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings, a five-country study by WHO revealed.
While the findings of the study are encouraging, WHO continues to highlight the urgent need for new and improved tools in the global response to malaria. To prevent erosion of the impact of core vector control tools, WHO also underscored the critical need for all countries with ongoing malaria transmission to develop and apply effective insecticide resistance management strategies.
According to WHO, resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum malaria parasites to previous generations of medicines, such as chloroquine and sulphadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.
The body stressed that protecting the efficacy of antimalarials is critical to malaria control and elimination. It also underscored the need for regular monitoring of drug efficacy to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.
WHO and partners are marking this year’s World Malaria Day by celebrating the achievements of countries approaching – and achieving – malaria elimination, stating that they provide inspiration for all nations working to stamp out the deadly disease and improve the health and livelihoods of their populations.
In a new report published during the week, the WHO highlighted successes and lessons learned among the “E-2020” group of malaria-eliminating countries.
WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, said: “Many of the countries we are recognising today carried, at one time, a very high burden of malaria. Their successes were hard-won and came only after decades of concerted action. Together, they have shown the world that malaria elimination is a viable goal for all countries.
“Despite the challenges posed by the COVID-19 pandemic, a number of these countries reported zero indigenous malaria cases in 2020, while others made impressive progress in their journey to becoming malaria-free.”
RELATEDLY, Technical Director of Malaria Elimination Programme in Nigeria, Professor Olugbenga Mokuolu has said that Nigeria risked more malaria morbidity ratio if the tropical disease is abandoned for the treatment of dangerous virus pandemics.
Delivering a lecture at the Fourth Annual Mokuolu Malaria Lecture organised by Ilorin University Medical Students Association (ILUMSA) in Ilorin yesterday, he said the death rates attributable to Malaria in Nigeria remained the highest globally.
Speaking on the topic, ‘Malaria Elimination in the Context of COVID-19 Pandemic, Lessons and Prospects,’ Mokuolu noted that, “Nigeria accounts for 23 per cent of global malaria deaths at present and it remains the highest. Any contributions we, as a nation, make to Malaria elimination will surely have an impact on the world statistics.”
Speaking on the challenges of COVID-19 on malaria eradication, the speaker said many Nigerians refused to go to the hospital for treatments when manifesting malaria symptoms during the peak of the pandemic for fear of them being stigmatised as COVID-19 patients.
Besides, he noted that the period led to a depletion in the workforce at various hospitals just as he disclosed that government attention and that of some private individuals shifted from other dangerous diseases to the COVID-19 management.
Mokuolu, while ruing the alleged diversion of private and government resources to COVID-19 management to the exclusion of other diseases, said the period also led to a huge loss in the initially gained grounds on malaria eradication in Nigeria.
He, however, expressed happiness that his team met its targets in the area of effective distribution of treated mosquito nets to about 12.9 million Nigerians, during the period under review.
IN the face of a dual-threat of antimalarial drug resistance and COVID-19, countries of the Greater Mekong sub-region have made major strides towards their shared goal of elimination by 2030.
In the six-country where the sub-region, the reported number of malaria cases fell by 97 per cent between 2000 and 2020. Malaria deaths were reduced by more than 99 per cent in the same period of time.
Of the 87 countries with malaria, 46 reported fewer than 10,000 cases of the disease in 2019 compared to 26 countries in 2000. By the end of 2020, 24 countries had reported interrupting malaria transmission for three years or more. Of these, WHO certified 11 malaria-free. Though each country’s elimination journey is unique, common drivers of success have been seen across all regions.
Director of the WHO Global Malaria Programme, Dr. Pedro Alonso, said: Success is driven, first and foremost, by political commitment within a malaria-endemic country to end the disease. This commitment is translated into domestic funding that is often sustained over many decades, even after a country is malaria-free.”
In 2020, COVID-19 emerged as a serious challenge to malaria responses worldwide. Since the early days of the pandemic, WHO has urged countries to maintain essential health services, including malaria, while ensuring that communities and health workers are protected from COVID-19 transmission.
Heeding the call, many malaria-endemic countries mounted impressive responses to the pandemic, adapting the way they deliver malaria services to the COVID-19 restrictions imposed by governments.
By Chukwuma Muanya (Lagos) and Odun Edward (Ilorin)