Posts or Comments 04 December 2021

Monthly Archive for "October 2021"

Climate Bill Brieger | 25 Oct 2021

Malaria and The 2021 Lancet Countdown on health and climate change

The Lancet has published the 2021 update of the important climate countdown series in time for the upcoming UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in Glasgow. Interestingly in that 44-page Lancet climate paper malaria is mentioned several times, but basically the same example of increased months of transmission in highland areas repeated. Specifically…

“The number of months with environmentally suitable conditions for the transmission of malaria (Plasmodium falciparum) rose by 39% from 1950–59 to 2010–19 in densely populated highland areas in the low HDI group, threatening highly disadvantaged populations who were comparatively safer from this disease than those in the lowland areas (indicator 1.3.1).”

Hopefully the malaria community will use the other information in the report to explore and document additional malaria-climate issues including…

  • Desertification reducing mosquito habitats
  • Climate heightened conflicts putting more people at risk of malaria
  • Translating economic losses into difficulty paying for health systems to support malaria programs
  • Increased zoonotic transmission of malaria (e.g. knowlesi) threatening elimination
  • Rising sea levels affecting mosquito habitats

Malaria is an ideal exemplar condition to demonstrate the effects of climate change by having definitive effects on the host, the vector and the parasite. These issues need immediate attention if malaria elimination targets are to be maintained and achieved.

Vaccine Bill Brieger | 07 Oct 2021

The RTS,S Malaria Vaccine: Logistics Are the Next Issue

The World Health Organization and its Global Malaria Program are happily announcing approval of the RTS,S/AS01 (RTS,S) malaria vaccine after many years of testing. Though research on this particular vaccine stretches back to the 1980s, the most recent test has been a pilot program in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019 in real life district health settings.  Because the vaccine is not 100% effective, WHO Director-General Dr Tedros Adhanom Ghebreyesus notes that the intervention will compliment other efforts such that by “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Specifically, WHO explains that he RTS,S/AS01 malaria vaccine would be used “for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.”  RTS,S/AS01 malaria vaccine requires a “schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.”

The vaccine was found to have a strong safety profile, and in keeping with the concept of using it together with other preventive measures it produces, “Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.”

The pilot effort was supported at the global and country levels by WHO, PATH, UNICEF and GlaxoSmithKline (GSK) in collaboration with the health systems of the three countries. An important component of the pilot effort was learning about delivery process, which in this case meant collaboration with district health services including overall childhood immunization programs. In fact, because of the link with vaccinations, children who were not reached with other malaria services had a better chance of getting protection from the vaccine.

It is important to state that WHO approval of RTS,S does not mean that malaria vaccine research has been complete. Several other vaccine candidates are currently in the research pipeline. In addition, the current COVID-19 vaccine efforts have led researchers to consider different approaches to malaria vaccine development.

Approval by WHO is just the beginning of the logistical and policy challenge up and down the supply chain. First, there are questions of production capacity. Secondly, Funding must be secured such as the assistance that Gavi (the Vaccine Alliance), GFATM (the Global Fund to Fight AIDS, Tuberculosis and Malaria), and Unitaid have provided to low- and middle-income countries to promote their immunization and health programs. In August Gavi announced that, “Gavi, MedAccess and GlaxoSmithKline (GSK) will join forces to guarantee continued production of the RTS,S antigen for the RTS,S/AS01e malaria vaccine

A third issue is obtaining regulatory approval in malaria endemic countries that wish to use the vaccine. Fourth, lessons on management of the vaccine delivery within both malaria and child health services on the ground, including community involvement, need to be shared with other countries in the region.

More than 30 years into the development and application of the RTS,S malaria vaccine, we are in a way just getting started when it comes to figuring out how to reach children and save their lives.