Tropical Health Matters

World Malaria Day 2023 is focusing on three key themes, Investment, Innovation, and Implementation, the 3 I’s. The recently approved malaria vaccines and those still under development embody these themes fully.  They all represent decades of investment in innovation, research, and now implementation.

After extensive several decades of clinical research and three years of field implementation in Ghana, Malawi, and Kenya by the World Health Organization and National Malaria and Immunization Programs, the RTS,S/AS01 malaria vaccine is being rolled out with assistance of GAVI, the Global Vaccine Alliance. During the malaria vaccine implementation program (MVIP) and also based on GAVI’s philosophy for vaccine programs generally, a key strategy was to provide RTS,S as routine immunization services alongside other essential services including a comprehensive package of malaria control and elimination interventions. RTS,S is not only being made available to the three MVIP countries, but as supplies come on board, other falciparum malaria endemic countries have started to apply for supplies and funding through GAVI.

It was well known from the beginning that although RTS,s might be first out the gate, other vaccines would be following closely on its heels. The benefits as well as the efficacy limitations of RTS,S were well known.  Therefore, talk was common for new products being available by 2026. Now in 2023, countries have started to move ahead on another vaccine candidate.

BBC reported that “Ghana is the first country to approve a(nother) new malaria vaccine that has been described as a ‘world-changer’ by the scientists who developed it.” R21 appears to be more effective than its predecessor, so Ghana’s drug regulators moved ahead quickly using final trial data on the vaccine’s safety and effectiveness, which is not even public, to approve it. Interestingly, this move is in parallel to the World Health Organization’s consideration of approving the vaccine.  Shortly thereafter, Nigerian medicine regulators also approved R21. Reuters noted that these “approvals are unusual as they have come before the publication of final-stage trial data for the vaccine.” The actual roll out will ultimately depend on official publication of the safety data and sourcing of funds.

As mentioned above, these malaria vaccines represented considerable investment of time and resources, embody the kind of innovation that is needed to tackle malaria as drug and insecticide resistance threaten progress toward elimination, and require detailed planning right down to the grassroots levels to ensure that a malaria vaccine delivery is part of a comprehensive package of malaria and child health services.

We need to return to the theme of investment. While international organizations, universities, ministries of health, and of course pharmaceutical companies have been investing in developing a safe, effective, and feasible product, these innovative products will not save lives until funds are invested for both purchase and service delivery are guaranteed. GAVI and Partners have put together over $200 million in support for RTS,S implementation for three years. The first window was open in September 2022 for the initial three MVIP countries, and a second window for others, depending on available supplies was open in December 2022.

Investment FOR implementation is a challenging subject because GAVI and collaborating agencies are not a bottomless well of money. What level of national investment by a country to protect its own children is feasible? Is there the national political will to contribute and invest in children in endemic countries, and not continue depending heavily on donors?

Malaria vaccines are a perfect example of what the 3 I’s can achieve. But beyond celebrating this addition to the malaria elimination toolkit, will we also be celebrating commitments by endemic countries of local funds to make zero malaria a reality?

In 2001 the first Africa Malaria Day (AMD) was observed. The opportunity to mark progress and exhort increased efforts for the continent continued through 2007. Then in 2008, the concept of World Malaria Day (WMD) took over, though it could not be denied that the bulk of malaria morbidity, mortality and intervention still was focused on African countries. Other countries have made progress such as the recent certification of malaria elimination in Argentina and El Salvador, but twenty years after the first AMD/WMD, Africa is still leading the way for creative, sustained intervention against the disease, despite threats to resources from economic downturns and new pandemic diseases.

Below we go straight to Africa to share activities and observances of WMD 2021 from Jhpiego’s African Malaria Technical Officers. After reading through, please watch “Jhpiego Leaves No One Behind | World Malaria Day, 2021″ on YouTube.

“Saramed” from Guinea reports that Guinea, like other countries in the world, celebrates World Malaria Day under the theme: ” Zero Malaria, Draw a Line on Malaria “. We are currently conducting the following activities:

• Lectures and debates on malaria in medical faculties and health schools;
• Animation of debate programs on malaria in public and private radios and televisions of the country,
• Advocacy and sensitization of religious and other influential people
• Carrying out a package of activities (administration of IPT to pregnant women who have missed their ANC appointment, community distribution of LLINs, screening and treatment of confirmed cases, awareness raising on malaria) in high incidence localities.

These activities is in line with the WHO approach of “high burden, high impact”.

Noella Umulisa reports that the WMD celebration took place in Eastern Province, in Bugesera district in the Mareba sector. Due to COVID-19 pandemic ,only 100 persons were invited to the event.This year’s the national theme is “Zero Malaria starts with me”.

Key activities during the event included …

• Visit of breeding sites under sentinel surveillance
• Visit of indoor residual spraying (IRS) sites
• Launching of the Awareness of the population using drones on the ongoing IRS campaign in this time of COVID-19
• Song by CHWs
• Certificate to Integrated Vector Management (IVM) Training of Trainers who will train others up to village level
• Speech of the Director General ,the guest of honor.

From Burkina Faso, Yousseff Sawadogo and Moumouni Bonkoungou shared photos of the celebration that featured a giant Insecticide-Treated  Net, a speech by the US Ambassador, a malaria song composed by a nurse, an official speech by the President of the National Assembly, and national recognition given to one of the current Jhpiego staff members, Thiery Ouedraogo, who at one time also served as director of the national malaria control program. He was decorated by the country’s authorities as a knight of the order of merit.

Bright Orgi from Jhpiego’s TiPToP malaria in pregnancy project in Nigeria ?? shared photos from a series of compound meetings in the community to mark WMD 2021. The meetings focused on malaria prevention and treatment. Provided opportunities to rural communities to ask questions on malaria issues. Here we can see that observance of WMD must be taken to the people who actually suffer from malaria and need to be actively involved in its solution. Deo Cibinda from the Democratic Republic of the Congo share photos of a national celebration, seen to the left.

Finally, As Kristen Vibbert noted, “These are such amazing World Malaria Day stories. I’m so heartened to see all of these great country efforts to remind everyone of how the fight against malaria must continue despite the Covid-19 pandemic.”  Charles Wanga tweeted, “We know how to defeat #malaria. But that’s not enough. We must do more to save pregnant women and children from the deadly scourge. This #WorldMalariaDay and everyday, because@Jhpiego leaves no one behind in our fight to #EndMalaria for good in Africa, and everywhere”