Big question: Who gets malaria vaccine first?

By Gatonye Gathura

It is almost time to decide which child will be on line to receive the world’s first malaria vaccine, those to wait, and who may miss out altogether.

The vaccine in its final verification in Kenya, Ghana, and Malawi, could be ready for mass distribution as early as next year, presenting a supply and distribution nightmare.

On Monday experts at the Imperial College London, projected mass roll-out could be recommended from 2021 onwards  but warn demand may initially outstrip supply.

“We sought to identify where vaccine introduction should be prioritized so as to maximize public health impact” says the college in a new report.

A massive operation, they say will be required to manufacture, distribute and vaccinate millions of children in Africa with more than 100 million doses annually.

Four doses

The task is more daunting because each child will require four doses, distributed between six months to two years in about 44 competing African countries.

Kenya many want to lay first claim to the vaccine arguing she has been involved in its development since 1984 to the ongoing piloting.

However, if countries with the highest malaria burden are prioritised, which is most likely, Kenya may have to queue behind 19 others, led by Nigeria, DR Congo, Uganda, Mozambique and Niger in that order.

But even internally, the Imperial College team led by Dr Alexandra Hogan argued there will be questions on which children or sub-regions gets into the mass rollout first.

Kenya will for example weigh whether priority should be given to Western with the highest malaria burden; Coast which is facing a resurgence of the disease or the highlands where outbreaks cause huge deaths for lack of immunity.

Computer modeling

Deciding on where to stage the ongoing malaria piloting in western Kenya had presented similar challenges.

“The selections were made randomly, through computer modeling, to give each sub-county an equal opportunity in an exercise involving all the counties’ health leadership,” explains the Ministry of Health in a brief.

While launching the World Malaria Report 2020 okast month, the head of the World Health Organization (WHO) Dr Tedros Adhanom Ghebreyesus called for the quick deployment of new tools against the disease even as the parasite   mounts a spectacular and expensive fight back.

Dr Ghebreyesus was reacting to mounting evidence indicating the malaria parasite is managing to avoid detection by the widely used rapid diagnostic tests called RDTs.

About a decade ago Kenya made malaria testing mandatory before treatment and introduced the RDTS, now the bedrock of malaria diagnosis in the country. Last year Kenya deployed more than 1.2 million RDTs.

The kits detect the disease by identifying particular genes; pfhrp2/3, in the parasite but now some strains are not expressing these genes hence avoiding detection.

Dr Ghebreyesus said their investigations have confirmed gene deletion in Uganda, Tanzania, Zambia, Sudan, Ghana, Nigeria, China and the UK among other countries.

The WHO now wants countries like Kenya   to investigate how much this may be affecting malaria test accuracy and whether it is time to change the kits – an expensive and monumental setback.

Drug resistance

There are also fears malaria strains resistant to current first-line drugs, though still limited to Asia, may eventually spread to Africa, with Rwanda recently raising a red flag.

“This is why we need to move fast and bring in new tools before we lose the current momentum against the disease,” said Dr Caroline Boulton, head of malaria programme at Novartis, the Swiss pharmaceutical company.

Novartis which developed the current first-line malaria medicines almost 20 years ago is working on the next generation of antimalarial.

The new drugs, currently in late-stage clinical trials in nine countries targets at both preventing and treating the disease including against resistant strains.

“We are experiencing some challenges and delays due to Covid 19 pandemic related restrictions but we are confident to deliver on time,” said Dr Boulton.

The new 2020 report however, shows Kenya is likely to miss its targets for reducing malaria cases and deaths by 90 per cent by 2030.

During last year’s Malaria Day in April, President Uhuru Kenyatta, who is also  the chair of the African Leaders Malaria Alliance said Kenya  will prioritise mosquito nets and  the vaccine to shore up its fight against the disease.

“We are expanding our malaria prevention efforts through the distribution of upwards of 15 million bed nets this year to cover up to 25 million Kenyans.”

The WHO report, however, indicates the free nets in Kenya may not be reaching the intended poorest families with most of them found in use by wealthier households.

Front seat

Kenya may also have to work harder for a front seat in the distribution of the malaria vaccine once approved for mass distribution with influential experts favouring the Sahel countries.

“Our results show that targeting of the vaccine to countries with the highest incidence—particularly those in the Sahel region—could have the greatest impact in reducing the burden of malaria,” says the Imperial College report.

The report appearing this week in the scientific journal Plos Medicine, says prioritizing countries of highest malaria burden will avert the largest number of child deaths.

“We may have a fight on our hands,” says Linda Mwatefwa, a retired community health mobiliser previously working at the Coast.

About Gatonye Gathura 47 Articles
Science Journalist

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