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In the coming weeks and months, hundreds of thousands of infants under the age of two in Ghana, Kenya and Malawi will receive the first vaccine demonstrating that the program can significantly reduce malaria in children through national immunization programs in their country.
The vaccine has already been sent out and the nurses and community workers who will administer it have been trained. The exercise in all three countries will establish the feasibility, impact and safety of the RTS, S. malaria vaccine.
But even with the optimism and fanfares of the health development community, its use remains limited.
The RTS, S vaccine does not offer lifetime protection against malaria; only four out of ten children belonging to a specific age group will benefit.
The RTS, S vaccine does not offer lifetime protection against malaria; only 4 out of 10 children belonging to a specific age group will benefit and it is less profitable than nets, except where it is implemented after reaching a high level of use of mosquito nets and extensive coverage. chemo-prevention of seasonal malaria, which alone has contributed significantly to the reduction, each year, of malaria deaths.
The World Malaria Report, 2018, indicates that sub-Saharan Africa remains the region of the world most affected by malaria. In 2017, there were an estimated 435,000 deaths from malaria in the world and six African countries were responsible for almost half of all deaths: Nigeria (19%), Democratic Republic of Congo (11%), Burkina Faso ( 6%), United Republic of Tanzania. (5%), Sierra Leone (4%) and Niger (4%).
But none of the countries most affected by malaria would participate in the implementation of the vaccine RTS, S developed for about 30 years by the pharmaceutical giant GSK.
Although the health ministries of the various countries attributed their selection to the impressive immunization programs in their country, the WHO revealed that their choices stemmed from the need for establishment, which constituted a distinct epidemiological framework in sub-Saharan Africa. covering areas of moderate to high transmission.
In addition, the incidence of malaria in the last three years is relatively stable in the three African countries, which has made it possible to detect the impact of the vaccine, which is expected to result in "a change in the incidence of malaria among children under three years old. older people are increasingly affected by the disease when stronger prevention measures are implemented, even if the overall benefit is positive. "
According to WHO, vaccine hesitancy is one of the top ten threats to global health for 2019, more and more concerns are arousing more and more concerns about current and future vaccines, including their side effects and their effectiveness, to justify their use and address the concerns of parents. and local communities who may be reluctant to allow their children to be immunized.
The RTS, S vaccine raises a number of problems that anti-vaxxers can control and spread. First, it does not protect against malaria in the long term and only children aged 5 to 17 months benefit.
The WHO concluded that in younger infants, the vaccine was not working well enough to warrant its later use in this age group.
"The weaker immune responses are induced by the RTS, S vaccine in infants aged 6 to 12 weeks compared to children," said the WHO.
He attributed this observation to possible interference with other vaccines, to components of the mother's immune system still present in the child's blood and to "the immaturity of the immune system in children aged 6 to 12 weeks. compared to the age group of 5 to 17 months ".
To get the maximum benefit, children will need to take four doses of the vaccine. The first three doses will be given one month apart, followed by a fourth dose 18 months later.
"This is going to be a problem," said Seyi Akinbiyi, a Nigerian expert on public health. According to him, as the number of doses of a vaccine increases, the number of children who will receive the full dose will decrease due to many problems such as logistics and migration. Even if vaccines are taken from one house to the other, parents can not be forced to stay at home while waiting for immunization officials, he said.
Even WHO and its partners are not entirely sure that it will be possible to deliver the four required doses of the vaccine in routine settings. They hope to know how this can be achieved in the three African countries.
Generalized support
The US government is one of the strongest supporters of the malaria vaccine. The US Center for Disease Control (CDC) believes that the vaccine "could prove to be a powerful tool to consolidate the progress made over the last ten years". He added that the vaccine could potentially: reduce the costs associated with health care management of patients with malaria.
"It could also end the emerging problem of drug resistance and the need to use insecticides to kill mosquitoes," the CDC said in a statement.
But the WHO has been cautious in raising great hopes. "The RTS, S vaccine is being offered as a complementary tool to the existing package of WHO-recommended measures for prevention, diagnosis and treatment of malaria and will be used in combination with current interventions," said the report. World Health Agency.
From WHO's point of view, the vaccine will complement other tools, including long-lasting insecticide bednets, indoor insecticide sprays, preventive treatment for infants and during pregnancy. rapid diagnostic tests and treatment of confirmed cases with an effective anti-immune. antimalarial drugs. "The deployment of these tools has already significantly reduced the burden of malaria in many African settings."
The agency was right. Between 2000 and 2015, the rate of new cases of malaria in sub-Saharan Africa fell by 42% and the malaria mortality rate by 66%, although the region continues to account for about 90% of malaria cases and deaths.
While the three African countries selected have high hopes that the vaccine will be manifested in their willingness to include it in their country's national immunization program, WHO is transparent and makes its partial effectiveness public.
"RTS, S being only partially effective, it will be essential to test malaria in all fever-vaccinated patients and treat all those whose malaria diagnosis is confirmed with effective and high-quality antimalarial drugs" said the WHO.
Read more: How to avoid infection if you go to a malaria area
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