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The 12e June 2021 at the G7 summit in Cornwall, Kenyan singer, rapper and songwriter Don Chrisantos Michael Wanzala, better known as Don Santo, said that ‘what the world needs today are alliances that improve people’s lives by creating opportunities, not cheap public relations stunts. . He went on to say, ‘where I come from, we say kwa ground vitu nor different’.
This week, the World Health Organization (WHO) recommended the widespread use of the malaria vaccine RTS, S / AS01 (RTS, S) under the trade name Mosquirix in children in sub-Saharan Africa and other areas where there is a moderate to high risk. transmission of Plasmodium falciparum malaria. To say this is a historic moment in the world is an understatement. Throughout history, malaria has been a major cause of ill health and death in humans.
While there is enough evidence to suggest that the mosquito’s life cycle can be disrupted to prevent malaria transmission, humans have not. In the past, some countries have tried to use chemical means to kill the mosquito.
In 1963, Sri Lanka was able to reduce its annual malaria cases to 17 from a maximum of over one million by using the double agent dichlorodiphenyltrichloroethane (DDT) (to kill mosquitoes) and chloroquine ( to cure infected people). Unfortunately, this approach was capital intensive and could not be sustained. Added to this was the ability of mosquitoes to develop resistance to DDT and Plasmodium to develop resistance to chloroquine.
The result was that in 1969 the annual workload had grown to over 500,000. This scenario has occurred in many other countries, rendering antimalarial drugs that were previously effective unable to treat the disease. Currently, most malaria treatment programs around the world rely on combinations of drugs to achieve the desired goal.
On the African continent, although lip service, eradication of malaria has never been on the agenda. This is in part because the malaria economy, both legal and illegal, has been very viable. The fundamentals included the manufacture and sale of all kinds of preventive and curative antimalarial accessories such as mosquito nets, coils, insecticides and antimalarial drugs. Along with this, there is the sale of fake, substandard and counterfeit antimalarial drugs. The percentage of these unhealthy drugs on the African continent varies. However, on average, it is estimated that around 30% of these drugs on the continent are unsafe for use in the healthcare supply chain.
A study from the London School of Hygiene and Tropical Medicine (LSHTM) found that these dangerous drugs cost patients and healthcare providers in sub-Saharan Africa US $ 38.5 million in future care needed due to failure of their first treatment. WHO also estimates that these types of drugs may be responsible for up to 116,000 deaths from malaria each year in sub-Saharan Africa.
In the statement announcing the recommendation for the new vaccine, officials also said malaria is responsible for the deaths of more than 260,000 African children under five each year. The historical antecedent therefore suggests that if solid preventive measures are not found, the fight against malaria may only be in name. We are therefore delighted that this first vaccine has emerged with some African countries taking part in some aspect of the final trials.
Since Mosquirix received a favorable opinion from the European Medicines Agency (EMA) for its use in children aged 6 weeks to 17 months, the journey to phase III trials has begun. In 2016, WHO asked countries to express interest in participating. This led to the identification of three countries (Ghana, Kenya and Malawi) as pilot sites. Since the start in 2019, 2.3 million doses of the vaccine have been administered in these three countries.
The data available from these pilots has been very encouraging. The vaccine has been shown to have a good safety profile and no serious side effects have been reported. It has also been shown to cause a significant (30%) reduction in fatal severe malaria in all countries.
With the vaccine available, the next hurdle in the fight against malaria will be funding to facilitate deployment. As the WHO said in its press release, “the next steps must include funding decisions from the global health community for wider deployment.” The question will therefore be whether Africa will rely on Gavi, the Vaccine Alliance and similar agencies that funded the pilot project to meet the cost. If not, is the continent prepared to be responsible for purchasing this malaria vaccine?
We are aware that many African countries have seen their financial situation deteriorate due to the COVID-19 pandemic. However, this pandemic has also highlighted the fact that the dependence on the global community for vaccines is not sustainable. One need only look at the data on the percentage of people fully vaccinated on the continent to conclude that Africa should use a different approach to ensure that this malaria vaccine is available as soon as possible for all children born on the continent.
At the time of writing, only 13 of the continent’s 54 countries had successfully fully immunized the expected 10% of their population against SARS-CoV-2 by the 30th.e September deadline set by WHO. Most rely on COVAX to ensure they would meet the next full immunization deadline for 40% of their population by the 31st.st of December 2021.
With many political leaders on the continent declaring that our health systems can no longer be supported by charity, Africa must demonstrate, by using this new vaccine, that we understand the value of investing in health and are ready to back up our words with our actions.
If this goal is achieved, it will be an additional incentive for other malaria vaccine candidates that are at various stages of development. In April 2021, the Oxford Vaccine Group, developer of the AstraZeneca COVID-19 vaccine, announced that data from phase II trials of their R21 / Matrix-M malaria vaccine candidate had a vaccine efficacy of 77%, which is another good prospect. Other candidate malaria vaccines, such as PfSPZ developed by Sanaria, have also shown promise. Without a functioning market, more vaccine developers are unlikely to emerge.
Countries on the African continent, where the prevalence of malaria is high, need to learn from the speed at which COVID-19 vaccines have been developed and understand that an available market is a huge incentive for research and development. pharmaceuticals.
They should also take note that with the approval of the first malaria vaccine and the enthusiasm that greeted it, there is going to be a global refocus on this endemic disease. Africa cannot afford to lose this momentum simply because the countries most affected by the plasmodium have not been able to organize themselves to develop a viable financing strategy.
We believe that there is enough to learn from COVAX and the African Union initiative to source COVID-19 vaccines for the continent to fully seize this malaria vaccine opportunity. Posterity will not forgive us if, under a viable vaccine, infant and under-five mortality from malaria does not decrease significantly. This vaccine should not become another “kwa sol vitu nor different”. for Africans. Getting there will require bold planning and leadership. Let’s not make it our Achilles heel.
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