Category Archives: Malaria

15 March 2022

In 2021, WHO recommended the first malaria vaccine, RTS,S/AS01, for children at risk, followed by a decision by Gavi, the Vaccine Alliance, to fund malaria vaccine roll-out in sub-Saharan Africa. Together, these two decisions pave the way for broader roll-out of this new vaccine.

Three WHO experts – Dr Mary Hamel, Dr Richard Mihigo and Dr Akpaka Kalu – provide updates on next steps for RTS,S, and how WHO and partners are supporting the vaccine’s wider roll-out.

Q: Dr Hamel, you lead the malaria vaccine pilot programme that informed the WHO recommendation for the first malaria vaccine. Can you share some reactions to the recommendation?  

The recommendation is a historic breakthrough – after more than 60 years of research and the efforts of thousands of people, we finally have the first malaria vaccine, which has the potential to reach millions of children and save tens of thousands of children’s lives annually. It is also a breakthrough for child health – the pilot introductions showed that this vaccine can substantially reduce severe malaria and all-cause mortality when provided through the routine child immunization clinics.  If introduced widely, the addition of this vaccine to other recommended malaria control tools will result in millions of malaria cases averted and can help get malaria control back on track.

The leadership of the Ministries of Health in Ghana, Kenya and Malawi, and their decision to participate in the pilot malaria vaccine introductions, were instrumental in generating the information necessary to support the WHO recommendation of the malaria vaccine.  The pilot implementations are only possible with the generous contributions from Gavi, the Global Fund and Unitaid.  I also want to recognize the important contributions of the evaluation partners who have evaluated the vaccine introduction, health workers, and key partners such as PATH, UNICEF and GSK.

The pilots will continue in the three countries through 2023 to understand the added value of the 4^th vaccine dose and to measure the longer-term impact on child deaths.

Q: And do you have key updates to share on next steps for the vaccine?

Since October, another key milestone for the malaria vaccine was achieved – international financing of vaccine doses for country implementation was secured when on 2 December 2021 the Board of Gavi, the Vaccine Alliance, approved funding for the malaria vaccine programme. The initial investment of US$ 155.7 million will support malaria vaccine introduction, procurement and delivery for Gavi-eligible countries in sub-Saharan African in 2022-2025.

Design for the Gavi malaria vaccine programme is underway, with WHO and partners in support, to streamline the procurement process and expand introduction of the life-saving vaccine as rapidly as possible. We understand that Gavi aims to open applications for country-level procurement of doses sometime in the third quarter (Q3) of this year.

Q: Dr Mihigo, as the lead for child immunization in Africa, can you tell us what to expect on malaria vaccine supply and demand in the region?

Demand for the malaria vaccine from endemic countries in Africa is expected to be high. It is an unfortunate fact that supply of the vaccine is expected to be insufficient to meet demand in the coming years. A recent WHO-commissioned study found that vaccine supply will likely be constrained through the medium term (potentially 4-6 years) unless additional investments and timely actions are taken.

Q: How will the limited malaria vaccine supply be allocated in the coming years?

In response to the situation, WHO is coordinating the development of a Framework to guide global decisions about malaria vaccine allocation and help inform national decisions about vaccine prioritization while supply is limited. The Framework will be based on best available scientific evidence, shared values, input by expert advisers and broad consultation with affected countries and communities and other malaria vaccine stakeholders.

The target date to complete the framework is the end of the first quarter (Q1) of this year.

Q: Given the constrained supply, what is being done to expand production of the malaria vaccine?

WHO and partners continue to support efforts to accelerate malaria vaccine access and a healthy malaria vaccine market. Achieving this vision will demand robust investments and new public and private partnerships to increase manufacturing capacity swiftly.

In January 2021, GSK, Bharat Biotech of India, and PATH announced the product transfer of the RTS,S antigen to Bharat Biotech, which will become the sole supplier of the vaccine no later than 2029 (GSK will continue to supply the AS01 adjuvant). The product transfer is an important step toward ensuring the long-term, sustainable supply of the vaccine to meet expected demand.

WHO and partners are exploring other ways to increase malaria vaccine supply – for example, in support of the development of new and next-generation malaria vaccines that could increase access.

Q: Dr Kalu, as a malaria expert for the Africa region, what guidance can countries expect from WHO to guide their use of the vaccine to reduce malaria illness and deaths?

The WHO recommendation and position on the RTS,S vaccine is now published in an updated WHO position paper on the malaria vaccine (Weekly Epidemiological Record, 4 March 2022) and as part of WHO Guidelines for malaria, an online platform called the MAGICapp.

WHO guidance for malaria control is moving away from a “one-size fits all approach” to apply an optimal mix of tools that fit the local context and can generate the most impact – the malaria vaccine is an additional tool for countries to consider as part of their national malaria control strategies.

WHO is also developing an operational manual on the sub-national tailoring of malaria interventions that will include the RTS,S vaccine, and a malaria vaccine implementation guide will inform planning for vaccine introduction in countries.

Q: Thank you very much Drs Hamel, Mihigo and Kalu. As we look to the future of the RTS,S malaria vaccine, any closing words you’d like to share?

Dr Hamel: This malaria vaccine is a big step forward in the fight to reduce malaria illness and death, but there is more to do. The vaccine can only reach its full potential if it reaches children at risk.  This means accelerated increased supply is of utmost importance.  WHO is working with partners to find ways to increase access to this vaccine and to facilitate development of future vaccines, while supporting research and development (R&D) for other innovative malaria control interventions.

Dr Mihigo: The community demand for the malaria vaccine is a bellwether for what we expect to come – caregivers want this vaccine for their children and will bring them for vaccination. The malaria vaccine is a positive step for child survival and malaria progress through the existing immunization platform.

Dr Kalu: African children are at highest risk of dying of malaria – one child died of malaria every minute, in 2020. The long-awaited malaria vaccine will benefit Africa, which shoulders the heaviest burden of the disease, if we can deliver it to the children who need it. We must seize this opportunity to help get malaria progress back on track and improve child health.

With thanks to the WHO experts: Dr Hamel leads the MVIP and malaria vaccines, Dr Kalu is the Africa region lead for malaria control, and Dr Mihigo is the Africa region lead for immunization.

Source: https://www.who.int/news-room/feature-stories/detail/ask-the-who-experts-next-steps-for-the-first-malaria-vaccine

First-ever malaria vaccine recommendation now published in a position paper and in the WHO guidelines for malaria

4 March 2022 

WHO today published an updated position paper on the RTS,S/AS01 (RTS,S) malaria vaccine that includes the October 2021 recommendation calling for the wider use of the vaccine among children living in areas of moderate-to-high P. falciparum malaria transmission. The paper complements the recent addition of the recommendation to the WHO Guidelines for malaria.

“The first malaria vaccine is a major step forward for malaria control, child health and health equity. If implemented broadly, the vaccine could save tens of thousands of lives each year,” said Dr Kate O’Brien, director of the Department of Immunization, Vaccines and Biologicals. “This guidance is essential to countries as they consider whether and how to adopt the vaccine as an additional tool to reduce child illness and deaths from malaria,” she added.

Source: https://www.who.int/news/item/04-03-2022-first-ever-malaria-vaccine-recommendation-now-published-in-a-position-paper-and-in-the-who-guidelines-for-malaria

Prevention

Over the last 2 decades, expanded access to WHO-recommended malaria prevention tools and strategies – including effective vector control and the use of preventive antimalarial drugs – has had a major impact in reducing the global burden of this disease.

Vector control

Vector control is a vital component of malaria control and elimination strategies as it is highly effective in preventing infection and reducing disease transmission. The 2 core interventions are insecticide-treated nets (ITNs) and indoor residual spraying (IRS).

Progress in global malaria control is threatened by emerging resistance to insecticides among Anopheles mosquitoes. According to the latest World malaria report, 78 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010–2019. In 29 countries, mosquito resistance was reported to all main insecticide classes.

Preventive chemotherapies

Preventive chemotherapy is the use of medicines, either alone or in combination, to prevent malaria infections and their consequences. It includes chemoprophylaxis, intermittent preventive treatment of infants (IPTi) and pregnant women (IPTp), seasonal malaria chemoprevention (SMC) and mass drug administration (MDA). These safe and cost-effective strategies are intended to complement ongoing malaria control activities, including vector control measures, prompt diagnosis of suspected malaria, and treatment of confirmed cases with antimalarial medicines.

Vaccine

Since October 2021, WHO also recommends broad use of the RTS,S/AS01 malaria vaccine among children living in regions with moderate to high P. falciparum malaria transmission. The vaccine has been shown to significantly reduce malaria, and deadly severe malaria, among young children.

Questions and answers on the RTS,S vaccine.

Case management

Early diagnosis and treatment of malaria reduces disease, prevents deaths and contributes to reducing transmission. WHO recommends that all suspected cases of malaria be confirmed using parasite-based diagnostic testing (through either microscopy or a rapid diagnostic test). Diagnostic testing enables health providers to swiftly distinguish between malarial and non-malarial fevers, facilitating appropriate treatment.

The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT). The primary objective of treatment is to ensure the rapid and full elimination of Plasmodium parasites from a patient’s bloodstream to prevent an uncomplicated case of malaria from progressing to severe disease or death.

Antimalarial drug resistance

In recent years, antimalarial drug resistance has emerged as a threat to global malaria control efforts, particularly in the Greater Mekong subregion. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.

For more on WHO’s work on antimalarial drug resistance in the Greater Mekong subregion, visit the Mekong Malaria Elimination Programme webpage.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures to prevent re-establishment of transmission are required.

In 2020, 26 countries reported fewer than 100 indigenous cases of the disease, up from 6 countries in 2000. Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last 2 decades, 11 countries have been certified by the WHO Director-General as malaria-free.

Countries and territories certified malaria-free by WHO.

Surveillance

Malaria surveillance is the continuous and systematic collection, analysis and interpretation of malaria-related data, and the use of that data in the planning, implementation and evaluation of public health practice. Improved surveillance of malaria cases and deaths helps ministries of health determine which areas or population groups are most affected and enables countries to monitor changing disease patterns. Strong malaria surveillance systems also help countries design effective health interventions and evaluate the impact of their malaria control programmes.

WHO response

The WHO Global technical strategy for malaria 2016–2030, updated in 2021, provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The strategy sets ambitious but achievable global targets, including:

• reducing malaria case incidence by at least 90% by 2030
• reducing malaria mortality rates by at least 90% by 2030
• eliminating malaria in at least 35 countries by 2030
• preventing a resurgence of malaria in all countries that are malaria-free.

Guided by this strategy, the Global Malaria Programme coordinates the WHO’s global efforts to control and eliminate malaria by:

• setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies and guidelines;
• keeping independent score of global progress;
• developing approaches for capacity building, systems strengthening, and surveillance; and
• identifying threats to malaria control and elimination as well as new areas for action.

Source: https://www.who.int/news-room/fact-sheets/detail/malaria

World Malaria Day 25 April 2022

World Malaria Day is held each year on April 25th. This annual event is a worldwide effort, to raise awareness of Malaria and funds for the treatment and prevention of malaria. The day works to highlight the need for better political intervention in malaria control and prevention. The day also marks the continuing great achievements in the fight against Malaria.

Last year’s theme for World Malaria Day was ‘End Malaria for Good’ and the day is hosted by the World Health Organization.

The World Health Organization is putting prevention of malaria to the forefront in this event, with the aim of reducing the massive global death toll of 400,000 people to Malaria every year. Efforts to highlight prevention has been reducing the death toll, especially through the use of insecticide and mosquito nets, as mosquitos are the most common carriers and spreaders of Malaria. The continued campaign of prevention is proving effective and saving lives, but there is still a long way to go.

World Malaria Day and continued awareness and prevention, as well as lobbying for better political support must continue and increase in order to eradicate the disease and prevent deaths from it. Investment and interest from governments is essential for this continued fight against Malaria and related deaths.

Key facts

• Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
• In 2020, there were an estimated 241 million cases of malaria worldwide.
• The estimated number of malaria deaths stood at 627 000 in 2020.
• The WHO African Region carries a disproportionately high share of the global malaria burden. In 2020, the region was home to 95% of malaria cases and 96% of malaria deaths. Children under 5 accounted for an estimated 80% of all malaria deaths in the Region.

Overview

Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes. There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat. P. falciparum is the deadliest malaria parasite and the most prevalent on the African continent. P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa.

The first symptoms – fever, headache and chills – usually appear 10–15 days after the infective mosquito bite and may be mild and difficult to recognize as malaria. Left untreated, P. falciparum malaria can progress to severe illness and death within a period of 24 hours.

In 2020, nearly half of the world’s population was at risk of malaria. Some population groups are at considerably higher risk of contracting malaria and developing severe disease: infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as people with low immunity moving to areas with intense malaria transmission such as migrant workers, mobile populations and travellers.

Disease burden

According to the latest World malaria report, there were 241 million cases of malaria in 2020 compared to 227 million cases in 2019. The estimated number of malaria deaths stood at 627 000 in 2020 – an increase of 69 000 deaths over the previous year. While about two thirds of these deaths (47 000) were due to disruptions during the COVID-19 pandemic, the remaining one third of deaths (22 000) reflect a recent change in WHO’s methodology for calculating malaria mortality (irrespective of COVID-19 disruptions).

The new cause-of-death methodology was applied to 32 countries in sub-Saharan Africa that shoulder about 93% of all malaria deaths globally. Applying the methodology revealed that malaria has taken a considerably higher toll on African children every year since 2000 than previously thought.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2020 the Region was home to 95% of all malaria cases and 96% of deaths. Children under 5 years of age accounted for about 80% of all malaria deaths in the Region.

Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.9%), the Democratic Republic of the Congo (13.2%), United Republic of Tanzania (4.1%) and Mozambique (3.8%).

Source: https://www.who.int/news-room/fact-sheets/detail/malaria