A ‘malaria-free future’ has a berth, five months after United Nations Secretary-General, Antonio Guterres, declared that such a future is possible. Speaking during the World Malaria Day in April, he said despite the COVID-19 pandemic and the multiple crises it has sparked, a growing number of countries are approaching and achieving malaria elimination.
“We commend all countries that have reached the ambitious target of zero malaria”, Guterres, said, adding, “together, they are showing the world that a malaria-free future is possible.”
With World Health Organisation (WHO) recommending widespread use of the world’s first malaria vaccine, in what its chief described on Wednesday as “an historic day” for the decades-long battle against the deadly disease, a malaria-free future has indeed, arrived.
Countries with zero malaria have reached the people at risk with the necessary services, from prevention to detection and treatment, regardless of citizenship or financial status, said the top UN official.
“Sustained funding, surveillance systems and community engagement have been the key to success”, he added.
Yet, while these achievements deserve celebrating, it is important to remember the millions around the world who continue to suffer and die from this deadly illness.
Each year, malaria claims the lives of more than 400,000 people, mainly young children in Africa. And, every year, there are more than 200 million new cases of this fatal parasitic disease.
With robust political commitment, adequate investment and the right mix of strategies, “malaria can be defeated”, upheld the UN Secretary-General.
Between 2000 and 2019, the number of countries with fewer than 100 indigenous malaria cases increased from six to 27, according to WHO, calling it “a strong indicator” that malaria elimination is within reach.
The UN health agency lauded those countries that have already done so saying: “They provide inspiration for all nations that are working to stamp out this deadly disease and improve the health and livelihoods of their populations”.
In 2019, Africa shouldered 94 per cent of all malaria cases and deaths worldwide, with more than half of all cases occurring in the five countries of Nigeria, 27 per cent; Democratic Republic of the Congo, 12 per cent; Uganda and Niger, five per cent each; and Mozambique, four per cent, according to WHO.
During that same period, about three per cent per cent of malaria cases were reported in South-East Asia and two per cent in the Eastern Mediterranean region.
The Americas and Western Pacific region each accounted for fewer than one per cent of all cases.
Certifying zero malaria
Certification of malaria elimination is WHO’s official recognition of a country’s malaria-free status, which it grants when a State has proven, beyond reasonable doubt, that the chain of indigenous malaria transmission has been interrupted nationwide for at least the past three consecutive years.
Following 50 years of solid commitment by the Government and people of El Salvador to end the disease, in February it became the first country in Central America to receive the distinction.
Meanwhile, China, which registered zero indigenous cases in 2016 and has stayed malaria-free to date, applied last year for the WHO malaria-free certification.
The vaccine is, however, geared towards children, in sub-Saharan Africa and other regions with moderate to high transmission.
The recommendation to begin using the RTSS vaccine, is based on an ongoing pilot programme set up by WHO and partners in Ghana, Kenya and Malawi, that has reached more than 800,000 children since 2019.
“The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control”, said the WHO Director-General, Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”
Tedros said the world had made “incredible progress” in the fight against malaria in the past two decades.
The malaria parasite is mostly transmitted by infective mosquitoes and carried in the blood, after being bitten. It is not contagious person-to-person, and symptoms include a fever of flu-like illness, nausea and vomiting, and if left untreated, it can be fatal, killing more than 400,000 each year worldwide.
Since 2000, deaths have fallen by more than half, and the disease has been eliminated in many parts of the world.
For the WHO chief, though, progress has stalled at an unacceptably high level, with more than 200 million cases still occurring each year. Two-thirds of those who die from the disease, are children
Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260,000 African children under the age of five die from malaria annually.
WHO Regional Director for Africa, Matshidiso Moeti,
“We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use”, she said.
For Ms. Moeti, today’s recommendation “offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”
Based on the advice of two WHO global advisory bodies, one for immunization and the other for malaria, the UN Agency has made a series of specific recommendations.
The immunization should be administered in regions with moderate to high transmission, in a schedule of four doses, in children from five months of age and up.
According to Tedros, the pilot study has shown that the vaccine can be easily delivered through child health clinics by Ministries of Health, reaching children with high coverage. There is strong community demand, and it has “broad reach to children, including the most vulnerable who may not use a bednet” to keep out mosquitoes, and it is highly cost-effective.
Deaths reduced by a third
To date, more than 2.3 million doses of the vaccine have been administered, showing a favorable safety profile.
The vaccine showed a significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.
The study showed that the distribution of the vaccine had no negative impact on uptake of bednets, other childhood vaccinations, or health-seeking behaviour for other febrile illnesses.
The next steps will include funding decisions from the global health community for broader rollout, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies.
“This is a powerful new tool, but like COVID-19 vaccines, it’s not the only tool”, stressed Tedros. Vaccination against malaria does not replace or reduce the need for other measures, including bednets, or seeking care for fever.”