The world’s first malaria vaccine has been rolled out to protect 360,000 children.

This malaria vaccine implementation programme (MVIP) has been structured by WHO to address several outstanding questions related to the public health use of the vaccine. The programme aims to reach about 360,000 children per year across the three countries. “Malaria is a constant threat in the African communities where this vaccine will be given. We know the power of vaccines to prevent killer diseases and reach children. This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination,” said Matshidiso Moeti, WHO regional director for Africa.

According to the European Medicines Agency — the benefits of the vaccine outweigh the risks. However, the WHO does not recommend the use of the RTS,S vaccine in the younger (6–12 weeks) age category, as the vaccine’s efficacy has been found to be low in this age category so far. Even as the pilot takes off in Malawi, the vaccine, costing $5 per dose, can have maximum public health impact and can be cost-effective too if it is considered as a package of preventive interventions along with high usage of long lasting insecticidal nets (LLINs), and high coverage of seasonal malaria chemoprevention (in places with high seasonal malaria transmission as suggested by WHO in 2013).

Even as Malawi, Ghana and Kenya are working with WHO, Uganda has decided to develop a new Mass Action Against Malaria (MAAM) strategy. The country accounts for four per cent of global malaria cases and is also among the top five countries responsible for nearly half of all malaria cases worldwide, along with Nigeria, Democratic Republic of Congo, Mozambique and India.

Children under five years are at the greatest risk of death, with at least 250,000 children dying of the disease in Africa each year. With India reducing malaria cases by 24% in 2017 over the previous year using conventional methods, such as to “test-treat-track” all cases and distributing free insecticide-treated bed nets in endemic areas, the vaccine is unlikely to be made part of India’s public health program, say experts. In the sharpest global reduction in malaria in a year, cases India fell from 1,087,285 cases in 2016 to 844,558 in 2017, according to the World Malaria Report 2018.

The rest of the world, however, has not been performing as well. After a reduction in global malaria deaths by 62% and cases by 41% between 2000 and 2015, cases went up from 217 million in 2016 to 219 million in 2017, according to the World Malaria Report 2018.

With around 95% of the under-5 malaria deaths taking place in Africa, the benefits for a vaccine that protects children will be far greater there, say ministry officials.

The world’s first malaria vaccine has been rolled out in Malawi to protect 360,000 children under two in Malawi, Kenya and Ghana in Sub-Saharan Africa from the mosquito-borne disease that causes 435,000 people global deaths each year.

This vaccine which took almost 30 years to be developed by GlaxoSmithKline, provides partial protection against malaria among young children. It will only protect about one-third of the children who are immunised, while those who get the shots are likely to have less severe cases of malaria.

The RTS, S/AS01 (trade name Mosquirix) is an injectible recombinant protein-based vaccine acts against P. falciparum, the most prevalent malaria strain in Africa. The vaccine prevents four in 10 cases of malaria in children who received four doses over a four-year period, according to the World Health Organization (WHO). The WHO welcomed the pilot program by the government of Malawi.

Even though the public health potential of the RTS,S vaccine was recognised by the WHO, a further evaluation of RTS,S/AS01 was required to address several gaps in knowledge before considering wider country-level introduction. Hence, WHO has selected three out of 10 African countries — Ghana, Kenya and Malawi.

The ministries of health in Ghana, Kenya and Malawi will focus on areas with moderate-to-high malaria transmission to ensure maximum impact of the vaccine. In selected areas in the three countries, the vaccine will be given in four doses: three doses to those between five and nine months of age, and the fourth dose provided around the second birthday.