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Ghana: Malaria vaccine should not replace prevention protocol

By Jonas Nyabor
Posted on Friday, 29 October 2021 11:47

Malaria Vaccine
The vaccine is the world's first for malaria and has been rolled out in Kenya, Ghana, and Malawi by the World Health Organisation (AP Photo/Joseph Oduor)

After participating in the Mosquirix™ malaria vaccine trials between 2009 and 2014, Ghana is hoping to progress from control of the disease to its elimination through the new jab. But health actors warn against shifting all focus on the vaccine, thereby neglecting other preventive activities.

The World Health Organization (WHO) has given green light for the wide use of the RTS,S malaria vaccine, Mosquirix™,  following a successful pilot implementation programme in Ghana, Kenya and Malawi.

Victories against the parasite

On 6 October, WHO announced its endorsement of the world’s first malaria vaccine to be used by children across Africa, and like many malaria-endemic countries in the world, the announcement was received with extreme excitement in Ghana.

Malaria remains one of the leading causes of death in Ghana, with many victims being children under the age of five.  Of the nearly one million confirmed cases in 2019, children under age five alone made up over 30% of the number.

Ghana is looking to eliminate malaria by 2030, and according to the manager of its malaria control programme, Kezia Malm, the introduction of the vaccine will speed up the process.

“This is great news for us. The vaccine is able to reduce severe malaria cases that are admitted to the hospital by 30% and last year alone, Ghana recorded almost 400,000 malaria cases admitted to hospital so a reduction by 30% is huge. On deaths, there is going to be a 7% reduction. This vaccine is something we really look forward to. We are very hopeful that this will help in our malaria fight,” Malm tells The Africa Report.

Outside of the vaccine, Ghana has achieved success in the fight against the mosquito-borne parasitic disease.

  • The reduction in deaths for those under five years from 21% in 2016 to 14% in 2019;
  • A reduction in malaria-related deaths in the general population from 2,799 in 2012 to 308 by the end of 2020.

But there is still a ways to go before Ghana can call itself completely free from malaria.

With a grain of salt…

Although promising, some health observers have sounded the alarm over the potential for over-reliance on the vaccine instead of the country’s existing malaria control activities.

The executive director of the African Media and Malaria Research Network, Charity Binka tells The Africa Report that the successes achieved in Ghana’s fight stem from different activities, including Indoor Residual Spraying (IRS) and the campaign or use of insecticide-treated nets (ITNs). She stresses that we must not abandon these because of the vaccine.

“We need to create awareness and let people know that this vaccine will save lives, but we also have the other tools. We must allow our children to be vaccinated but we must use other tools such as the use of insecticide-treated nets and indoor residual spraying. If we do these together there is no reason why we should not be moving from malaria control to pre-elimination and to elimination.”

Vaccine could be a financial lifeline

The approval of the Mosquirix™ vaccine comes as a lifeline in Ghana’s fight against malaria amidst dwindling donor funding for its malaria control programme.

The WHO has estimated that eliminating malaria in Ghana could cost $951m from 2020 to 2029. It has called on the country to increase its domestic funding of malaria control activities.

But Ghana largely depends on donor funding to meet the cost of its malaria control programmes as it can only fund about 25% of the total cost.

The American President’s Malaria Initiative (PMI) has been a major supporter of Ghana’s malaria control programme. Since 2006, it has invested $361m into the programme primarily to purchase and deliver bed nets, doses of antimalarial medications, malaria rapid diagnostic tests and training of health workers.

A lecturer at the School of Medicine and Health Sciences at the Central University, Benson Owusu Atuahene, believes that Ghana’s health services must intensify public education on pre-vaccine malaria prevention activities to avoid retrogression in its fight against the disease.

“Having the malaria vaccine approved doesn’t mean an end to measures currently being implemented towards malaria prevention. The Ghana Health Service and other stakeholders must continue educating the populace on malaria and its prevention, encouraging people to continue sleeping under insecticide-treated bed nets, reporting to the hospital when they start exhibiting the signs and symptoms of the disease, among others. These measures will make the vaccination more useful,” he tells The Africa Report.

Over at the Achimota Hospital in Accra, some nursing mothers say the vaccine approval is positive news, given it would ease the strain on their finances.

They spend, on average, between GHS35 ($5.50) and GHS100 ($16) on the treatment of malaria per child. This amount excludes the cost covered by the National Health Insurance Scheme – whose highest disease expenditure is malaria.

“Having a vaccine is good news for us because our children will not suffer malaria as much to get us to come to the hospital often and spend money. I don’t have a problem if they add it to the existing immunisations. I’m ready to bring my 4-year-old son for the vaccine,” says Sarah Okine, a nursing mother.

Important tool

Magdalene Ansah, a resident paediatrician at the Korle-Bu Teaching Hospital notes that although the vaccine does not offer complete protection against malaria, it is an extremely important tool and should be added to the country’s existing immunisation schedule to achieve wide coverage.

“Once it is added to the immunisation schedule, it would be easier to administer to children, gaining enough coverage and obtaining herd immunity,” she says.

Ghana has one of the most robust immunisation programmes in Africa and it is optimistic that the malaria vaccine will hasten its drive towards the elimination of the disease in the next decade.

As stakeholders involved in Ghana’s malaria control activities wait on the Ministries of Health and Finance and their partners to secure the vaccines once it hits the international markets, they want the government to continue its focus on the existing malaria control protocol.

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