The world received the long-awaited announcement on October 6th 2021 of “the broad use of the first malaria vaccine”. The recommendation was based on the results from an ongoing pilot program in Kenya, Ghana and Malawi which has reached over 800,000 children since 2019 as announced by WHO Director-General, Dr Tedros Adhanom Ghebreyesus who went on to say the malaria vaccine was a “breakthrough for science, child health and malaria control”.
Malaria is a leading cause of childhood illness. It kills over half a million people annually, mostly in Africa, and over 260,000 of those are children. The new Mosquirix (RTS,S) vaccine developed by GlaxoSmithKline protects against Plasmodium falciparum malaria, which causes the deadliest form of the disease, the form most prevalent in Africa. Deployed in conjunction with the other tools to prevent and treat malaria, the new vaccine is expected to save tens of thousands of young lives.
Mosquirix is also historic because this is the first vaccine developed against any parasitic disease. In clinical trials, the vaccine demonstrated the efficacy of about 50% against severe malaria in the first year, but this was not sustained and dropped significantly to near zero by the fourth year. Because severe malaria is responsible for up to half of malaria deaths, however, this is considered a “reliable proximal indicator of mortality”
Administering the malaria vaccine will not free us from other widely-adopted effective preventive and treatment measures including sleeping inside insecticide-treated bed nets, using insecticide sprays and other measures to prevent the bite of the female anopheles mosquito. We also continue to emphasize the importance of promptly seeking medical attention when a child develops a fever.
Malaria is a disease that can strike repeatedly, and indeed, in Sub-Saharan Africa, young children can have multiple infections within a year, hence the seasonal chemoprevention which involves administering preventive medicine to young children by mouth monthly during the transmission season. Already, as part of the vaccine trials, the combination of giving the vaccine along with seasonal chemoprevention showed significantly better protection using both than by using either method alone.
The malaria vaccine will be given by intramuscular injection in 3 initial doses a month apart starting from age 5 months with a proposed fourth dose given near the child’s second birthday. We propose that as countries move to make plans to introduce the Mosquirix vaccine, the new 5-month visit be developed into an integrated wellness check: the first Mosquirix shot administered, a weight check to detect any growth faltering and for the education and conversations to centre on the proposed weaning diet, and locally available weaning foods. Well provided, the timing of this anticipatory guidance visit will likely boost the knowledge and confidence of mothers around the introduction of complementary feeds especially as it becomes topical for them at this point.
The value of this scheduling is that it can be conveniently integrated into current National immunization programs, providing an additional opportunity to examine infants during the important period when they are being weaned to a complementary diet, a time when many caregivers struggle with this adjustment.
As a paediatrician working now in urban high-density Lagos, this opportunity is priceless. In my focused interactions with hundreds of mothers of weaning infants in the past two years, I have been surprised at the gaps in knowledge mothers of all socio-economic strata have around introducing complementary feeding. Almost everyone knows about exclusive breastfeeding, but subsequent to that, many people are at a loss on how to successfully transition children to a healthy infant and toddler diet.
In recent conversations about the value of the additional opportunity to engage mothers on the introduction of complementary feeds and child development, I have proposed the need for a child wellbeing visit between the 14-week and six-month visits that would provide this opportunity. With a malaria prevention vaccine that could be administered from age 5 months, this presents the perfect opportunity to integrate the administration of this vaccination with a focused nutrition visit that would educate caregivers. Beyond marketing products, many caregivers need education on how and when to introduce complementary feeds, and this 5 month child well being visit would address the need of the primary caregiver to adequately prepare for the wean and the need of the primary care provider to have some one-on-one time with baby and mother to assess well-being.
It could be another year before Mosquirix is available to be administered at your neighbourhood health centre- it must still be vetted by GAVI- The Global Alliance for Vaccines- whose board has yet to approve the vaccine, followed by country-level engagement. Nonetheless, we have made significant progress already, and we are this much closer to having this additional weapon in our fight against childhood malaria.
From where we sit as paediatricians, child health advocates and public health physicians with significant experience in malaria elimination programming in Africa, this is certainly a breakthrough for “science, child health and malaria control” and a win for Africa.
Dr Orode Doherty is the Medical Director of Ingress Health Partners and the Founder of the African Children’s Hospitals Foundation whose mission is to optimise training, research and infrastructure development for care in hospitals in Africa dedicated to the well-being of children while coordinating and integrating these into the wider healthcare systems. www.afchf.org @theafchf
This article was initially published on October 14 2021 on LinkedIn as "The new malaria vaccine: An opportunity to integrate weaning and complementary feeding education into the immunization schedule"