Africa’s fight against malaria at key juncture with approval of two vaccines

Carlos ExpósitoNairobi)

The fight against malaria, which is transmitted to people through the bite of infected Anopheles mosquitoes, is at a critical juncture in Africa, where 94% of cases occur, and there are hopes that the approval of two new vaccines will halt the progression of the disease.
“The fight is at a decisive moment. In recent years, it has become clear that stagnation has set in,” Chrisal Birungi, entomology coordinator at the Target Malaria research consortium in Uganda, told EFE on the occasion of International Malaria Day. , which is celebrated this Thursday.

According to the World Health Organization (WHO) in its World Malaria Report 2023, there were 249 million cases in 2022—five million more than in 2021—and more than 600,000 deaths.
94% of cases occur in Africa, half in Nigeria (27%), Democratic Republic of Congo (12%), Uganda (5%) and Mozambique (4%).

“Over the past twenty years, the incidence of malaria has decreased significantly throughout the world (…). The problem is that most of it is found in African countries, where there is a huge increase in incidence,” the director of the Johns Hopkins Institute told EFE. from malaria research (USA) by Jane Carlton.

Insecticide resistance

According to WHO, despite improvements in people’s access to insecticide-treated mosquito nets or drugs to prevent malaria, the number of people contracting the disease is increasing.

Kenya Medical Research Institute (KEMRI) pediatrician Sam Akech explains to EFE that this reality can be explained by “mosquito resistance to the insecticides used to treat nets” or the fact that “malaria control interventions have not reached all those who need them.” get.

Thus, he adds, the global malaria response has faced multiple threats, such as drug resistance, humanitarian crises, climate change and program delays.
“We need more tools to make progress. So far, the use of mosquito nets and rapid treatment have been successful,” Akech says.

Climate change: ‘a serious problem’

WHO has warned that climate change is affecting the spread of malaria.
“This is a major concern,” Carlton emphasizes, “and environmental disasters also play a role.”
When extreme weather events such as floods occur, mosquito breeding sites increase, facilitating the spread of malaria.

“This is a result of climate change. In addition, areas may appear that become more favorable for mosquitoes. So we may have places where in the past mosquitoes could not breed, but now they can,” Akech notes.

Another problem, he adds, is disruptions in health care services. “If there are landslides, people cannot get to health centers, and this is a big problem because malaria remains the disease that places the greatest burden on the health systems of most African countries.”

Hopes for the future

Despite the stagnation, vaccines can change this situation. In 2021, WHO recommended the use of the RTS,S/AS01 vaccine, better known as Mosquirix, in areas with moderate to high malaria transmission.

Since 2019, through a WHO-coordinated programme, Ghana, Kenya and Malawi have administered the vaccine to more than two million children, demonstrating a 13% reduction in mortality and a significant reduction in the incidence of severe malaria.

Already in 2023, WHO approved the use of Mosquirix in addition to the approval of the second vaccine R21/Matrix-M.

“One important approach to combating malaria is the development of vaccines (…), but there is no magic solution. The vaccine should be used in combination with existing malaria control measures. This will speed up progress,” says Akech.

These vaccines provide partial immunity, so a person can still get malaria after receiving the vaccine, although it will be less likely and less virulent.

Birungi believes there is “hope for the future” to “achieve malaria elimination, but it will require a lot of teamwork and commitment.”

Carlton is also optimistic: “I definitely see hope. Together, these vaccines will reduce malaria by 75% and are already beginning to be rolled out in many countries in sub-Saharan Africa.”