More than 800,000 doses of malaria vaccine are to be distributed in Nigeria. As part of Nigeria’s Routine Immunisation, this is the first phase of the vaccine received in an effort to eliminate the disease in the country.
On October 17, Professor Muhammed Ali Pate, Nigeria’s Minister of Health and Social Welfare said the first phase of the vaccines which requires four doses will be administered to children under one in the most affected states in November.
“This vaccine will be life-changing for millions of Nigerian families, particularly in regions where malaria devastates lives,” said Cristian Munduate, UNICEF’s Representative in Nigeria. Malaria disease can be fatal and lead to several complications such as breathing problems, organ failure, and low blood sugar across all ages.
In 2022, Nigeria recorded close to 68 million malaria cases, 27% of cases reported worldwide and 28% of cases within the WHO African Region. Notably, data specified that while malaria incidence continues to rise in Nigeria, mortality rates have also increased, particularly over the last three years.
According to Dataphyte’s analysis, malaria-related deaths rose from 82,650 in 2017 to 191,890 in 2021. By 2022, this figure slightly decreased to 188,480, a 2.8% decrease from the previous year. Despite this short decrease, the high rate of malaria mortality rate in the country remains a concern.
Since 2020, more than 500,000 lives are lost to malaria, and the upcoming 2024 World Malaria Report will likely reveal an even higher rate, as available interventions, such as mosquito nets, have proven not-so-effective.
Malaria: Nigeria and its Counterparts
Currently, Nigeria ranks first among African countries with high cases of malaria. According to the World Health Organisation, 95% of malaria diseases worldwide were recorded in Africa, along with 97% of its mortality rates.
However, some African countries, such as Cabo Verde, Algeria, Morocco, Mauritius, and recently Egypt, have been certified ‘malaria-free’ by WHO. Egypt joined this list on October 20, becoming the 5th African country to be free of malaria cases.
Following WHO’s guidelines, a country is considered ‘malaria-free’ once it provides confirmed evidence that malaria has been kicked-out nationwide for at least three years and there’s a capacity to prevent future transmission.
For over a decade, Nigeria has been seeking support from international organisations, including The Global Fund, deploying several methods to tackle the disease across the country. Take for instance, Nigeria introduced the Insecticide-Treated Nets (ITNs) to various states in 2000 as part of its strategic plan to become a ‘malaria-free’ country. By 2013, the Federal Ministry of Health had distributed 57.7 million nets. With more than 1 million cases in 2021, Sokoto distributed 2.5 million nets to 23 local government areas in the state.
Likewise, the United States government donated 2.6 million bednets for distribution in Kebbi state, one of the states with the highest number of cases in Nigeria. Since 2011, the U.S government alone has invested over $490 million to support Nigeria in its quest to end malaria.
Effectiveness of current vaccines
The R21/Matrix-M is the second vaccine recommended by WHO to fight the malaria crisis in Africa. This month, the first phase of the vaccine would be set for distribution in Kebbi and Bayelsa states in Nigeria, after 12 other African countries already rolled out the first vaccine.
For example, Ghana started rolling out the RTS,S/AS01 (Mosquirix) malaria vaccine in 2019, alongside Kenya and Malawi. Testing the vaccine’s safety and effectiveness, the Ghanaian government introduced the vaccines to its people in selected areas as well as the other two governments.
Since then, the vaccine has reached nearly 2 million children in the three countries through the Malaria Vaccine Implementation Programme. For greater results, Ghana expanded the vaccination programme to reach additional areas with the R21 vaccine deployed across the regions of the country in 2023.
More recently, Ghana, who recorded over 5.2 million confirmed cases of malaria in 2022, has reported its falling malaria burden and is working toward eliminating the disease in the country. Hypothetically, this shows a positive change due to the implementation of the vaccine.
A study published by The Lancet this year describes the safety and effectiveness of malaria vaccine in African children. “Recently, we found that a new malaria vaccine, R21/Matrix-M, had over 75% efficacy against clinical malaria…,” the investigators wrote, “in the second phase.”
The trial was conducted across Burkina Faso, Kenya, Mali, and Tanzania, involving 4,800 children aged 5 to 17 months. According to the report, safety data from the trial has been reassuring with no serious adverse events linked to immunisation.
“No other vaccine has reported over 55% efficacy in the same age group. A booster dose after a year maintained good efficacy over the following 6-12 months.”
Becoming malaria free
It is most likely that Nigeria will achieve the same bold results as Ghana but with proper implementation of the vaccines and its acceptance by Nigerians. In verifiable instances, vaccines have worked effectively in Nigeria, drawing from the case of similar diseases like polio, yellow fever, and tuberculosis.
For over five years, Nigeria has not recorded a case of poliovirus, an outbreak that was last recorded in Borno State in 2016. The United Nations Children’s Fund (UNICEF) said a network of frontline workers and traditional leaders have been instrumental in polio eradication and strengthening community health systems.
For Nigeria to reach its target on malaria, it would require a similar action, advancing care through the primary healthcare system and focusing on improving funding. While Nigeria has been getting financial support from donors, it is not enough as said by an expert. The government needs to also “attract the private sector and narrow the funding gap.”
Dr. Folayan Temiloluwa, a medical expert, further noted that even though there may be plans to roll out the vaccine in specific states, questions remain about its sustainability. “Is there a long-term plan in place to ensure its continued availability, even for underserved populations across the country?”
According to the National Malaria Elimination Programme (NMEP), Nigeria aimed to reduce the prevalence of malaria cases to less than 10% and reduce its mortality rates to less than 50 deaths per 1,000 births by 2025.
The vision is to become a ‘malaria-free’ country, a place where the buzz of the mosquito is worse than its bite.