Breaking down the WHO’s new pediatric malaria vaccine

In early October 2021, the World Health Organization approved a pediatric Malaria vaccine, the first of its kind. The vaccine is a medical breakthrough, offering hope to families in sub-saharan Africa where malaria kills nearly 260,000 children every year.

The vaccine was originally piloted in 2019 and has since reached over 800,000 children throughout Kenya, Ghana and Malawi.

Commenting on the success, WHO Director General Dr. Tedros Adhanom Ghebreyes said that the vaccine comes at a pivotal time.

“This is a historic moment,” he said. “The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control… using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

The announcement arrives on the heels of alarm bells sounded by disease experts and researchers who started to report that insecticides used on bed nets and homes to kill malaria-carrying mosquitoes have begun to lose their efficacy. The over-reliance on these chemicals combined with the quick evolution rate of mosquitoes means that traditional methods for malaria prevention may need to be discarded completely within the next decade, making the approval of a malaria vaccine a massive relief to those living in transmission-heavy areas. 

However, the excitement of vaccine approval looks to be short lived as issues with distribution and feasibility continue to grow. 

The vaccine needs to be administered in four separate doses, and each dose needs to be exactly six month apart. In countries where censuses are not taken and where many families do not have home addresses, keeping track of childrens’ doses and finding them in time for their next vaccine may be next to impossible. 

Furthermore, vaccine doses must be chilled between two and eight degrees celsius at all times, or could risk compromising their effectiveness. The questions of reliable electricity access are no doubt on the minds of public health officials, who faced similar challenges in the past with polio vaccinations. 

And because of a lack of equitable access to healthcare, there will likely be a shortage of medical staff available to travel and administer care to rural communities. The vast majority of the population in sub-saharan Africa cannot afford to travel to receive care in basic medical facilities, and many families will likely view the biannual expenses as completely unreasonable. 

One solution would be to construct more facilities and the hire of more doctors, but even without the vaccine issue considered, sub-Saharan Africa is already far behind the necessary threshold for adequate healthcare infrastructure. The National Academy of Sciences estimate that there is a dire need for 6,000 new healthcare facilities in the next eight years and add 2.5 million new hospital beds to account for Africa’s rapidly growing population. This expenditure will undoubtedly rise as the push for vaccinations begins. 

Public health officials must also consider that this vaccine is arriving on the heels of the COVID-19 pandemic, which has sparked the first significant wave of anti-vaccine rhetoric in Africa. In the past, vaccines have rarely been questioned in this region, but recent viral videos of fake vaccine side effects and online rumors have fueled a misinformation crisis and infodemics that is putting sub-Saharan populations at serious risk for disease fatality. 

Nature reported on the story of Shade, a58-year-old Nigerian frontline healthcare worker living with diabetes and osteoarthritis, conditions that qualified her for the first round of vaccinations in her country. However, after seeing videos of patients fainting and reading rumors of infertility and cancer on American social media pages, she refused to be vaccinated. Nature reported that Shade’s hesitancy to accept a vaccine represents one story in a growing trend of pharmaceutical distrust which could easily crossover into attempts for a successful malaria vaccine rollout, further hindering distribution problems. 

One of the biggest concerns echoed about the new vaccine, however, is that even after all of these logistical and cultural hurdles, the WHO’s pediatric malaria vaccine provides a 30% decrease in child mortality. Although any decrease in mortality can be considered a success, many critics believe that sub-saharan African populations deserve better odds from the public health community, encouraging experts and researchers to do more.

While the approval of the first malaria vaccine marks a historic turning point in the fight against one of the world’s most endemic diseases, issues with its implementation continue to ensure that populations the vaccine was designed for will not fully reap its benefits for decades. 

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