Liberia: Goodbye Malaria Deaths?

Liberia is set to benefit from the global rollout of the first-ever malaria vaccine, along with eleven other countries in Africa.

The distribution of 18 million doses over the next two years marks a significant step forward in the fight against malaria, one of the leading causes of death on the continent.

The allocation of the vaccine has been determined based on the principles outlined in the Framework for allocation of limited malaria vaccine supply. The doses will be prioritized for areas with the highest need, where the risk of malaria illness and death among children is greatest.

“This vaccine has the potential to be very impactful in the fight against malaria, and when broadly deployed alongside other interventions, it can prevent tens of thousands of future deaths every year,” said Thabani Maphosa, Managing Director of Country Programmes Delivery at Gavi, the Vaccine Alliance, according to a WHO release. 

“While we work with manufacturers to help ramp up supply, we need to make sure the doses that we do have are used as effectively as possible, which means applying all the learnings from our pilot programmes as we broaden out to a new total of 12 countries,” Maphosa added. 

Malaria remains one of Africa's deadliest diseases, claiming the lives of nearly half a million children under the age of 5 in 2021 alone. It accounts for approximately 95% of global malaria cases and 96% of deaths.  

Liberia, however, is no exception as malaria is endemic in the country and transmission occurs year-round within all geographic areas with nearly everyone at risk.

According to the World Health Organization, malaria is the greatest cause of disease and death in Liberia, accounting for 46.9% of hospital outpatients in 2020. 

Children under the age of five and pregnant women are the most affected groups. The 2013 Health Facility Survey (HFS) found that malaria cases account for about 42% of all outpatient consultations and 44% of all inpatient deaths among children under the age of five years. 

The introduction of the malaria vaccine is expected to therefore significantly reduce these numbers and save countless young lives.

The malaria vaccine, known as RTS,S/AS01, has been administered in Ghana, Kenya, and Malawi since 2019 through the Malaria Vaccine Implementation Programme (MVIP). This program is coordinated by the World Health Organization (WHO) and funded by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, according to Unitaid. So far, over 1.7 million children in these countries have received the vaccine, and it has proven to be safe and effective. It has led to a significant reduction in severe malaria cases and a decrease in child deaths. Interest in receiving the vaccine has been expressed by at least 28 African countries.

Apart from Ghana, Kenya, and Malawi, the initial allocation of 18 million doses will enable nine more countries, including Liberia, to introduce the vaccine into their routine immunization programs for the first time. This allocation round will make use of the vaccine doses available to Gavi, Vaccine Alliance via UNICEF. The first doses are expected to arrive in the countries during the last quarter of 2023, with the rollout beginning in early 2024.

“Nearly every minute, a child under 5 years old dies of malaria,” said UNICEF Associate Director of Immunization, Ephrem T. Lemango. “For a long time, these deaths have been preventable and treatable; but the roll-out of this vaccine will give children, especially in Africa, an even better chance at surviving. As supply increases, we hope even more children can benefit from this life-saving advancement.”

“The malaria vaccine is a breakthrough to improve child health and child survival; and families and communities, rightly, want this vaccine for their children. This first allocation of malaria vaccine doses is prioritized for children at highest risk of dying of malaria,” said Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals. “The high demand for the vaccine and the strong reach of childhood immunization will increase equity in access to malaria prevention and save many young lives. We will work tirelessly to increase supply until all children at risk have access.”

Given the limited supply in the first years of the roll-out of this new vaccine, in 2022, WHO convened expert advisors, primarily from Africa – where the burden of malaria is greatest – to support the development of a Framework for the allocation of limited malaria vaccine supply, to guide where initial limited doses would be allocated. The Framework is based on ethical principles on a foundation of solidarity; and it proposes that vaccine allocation begin in the areas of greatest need.  

The Framework implementation group that applied the framework principles included representatives of the Africa Centres for Disease Control and Prevention (Africa CDC), UNICEF, WHO and the Gavi Secretariat, as well as representatives of civil society and independent advisors. The group’s recommendations were reviewed and endorsed by the Senior Leadership Endorsement Group of Gavi, WHO and UNICEF. Annual global demand for malaria vaccines is estimated at 40–60 million doses by 2026 alone, growing to 80–100 million doses each year by 2030. In addition to the RTS,S/AS01 vaccine, developed and produced by GSK, and in the future supplied by Bharat Biotech, it is expected that a second vaccine, R21/Matrix-M, developed by Oxford University and manufactured by Serum Institute of India (SII), could also be prequalified by WHO soon. Gavi has recently outlined its roadmap to support increasing supply to meet demand.