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Malaria vaccine shortfall, heavy cost of Africa’s child deaths all thanks to global complacency

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Zacharia Kafuko is the Africa Chapter Manager of 1Day Sooner. He is a molecular biochemist and a 2017 recipient of the Mandela Washington Fellowship of the Young African Leaders Initiative. He has been the producer and presenter of the award-winning radio programme Science Bench and has been involved in vaccine equity advocacy. He has previously worked as a public health educator under the Water for African Cities programme. He currently lives in the Seychelles.

Where is the global commitment? One would think that institutions such as Unicef and Gavi, The Vaccine Alliance would be moving at maximum speed to deploy the new malaria vaccines. After all, this is literally a race against time: each day sees about 1,000 children dying of malaria in Africa.

Malaria today kills more than 600,000 people globally each year, with 96% of those deaths in sub-Saharan Africa, primarily among very young children.

African nations must be at the forefront of the fight against malaria. But as they balance competing economic, political, health and climate troubles, outside assistance is necessary and morally imperative. The international community has been willing to help – to a point – but a shortfall in malaria vaccine doses is cause for serious concern and raises questions about global commitment to vaccine and health equity.

The fight against malaria has been a long one and has cost countless millions of lives. Nonetheless, the last three years have been defining in the global fight against malaria as we saw for the first time the recommendation of effective malaria vaccines, a major breakthrough.

The RTS,S/AS01 malaria vaccine produced by GSK was recommended by the World Health Organization in 2021. In October 2023, WHO recommended the second malaria vaccine, R21/Matrix-M, developed by Oxford’s Jenner Institute and manufactured by the Serum Institute of India. Both the RTS,S and R21 vaccines have been shown to be effective and safe

Read more in Daily Maverick: AngloGold Ashanti’s malaria initiative is a game-changer

At the same time the WHO announced its recommendation of R21, the world learned that its manufacturer, the Serum Institute of India, had already produced more than 20 million doses, and moreover, the company stated that 100 million more could be produced in 2024. The total of 120 million doses would be enough to protect 40 million children with a three-dose initial course of vaccination. Compare this to RTS,S – with enough doses to protect less than seven million children in 2024 and 2025. 

Dying children race vs time

With the availability of R21, one would think that global institutions such as Unicef and Gavi, The Vaccine Alliance would be moving at maximum speed to deploy them. After all, this is literally a race against time: each passing day sees about 1,000 children dying of malaria in Africa. 

Yet for months it was unclear how many doses of R21 would be ordered and delivered; only recently has a number arisen: just 10 million. That is less than half the number of doses now available, which stood at 25 million at the beginning of this month. Such a shortfall is disturbing.

The solution to this shortfall will require African action, summoning the internal political will to prioritise these lifesaving vaccines and to push Unicef and Gavi to procure supply. These institutions respond to applications from African nations, after all.

Sharing rollout information

At the very least, perhaps these institutions could share information on what is happening with regard to the rollout. And what actions must be taken by which actors to move things along. African countries and the world at large deserve to know the specific sources of the shortfall, and why the goal is not to deliver all 120 million vaccine doses.

We cannot pretend, of course, that vaccine distribution is an easy task. There are many steps in the long process of testing, quality assurance, delivery and community uptake.

For example, following WHO’s prequalification in December 2023, the Serum Institute is required to conduct batch testing of the R21 vaccines, both in India and in the target population in Africa (this is an added quality control measure to ensure conformity).

Regulation

Respective countries aiming to roll out the vaccines also need to authorise R21 through their regulatory authorities. So far, only Nigeria, Ghana and Burkina Faso have done so. This process normally takes time to complete and for some countries, it can even take more than six months. 

Even when countries have authorised vaccines, they must submit applications to Gavi. This process generally must go through the ministries of health and ministries of finance (because vaccines’ costs are shared with Gavi). But Gavi only accepts applications from countries once every three months; allowing a rolling window for applications to be submitted as soon as they are ready may help speed things along and save precious time.

While certainly complex, an expedient rollout of the R21 vaccine is not an impossible task. Malaria was eradicated in the US in 1951, and 70 years later Africa has a real opportunity to make gains towards the same.

Perhaps this is also a wake-up call to Africa to build its own capacity for pioneering research and development of countermeasures against endemic diseases. When the continent builds its capacity, it will retain control of how quickly it should respond to emergencies threatening the lives of its citizens. 

In the interim, however, Africa will continue to lose 1,000 children per day to a disease which has available, recommended, prequalified, safe and efficacious vaccines.

At this stage, any child deaths from malaria must be understood to be as a result of institutional complacency, which comes at a severe cost.​ DM

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  • Ben Harper says:

    Perhaps if said country’s leaders stopped stealing and plundering their countries bare and actually looked after their own people this wouldn’t be necessary. There’s no “global complacency”, the world is simply sick and tired of the constant begging from corrupt leaders

    • Rob Winter says:

      I totally agree Ben, it’s time the people of Africa actually stood up for themselves and got rid of there begging mind set and corrupt “leaders”/ dictators.

      • Ben Harper says:

        Given they’re all in Moscow at the moment berating and ridiculing their main donors and benefactors, nothing is likely to change any time soon

  • James Webster says:

    Why should the West always be expected to run after African countries and wipe their runny noses ? When the author whines about the “globe” not doing something he means the West, because neither Russia, China, the bulk of Asia nor South America give a damn about anyone except themselves. Africa is a mess, packed with corrupt authoritarian and incompetent regimes who either don’t care about their own citizens or are incapable of looking after their own citizens. Why then, should the West give a damn about Africans suffering because of African bad choices, African incompetence, African greed, African selfishness and African indifference ? Why must the West always bail Africa out of problems of its own making ? Enough already, if Africa can’t learn to swim, then let it drown, perhaps once it is fighting for air, it will learn to stop mucking about, stop stealing from its own and stop acting like a pathetic wicked child who throws stones at hornets’ nests and then screams blue murder when it gets stung. Enough !

  • MT Wessels says:

    Hard pressed to see the “global” complacency here. Looks awfully much like uncaring local leaders. There is money for all kinds of pet projects and crony deals, WHILE 1000 AFRICAN CHILDREN DIE EVERY DAY. So much for the village that looks after every child; is ubuntu only a thing when someone else pays for it?

  • Louise Louise says:

    “Malaria was eradicated in the US in 1951”. Please tell us more how they did this? Thanks!

    • MT Wessels says:

      At massive ecological cost: spraying DDT and draining wetlands – all of which was acceptable in those days. It was restricted to the wet, tropical south.
      We know better now, and have not one but two vaccines. All that is needs is for African leaders to throw a bit of money at their people instead of JW Blue Label.

  • Fanie Rajesh Ngabiso says:

    “outside assistance is necessary and morally imperative”

    I’m assuming you’re referring to Russia or China here as we can’t seriously expect anything from the West. I mean with the amount we run the West down it would be seriously hypocritical to even ask for their help, let alone presume we have some form of right to expect it.

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