Malaria vaccine implementation ….. part 2

Malaria is a disease with no magic bullet – everything is being thrown at it in the hope that various combinations of interventions will be able to control malaria.

Yesterday I wrote about the malaria vaccine, RTS,S raising my worries that people may perceive the vaccine in the way that is not intended. That parents and careers may think that the RTS,S malaria vaccine works like the measles or polio vaccine – which provide high levels of protection for life. I worry that mothers who take their babies for vaccination may become lax about sleeping under an insecticide treated mosquito net since their baby is vaccinated. They may be slow at responding to fevers because of the feeling that the vaccine is protecting their children from the worst disease.

I expressed this fear to Dr Nathan Nsubuga Bakyaita, malaria advisor at the WHO Kenyan office in a phone conversation and this is what he said.

‘We are very aware of this but our message is clear – the vaccine is complementary to other established interventions. We are already planning implementation process and have in place various sub-committees. Among them is advocacy and social mobilization. Kenya has a good history of social mobilization with smooth introduction of new vaccines. We shall use all this experience to ensure that the message gets down to the people. That people are well informed that the malaria vaccine is not a magic bullet and other interventions must be used,’

The World Health Organization (WHO) has produced a position paper for national malaria control programs that details all the information that has been generated to support the role out of immunizations. This paper also emphasis the need for countries to ensure that other malaria control interventions are not neglected during the immunizations……

WHO position paper on malaria vaccine RTS,S

The countries selected: Ghana, Kenya and Malawi have good coverage of Insecticide Treated bednets, good EPI vaccine coverage, access to diagnostics and treatment for malaria. These must be maintained throughout the trial period. Where appropriate SMC should be used.

Seasonal malaria chemoprevention (SMC) is defined as the intermittent administration of full treatment courses of an antimalarial medicine (currently amodiaquine plus sulphadoxine-pyrimethamine) to children during the malaria season. SMC is relatively new in practice.

Prof. Bob Snow wrote a review, which is a must read on this topic…..

An excellent review on SMC

SMC has been tried in some countries in West Africa where all children under 5 years of age, were given a treatment dose of antimalarial drugs monthly for the 3 to 4 months – which was the duration of the malaria season. This was so that they would have the malaria drugs within their body at a time when they were at the greatest risk of getting malaria. It was hoped that if infected, the malaria parasites would be destroyed by the drugs and not multiply and therefore not cause disease.

The results showed that malaria disease was reduced by 75% in these young children. The results were stunning and the WHO acted quickly in recommending the use of SMC during the malaria season for children under 5 years of age in areas where transmission was high.

Malaria control is challenging the set thoughts about how to control diseases. A blanket intervention cannot be set for every region – that countries will have to decide from evidence what works best for them.

The large RTS,S malaria vaccine trial that will involve over 750,000 children will be an ideal place to try out various combinations of interventions to see which would be best suited for different areas.

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