Why African countries need to prioritise malaria vaccine – Wentworth

In this interview, Marian Wentworth, the chief executive officer of Management Sciences for Health, a non-profit global health organisation, speaks on malaria vaccine and the impact it would have in African countries.

How much of a game-changer will a malaria vaccine be for Africa, especially a country like Nigeria, which accounts for the world’s largest malaria deaths?

Yes, millions suffer, and hundreds of thousands die, but my hope is that the number would drop drastically. It is going to take not just the vaccine but concerted efforts around treatment, malaria prevention and control, and other interventions we have with respect to malaria. So, you can define what a game changer is.

 By game changer I mean: How much of an impact will it be for African countries, especially Nigeria?

We will have to see. The pilot programmes have seen significant reduction in malaria among those who were directly vaccinated. But the population of a country like Nigeria is unique, so we would have to see.

 When vaccines are mentioned, there is the expectation of 100 per cent immunity. Is that the case with the malaria vaccine, or would we have to combine it with other preventive methods?

I haven’t seen a vaccine yet that you wouldn’t have to combine with other preventive measures. There aren’t any vaccines that are truly 100 per cent effective; there is an expectation, so you are correct. But very few are; and of course, they don’t get rolled out and have a 100 per cent uptake in the first year either. So, we need to keep vigilant around every one of our preventive measures for some time to come.

 Your organisation, Management Sciences for Health, has been very active in malaria elimination efforts in Nigeria. Reflecting on your work, how will a malaria vaccine rollout complement current approaches being used in the fight against the disease in Nigeria?

Currently, we are pleased to work with the United States Agency for International Development (USAID) and the Global Fund, particularly with the USAID, and the President’s Malaria Initiative for States (PMI-S) programme. That has a series of components to it that include prevention initiatives and supply chain related initiatives. But we have not gotten to malaria control in Nigeria, which still accounts for a quarter of the world’s malaria disease and deaths. We are hoping that the vaccine would help tip the scales.

 When you talk about vaccines, many people immediately talk about cost implications. Will these vaccines be free; if not, how accessible will they be to the average Nigerian?

Let me start by saying that the economic impact associated with malaria disease and deaths is profound. Investments in health lead to improvements in the economy; we have seen that with malaria, COVID-19 and other health issues. I think that is an important context to start the conversation. In terms of financing mechanisms for malaria vaccines, the Global Alliance for Vaccines and Immunisation (GAVI), has committed to supporting the rollout. I expect that the programme would offer considerable support to numerous countries. I don’t think they have said anything specific about Nigeria yet, so I certainly cannot, either.  But strong endorsements and results of the pilots through the World Health Organisation (WHO) programme and GAVI’s commitment should lead to some optimism about making malaria vaccines accessible.

 Reflecting on your organisation’s work in the fight against COVID-19, what suggestions do you have for African governments to increase acceptance of the malaria vaccine?

It is important that we understand that introducing any new health intervention requires careful planning, with all stakeholders, all the way down to the last mile. That means thinking about the supply chain and how the health system will deliver the vaccine to people. The last part, which has been the most frustrating thing for me in recent years, is ensuring that communities, patients and families are participating in the change. It is important that we plan together. I think that makes a big difference, in terms of success of any rollout, especially with malaria, which is very complex, but for which the burden of disease is well understood.

African governments rely on credit facilities from lending institutions to fund malaria interventions. Does this look like a sustainable approach to consider for the rollout of the vaccine, or should African governments think differently from what they have been doing?

I think those current facilities are meant to be a starting point and not an end. I think it is extremely important for governments to think about how their long-term health care interventions are going to be part of their investment strategies. I don’t have a particular critique of Nigeria, but I will say that very frequently, I see investments go to other developmental aspects besides health because it is so well covered by some of these other mechanisms. If you think about health as an engine of your economy (and you really should think about health as the engine of your economy), it is part of creating a workforce. Lack of an efficient health system is destructive to the economy. I think that over the long term, we would have to think about more sustainable approaches that include much more self-funding from individual governments as those interventions become more affordable.

 Anti-malarial drugs are a significant source of revenue for local pharmaceutical industries, especially in Nigeria, where it has been estimated that for every five anti-parasitic medication you would have three anti-malarial. Would local manufacturers lose out when the big pharmaceutical industries begin to roll out these vaccines that would be supplied to Nigeria directly?

I don’t really think so. My experience with various new vaccines and in new disease and treatment areas is that treatments stay around for a long time and are an important part of the arsenal of combating diseases. That’s because vaccines require time to be taken up because most of them are not actually 100 per cent effective. Another thing that happens is that untreated individuals start coming to the forefront.

When you have more ways to work on a disease you actually identify more untreated individuals, so you can actually see a fairly long lead time before you see an impact on treatment. In the United States it took more than 10 years for the Human Papillomavirus vaccine to change screening. That was a relatively rapid uptake. It could be much longer elsewhere. So, for any private sector organisation, 10 years are probably more than a lifetime. I think my exhortation to local manufacturers is for them to embrace one more avenue for elevating the severity of the disease and getting people treated.

 Sometimes vaccines fall under a certain age bracket. Is this going to be the same with the malaria vaccine?

Well, for the malaria vaccine, the WHO has been clear that there will be priority for children. So, expect to see children prioritised in the vaccine rollout.