The malaria vaccine’s global debut and the road that lies ahead
Last month, the World Health Organization (WHO) sent joyous shock waves through the global health community and the Global South by officially recommending that the new RTS,S/AS01 (RTS,S) malaria vaccine be adopted into widespread use among children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria incidence. Now the international community, through Gavi, the Vaccine Alliance, has just stepped forward to help finance the rollout of the world’s first malaria vaccine.
It has been true for some time that sub-Saharan Africa bears the largest malaria burden in the world, with children shouldering the largest proportion of deaths. Over 90% of global cases are on the continent, with children under the age of 5 years constituting a staggering two-thirds of all malaria deaths. This is due to a confluence of factors, not least because of the widespread prevalence of P. falciparum (the most deadly species of malaria parasite), and a very efficient mosquito that spreads it (Anopheles gambiae). The economic impact of malaria is estimated to cost Africa $12 billion every year—a figure that also factors in costs of healthcare, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The introduction of an effective vaccine offers a beam of hope in the fight to mitigate the massive toll this centuries-old disease inflicts on Africa.
However, the same challenges that plague other vaccine rollout programs are likely to also affect the RTS,S vaccine’s delivery as well. In order to reach the vaccine’s efficacy rate of 40% (and a 30% hospitalization reduction rate), four injections of the vaccine must be administered over the first two years of a child’s life. Given these statistics, deployment makes the most sense in combination with more established malaria prevention methods (such as long-lasting insecticide-treated bed nets, indoor residual spraying, and mass drug administration) in order to create the largest impact in places where malaria remains a chronic problem. This delicate layering of interventions requires meticulous attention to detail and coordination; the kind that is prone to human error and is hard to accurately measure if conducted entirely by hand.
The use of geospatial data is beginning to accelerate in the field of public health—satellite imagery, earth observation, and connectivity is dramatically improving. As these products gain speed, we are also learning how to best apply and operationalize spatial data for surveillance and delivery of life-saving health interventions. Reveal, a digital global good brings the power of spatial intelligence and puts it in the hands of health workers on the ground in some of the remotest regions. Reveal is used to map out interventions and engage in microplanning. Using this roadmap, field teams carry GIS-enabled tablets into areas where the intervention is taking place and log each intervention against the household where it has been conducted. Through these processes, Reveal is enabling significant increases in intervention coverage and impact.
Over the past several years, Reveal has already demonstrated success in the deployment of a number of interventions against malaria, vaccine-preventable diseases. and neglected tropical diseases, even layering different combinations of these. A platform with the capability to streamline intervention efforts like this not only maximizes the extent to which allocated funding can reach, but also realizes the largest human impact possible for these various prevention methods. None of these malaria prevention methods separately are a silver bullet for halting transmission, especially in real-world conditions when deployed unevenly and imperfectly. However, as we’ve seen play out with COVID-19 and the layering of several preventive measures (such as masking, vaccination, and social distancing) a combination of interventions may be the most effective at keeping the disease at bay. Reveal provides the foundation to make this integration possible and to rapidly take advantage of the exciting new opportunity that the RTS,S vaccine provides to push Africa closer toward its malaria elimination goals.