As the global community is marking another World Malaria Day slated for April 25, children in Sub-Saharan Africa, including their counterparts in Ghana, are waiting with bated breath, the announcement of the availability of a vaccine to protect them against malaria infection that kills them every minute!
A vaccine, known as RTS, S/ASO1, which is expected to be an additional combative tool for the protection of mankind, especially under five children and pregnant women, from the world’s deadly malarial disease, has been evaluated in a large clinical trial in seven countries, including sites at Kintampo in the Brong Ahafo Region and Agogo in the Ashanti Region.
It has now been submitted to the European Medicine Agency (EMA) under Act 58 of the European Patent Convention, for regulatory review.
Indeed, children in Kassena-Nankana in the Upper East Region, a malaria endemic area, will heave a sigh of relief with the supply of the anticipated vaccine, to give them additional protection from pua/paa, the local name of the disease that easily takes away their lives, before they enroll into class one.
The World Health Organisation(WHO) recommendation for the use of the vaccine as an add on to existing malaria control tools, which is expected later in the year, is dependent on the final results from the clinical trial and positive regulatory review by the EMA.
The expected vaccine is supposed to have 50 per cent protective efficacy and potency lasting for about a year. Indeed, this will be a big relief to under five children and pregnant women who are most susceptible to the disease.
According to the Malaria Vaccine Technology Roadmap, by 2025, an efficacious vaccine capable of giving more than 80 per cent protection against clinical malarial diseases, and lasting for more than four years should have been in place.
On the occasion of World Malaria Day on the theme “Invest in future; Defeat Malaria,” the WHO is calling for greater commitment from member countries to the vision of a world free from malaria, especially in sub-Saharan Africa, which is the epicenter of the disease.
The new strategy aims to reduce the malaria cases and deaths by 90 per cent by 2030 from the current levels burden, with the ultimate goal of eliminating the disease from the territories of endemic countries, including Ghana.
Malaria, a life-threatening disease, is caused by Plasmodium parasite, the deadly specie, and it spreads to people through the bites of the infected anopheles mosquitoes called malaria vector, which bites between dusk and dawn.
The transmission of the disease is largely induced by climatic and geographical conditions and Sub-Saharan Africa by virtue of its location in the tropics is home to the most deadly malaria specie of Plasmodium Falciparum.
The malaria disease is an acute illness which appears seven days or more after the bite of the anopheles mosquito, with symptoms of headache, fever, chills and vomiting and when not treated within 24 hours, can progress to severe illness, often leading to death.
It is estimated that half of the world’s population is at risk of the disease, with most cases and deaths occurring in sub-Saharan Africa. Asia, Latin America, and to a lesser extent the Middle East and part of Europe are also affected.
The best available treatment for the disease is Artemisinin-based Combination Therapy (ACT), which succeeded the old generation of the Chloroquine that has been phased out as result of drug resistance.
According to the latest estimates released in December 2014, there were about 198 million cases of malaria in 2013 and an estimated 584,000 deaths that occurred mainly in Africa.
Globally, malaria mortality is estimated to have fallen by 47 per cent since 2000 and by 54 per cent in the African Region.
Ghana has achieved some successes in malaria control and general health care resulting in infant mortality rates declining over the last 10 years. The 2014 Ghana Demographic and Health survey shows that infant mortality rates declined from 64 per 1,000 live births to 41 per 1,000.
Under five mortality rates also decreased from 111 per 1,000 to 60 per 1,000 in 2014 putting the country on a good track in terms of progress on key indicators such as maternal and child health care which are key milestones for the Millennium Development Goals.
Comparatively, the 2014 GDHS results with those from the 2011 Ghana Multiple Indicator Cluster Surveys indicate that the prevalence of malaria among children by the RDT has decreased from 48 per cent to 36 per cent and the prevalence as measured by analysis of blood smear, via the microscope, has slightly changed from 28 per cent to 27 per cent.
The use of insecticide-Treated mosquito Nets (ITNs) as an additional layer of protection to reduce the transmission of malaria differs markedly by residence with 61 per cent urban household owning at least one ITN as compared with 79 per cent of rural households.
Although the national malaria prevalence rate has dropped over the past five years and malaria cases reduced from 11.4 million in 2013 to 8.4 million in 2014, butit still remains a major cause of hospital attendance, contributing about 30 per cent of Out- Patient- Department, 27 per cent of In-Patient and 7.7 per cent of deaths.
The disease is most prevalent in the Northern, Upper East and Upper West Regions, where the National Malaria Control Programe is implementing the Seasonal Malaria Chemoprevention, as an additional intervention, to reduce transmission burden, especially during the rainy season, which comes with huge bouts of malaria.
In 2012, the malaria control authorities distributed over 12 million ITNs countrywide in an effort to achieve universal coverage, and are in the process of replacing them, as the three- year- old life span of the net has come to an end.
Eliminating malaria is a daunting task, but not insurmountable! The scientific community had been engaging in painstaking research and other activities over the years to understand the epidemiology of the disease and develop several tools to effectively combat the disease to “ground zero,” but it has not been easy, because the malaria parasite, as a living entity, has also got a survival instinct that makes it difficult to tame.
The WHO has given United Arab Emirates, Morocco, Turkmenistan and Armenia, a clean bill of health, having certified that they have succeeded in eliminating the scourges of malaria in their territories.
Ghana and other endemic countries have stepped up efforts to get to the elimination point, “yes we can,” but not without challenges that must be addressed.
Deployment of malaria combative tools must go hand in hand with extensive social mobilization and behavioural changed communication to changes attitudes that militate against efforts at combating the disease, and to induce the uptake of the interventions.
The challenge in the fight against the world’s bitterst enemy goes on unabated; but the world of children and pregnant women can no longer wait for this all important vaccine. It is unacceptable for children to die minute by minute from a disease that is preventable!
By Salifu Abdul-Rahaman