Childhood immunization is the cornerstone of child and infant healthcare, helping to prevent life-threatening infectious diseases, and malaria is no exception. Malaria control currently relies on insecticide-treated nets (ITNs) for vector control and antimalarial drugs to treat infection; however, vaccination is a promising and essential intervention in the fight against this deadly disease. This article discusses why childhood immunization is an important intervention in malaria prevention, as we discuss the status of malaria vaccines, their benefits, and how they integrate into malaria control strategies.
Understanding Malaria and Its Impact
Malaria is a disease caused by parasites of the Plasmodium genus that are transmitted by mosquitoes of the Anopheles genus. There are various species of parasites but Plasmodium falciparum and Plasmodium vivax are the most common. Symptoms include fever, chills, and headache, and in difficult cases often progress to complications such as cerebral malaria and anemia. Children under five years of serious disease and mortality.
Due to the serious consequences of malaria on children’s health, preventive methods are very necessary, such as:
- Insecticide-treated nets (ITNs)
- Indoor Residual Spraying (IRS)
- Antimalarial Medications
However, vaccination would serve as a complementary and powerful measure to reduce malaria incidence and mortality, providing a permanent solution to the problem.
The Role of Vaccination in Malaria Prevention
Vaccines train the immune system to recognize important pathogens as intruders without causing the disease. For malaria, this means that a vaccine would:
Prevent Infection: By inducing immunity against malaria parasites.
Avert Disease: By offering protection against infection, preventing the disease from manifesting in the first place. Disease severity corresponds to the impact you’ll experience if you do become infected. For example, if you get a vaccine for the flu, there’s still a 5 percent chance of developing the disease (in other words, your vaccine efficacy is 95 percent), but this is compensated for by the fact your symptoms are likely to be milder than for an unvaccinated person. So, if you get sick, it might just be a case of a nasty cough, rather than a hospital stay.
Current Malaria Vaccines
After several decades of research, two effective vaccines against malaria have emerged:
RTS, S/AS01 (Mosquirix):
- Development and Approval: RTS, S/AS01 was developed by GlaxoSmithKline (GSK) and is the first malaria vaccine to get a positive opinion from the European Medicines Agency and WHO prequalification, and to be approved for use in malaria-endemic regions of Africa.
- Efficacy: there is evidence from clinical trials that RTS, S/AS01 confers partial protection against Plasmodium falciparum malaria in young children. It prevents malaria in children under five years old by about a third.
- Administration: The vaccine is given in a series of four doses, administered best to children aged 5-17 months.
R21/Matrix-M:
- Development and Authorisation: Based on an earlier vaccine researched at the University of Oxford and manufactured by the Serum Institute of India, R21/Matrix-M is a newer malaria vaccine that has been successful in clinical trials.
- Efficacy: R21/Matrix-M has demonstrated greater efficacy than RTS, S/AS01—up to 77 percent—in the clinical trials conducted so far. It is also set to undergo several more Phase III trials and is expected to go through regulatory assessments.
- Administration: Like RTS, S, R21/Matrix-M is administered in multiple doses.
Benefits of Malaria Vaccines
The introduction of malaria vaccines brings several benefits:
- Lower Mortality and Morbidity: protection against malaria in children averts a great number of severe diseases and deaths.
- Synergistic Tool: Vaccines work alongside existing malaria prevention and control measures such as ITNs and IRS to provide a boost to the population-level control of malaria.
- Long-term effects: the potential to reduce malaria transmission and help us get to the goal of elimination.
- Benefits to the Economy: Decreased cases of malaria lower the economic burden that families and healthcare systems face, and can lead to better health and economic resilience.
Integrating Vaccination into Malaria Control Programs
Malaria vaccines, to be effective, must be used in conjunction with malaria control programs that include:
- Health system strengthening: Infrastructure that enables broad vaccine distribution, storage, and delivery needs to be available. This can entail training of staff and cold chain logistics.
- Community engagement: We must educate communities about the benefits of malaria vaccines and address any misconceptions surrounding malaria and vaccines to achieve high vaccination rates.
We need to collect monitoring and evaluation metrics on vaccine efficacy, safety, and coverage continuously to fine-tune vaccination programs and address any issues as they arise.
Future Directions and Challenges
While malaria vaccines represent a significant advancement, several challenges remain:
- Vaccine coverage: It’s difficult to reach such high coverage, especially in remote and underserved areas. Difficult but doable. Reach all who need to be reached: Difficult. But of course doable.
- Second, vaccines, like any other move against disease, prompt us to keep a watch out for resistance or waning effectiveness down the line.
- Cost and access: making sure the vaccines are affordable and available to populations in the developing world, especially poorer countries, ensures success.
Research to make existing vaccines more effective, to develop new ones, or to overcome constraints is underway. Governments, international organizations, and the private sector need to work together to advance malaria vaccination and contribute to global health targets.
Childhood immunization against malaria is a critical component of the effort to eliminate this dreaded disease. RTS, S/AS01, and R21/Matrix-M malaria vaccines serve as potential optimal tools to protect children from malaria and the burden of disease. Utilization of vaccination as part of a well-coordinated, integrated malaria control program with supportive elements such as long-lasting insecticidal-treated mosquito nets and indoor residual insecticide spraying can bring about a tremendous improvement in health and perhaps bring us closer to the elimination of the disease.
The biggest portion of our collective malaria reduction effort must remain childhood immunization, which will continue to reduce malaria morbidity and mortality, improve the quality of life of millions of children, and bring the end to malaria even closer.
