It’s a sunny day in a rural subdivision of Lilongwe, Malawi. Seventeen-month-old Lusitana is playing outdoors with friends as her mother chats and laughs with neighbors. Just across the way, in another village, a young boy named Evision is also enjoying the end of the rainy season. Exactly one year ago, when both were roughly five months old, they became the world’s first two children to receive a malaria vaccine as part of routine immunization.
Given the constant threat of malaria in Malawi, parents and caregivers of young children must pay close attention to strategies for preventing the disease. Lusitana and Evison were born at the tail end of 2018, at a time of year when the rainy season amps up and the risk for transmission of the malaria parasite increases. The recommended tools that have been available to stave off infection include mosquito nets, indoor spraying with insecticides, and anti-malarial medicines. In 2019, a vaccine was added to this malaria toolkit in selected parts of the country.
Adding to the malaria toolkit
In April 2019, Malawi (followed later by Ghana and Kenya) introduced a malaria vaccine into some areas of the country where malaria transmission is highest. As part of a phased introduction, supported by the World Health Organization (WHO) in collaboration with partners, including PATH and vaccine developer and manufacturer, GSK, the health ministry began administering the malaria vaccine in 11 districts. The phased introduction of the vaccine is meant to inform global policy decisions on its broader use in other areas where malaria poses a public health problem.
Lusitana and Evision each received a first dose of the malaria vaccine at the Mitundu Community Hospital in Lilongwe. Though they can sometimes take advantage of scheduled outreach health services closer to home, the families must often make the challenging, five-kilometer walk to the community hospital in order to access immunization services. Still, indications are that the families, aided by health workers—particularly the health surveillance assistants who administer vaccines—have kept both children healthy.
“Malaria gives us a lot of problems”
In September 2020, Evison will be due to receive the fourth and final dose of the malaria vaccine. His mother, Fanny, smiles as she describes their immunization journey.
“When I heard that a new vaccine was coming, I was eager to get him vaccinated. And when we were told the vaccine was to protect children against malaria, I was more than ready to get it. As you know, malaria gives us a lot of problems,” Fanny says in her native Chichewa, adding that she believes vaccines are good for children. The RTS,S vaccine reduces malaria cases in children, including cases of severe malaria. In addition to receiving the vaccine, children must continue to use other interventions to prevent malaria.
Evison and his friends watch as his mother flips through his health passport, a document they must carry for each visit to the health facility. The passport shows that Evison has received all the vaccines recommended for his age by the Ministry of Health’s Expanded Program on Immunization (EPI).
In Malawi, children are immunized against tuberculosis (BCG) at first contact after birth. Six weeks later, they continue their health journey with a number of interventions that are given within the first two years of life. These also include Vitamin A, three doses of the pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b), and two doses of the integrated measles and rubella (MR) vaccine. They also receive the pneumococcal conjugate, oral poliomyelitis, and rotavirus vaccines. As the COVID-19 pandemic evolves, the Ministry of Health recognizes the crucial importance of malaria prevention, immunization, and other essential health services.
“I will be going to the clinic monthly for growth monitoring,” Evision’s mother explains. “I am also just waiting for September to get Evison’s last dose of the malaria vaccine.”
Lusitana is waiting to receive the third dose of the vaccine. Her mother, Gilimbeta, expects to take her soon. “Just got malaria second dose. I will make sure we finish all the four doses,” Gilimbeta explains.
To date, an estimated 275,000 children in selected areas of Ghana, Kenya, and Malawi have received the first dose of the RTS,S malaria vaccine.