Vaccine Elusive As Malaria Kills Thousands In Nigeria

Despite the menace of malaria in Nigeria and globally, there is still no vaccine for the disease. Daily Trust Saturday reports that the need for a malaria vaccine is further underscored by the rising cases and deaths from the disease in Nigeria even as many of its 200 million population are finding it difficult to get treatment.

Malaria is a life-threatening disease caused by parasites transmitted to people through bites by infected female anopheles mosquitoes.

Some of the symptoms are fever, headache, vomiting, diarrhoea, profuse sweating and anaemia.

According to the Minister of Health Dr Osagie Ehanire, Nigeria alone contributes 27 per cent of the global malaria cases and 23 per cent of global deaths.

Speaking recently when he led a delegation from his ministry and the Society for Family Health (SFH) on a visit to the deputy governor of Ogun State, Mrs Noimot Salako-Oyedele, the minister, who was represented by Timi Obot, the team leader for the Advocacy Against Malaria, said nine persons died of the disease every hour in Nigeria.  This translates to 216 deaths daily.

According to the World Health Organisation (WHO) malaria report, 2020, nearly 61million malaria cases occur in Nigeria annually, with one of four global cases occurring in the country.

This is happening as some countries in the region have achieved elimination of the disease or are near elimination.

Globally, 40 countries and territories have been granted a malaria-free certification by WHO. China, with its huge population was awarded a malaria-free certification recently, while some African countries that have been awarded the malaria-free status are Algeria, Lesotho, Mauritius and Seychelles.

The Kaduna State Commissioner for Health, Amina Mohammed Baloni, said malaria killed 167 children in the state from January to June 2021 as recorded. She said the disease also killed 314 children under five years across Kaduna State in 2020.

She further said the state was aware that it had a malaria problem just like the country in general. She said the state government offered free treatment to children under five and pregnant women at government hospitals with support from partners.

“These numbers we have recorded make up about 50 per cent of deaths of all the children under five. So we know we have a malaria problem because Nigeria is a malaria-endemic country,” she said.

She added that people should quickly do tests in recognised hospitals especially when a child has a fever. She also said pregnant women easily got malaria which could cause loss of pregnancy as it affects the placenta and cause miscarriage, among other problems.

“We target pregnant women who also get free treatment. When they come for ante-natal they get two doses of anti-malaria stuff,” she said.

The Commissioner for Health in Lagos State, Professor Akin Abayomi, said malaria accounted for more than 70 per cent of outpatients in public health facilities. “More than 700,000 malaria cases are reported annually. At least 657,154 patients with malaria were seen in both private and public health facilities in 2020.

“Malaria is prevalent in the vulnerable groups – children under 5 years and pregnant women, where the infection can be profoundly more severe,” he said.

Over 7,000 cases of malaria were recorded across the 13 local government areas of Nasarawa State between January and August, the director of public health in the state Ministry of Health, Dr Ibrahim Alhassan-Adamu, told Daily Trust Saturday.

He said that no fewer than 5,000 persons had also been confirmed with uncomplicated cases of malaria in the state.

According to him, the state recorded an average of 1,200 cases per month between January and August this year.

He said the ministry had embarked on an awareness campaign in the state to make people know the cause of the disease, how to protect themselves as well as disabuse their minds that it is not caused by witchcraft.

He urged people to always live in clean environments by clearing the bushes around their various houses and sleep in a well-treated mosquito net every night, adding that it would go a long way in curtailing the burden of the disease in the state.

Minister of Health, Dr Osagie Ehanire.

In Benue State, cases and deaths record of malaria since the beginning of this year are still being computed. It would be recalled that at least 164,963 malaria cases were confirmed in the state last year alone.

The programme manager, State Malaria Elimination Programme, Mrs Susan Abege, told our correspondent that the figures of cases and deaths from malaria this year were not yet made public as they were still being computed.

The Kano State Government has said that between July and October last year, it administered over 3million doses of malaria drugs to prevent the disease in the state.

The state’s Commissioner for Health, Dr Aminu Ibrahim Tsanyawa, said the drugs were distributed by his ministry to help reduce cases of malaria in the state, especially among children under the age of five.

He said, “The World Health Organisation has recommended SMC as a strategy for malaria prevention in areas with high seasonal malaria transmission with 60 per cent of clinical cases occurring within four months for the rainy season.

“The intervention was found to avert more than 70 per cent of both cases of uncomplicated and severe malaria cases among children under the age of five,” Tsanyawa added.

According to the National Coordinator of the National Malaria Elimination Programme (NMEP) of the Federal Ministry of Health, Dr Perpetua Uhomoibhi, there is currently no vaccine for preventing malaria in adults.

She, however, said a malaria vaccine for children called RTS,S or Mosquirix vaccine (the brand name) has been developed.

“There is a vaccine for malaria that has been approved by WHO; it has been approved for piloting in three African countries – Ghana, Kenya and Malawi. The pilot was concluded last year and we are now awaiting the report, which was done to evaluate the efficacy of its use in children.

“The report will let us know the next stage and how we are going to run it in other countries based on the report of the efficacy test that was done in the three African countries,” she said.

Dr Uhomoibhi said another malaria vaccine for children called R21 Matrix-M Malaria vaccine was recently announced by Oxford.

“It is still undergoing clinical trial and has not been piloted in any country yet. It has also not been approved by the WHO.

“RTS,S is the only malaria vaccine so far approved by the WHO,” she added.

The programme manager, Benue State Malaria Elimination Programme, Mrs Susan Abege, said whenever relevant health authorities certify the vaccine being test run in the three African countries for use, they would be used for children like other routine vaccines.

Dr Uhomoibhi said they believed the rising cases in the country were mere presumptions. “These are just speculations as there are no facts or evidence to show that there are rising cases of malaria in the country,” she said.

She said people could only know when they have malaria by doing tests, adding that it is important for people to know that not every fever is malaria.

“Without a test, you cannot know if someone has malaria; it is not by looking at someone’s face. And every fever is not malaria. There are many causes of fever. So when they test you through the rapid kit or your blood sample is tested in the lab and you are confirmed of having malaria, you will be given the recommended treatment which is the artemisinin-based combination therapy (ACT). We don’t use chloroquine or any monotherapy for malaria treatment anymore,” she said.

The NMEP boss said the organisation had continued to roll out interventions to address malaria despite the COVID-19 outbreak.

Dr Uhomoibhi said vaccines would help in tackling malaria when it becomes available, adding, “But we still need to focus on what is available because malaria is a preventable and treatable disease. So when people do what they need to do we would not have to these cases and deaths from malaria again.”

She said the mainstay was vector control that is protecting people against malaria-causing mosquitoes.

“Vaccine will help but for now, the ones available are targeting children, not adults.  They target only children under the age of two, not even everybody.

“So for now, the mainstay is still vectored to prevent contact between humans and mosquitoes. Vector control means simply reducing the population of mosquitos and contact between humans. As we know, the mosquito is the one that transmits the plasmodium parasite that causes malaria.

“Some of these measures include the use of the insecticide-treated net for people to sleep under every night so that the mosquitoes don’t bite them. That is complemented by indoor residual spraying so that when mosquitoes perch on the walls, they fall and die,” she said.

She said some interventions by the organisation in tackling malaria included rolling out a national malaria strategic plan (2021 to 2025) to bring down significantly, the burden of malaria cases and deaths, towards achieving elimination.

She also said the interventions under the strategic plan included vector control and larviciding, which kill the mosquitoes from where they are breeding, as well as rolling out long-lasting insecticidal nets in the water and environmental management.

She said environmental management was very critical and everybody has to play a role.

“Cut bushes around the house, clear out gutters and stagnant water that encourage the breeding of mosquitoes; that is how to prevent it. That is one of our strategies. We have been rolling out net campaigns to different states each year to make sure that people have enough net to sleep at night so that they are protected,” she added.

Uhomoibhi said the NMEP, with the support of partners, had scaled up seasonal malaria prevention from nine states in the North to 21 in the country. She also encouraged people to go for treatment in health facilities as the organisation is providing free diagnosis and treatment in the states.

The chief research fellow/head, Biochemistry and Nutrition Department,  Nigeria Institute of Medical Research (NIMR), Dr Oluwagbemiga Aina, said the two malaria vaccines targeting children could take up to five years before they could be widely available and administered like other routine immunisation doses.

Dr Aina, who is also a malaria researcher, explained that the vaccine being developed for children was about 56 per cent effective over one year and 36 per cent effective over four years.

“In a trial in 450 children aged five to 17 months, the vaccine called R21 was up to 77 per cent effective at preventing malaria over the course of one year, which, if confirmed, would clear a 75 per cent effectiveness target set by the WHO.

“Two years on from the launch of a pilot programme, more than 1.7 million doses of the world’s first malaria vaccine have been administered in Ghana, Kenya and Malawi, benefitting more than 650, 000 children with additional malaria protection.

“The number of children reached in this relatively short period indicates strong community demand for the vaccine as well as the capacity of the countries’ child immunisation programmes to deliver the vaccine on a novel schedule (4 doses up to about age 2 years),” he said.

Asked why Nigeria was not enlisted in the RTS,S malaria vaccine trial despite its huge malaria burden, he said, “When we asked the  organisers, we were told that Nigeria was very large and they didn’t have enough resources for the trial.”

Ojoma Akor (Abuja), Umar Muhammed (Lafia), Hope Abah Emmanuel (Makurdi),  Risikat Ramoni (Lagos), Mohammed I. Yaba (Kaduna) & Sani Ibrahim Paki (Kano)

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