Contributing to the RTS,S malaria vaccine introduction in Ghana and Malawi

By Access and Delivery Partnership

Health workers with the Ghana Health Service organize a community immunization session where the RTS,S vaccine is delivered alongside other routine vaccines. Photo: Ghana Health Service

Malaria continues to threaten millions of people around the world. Africa bears a disproportionate share of malaria cases—making up 95 percent of all malaria cases and 96 percent of deaths. Children under 5 years old are among the most vulnerable, accounting for 80 percent of the malaria deaths in the region.[1]

Fortunately, a powerful new tool is available in the fight against malaria: a vaccine called ‘RTS,S’, which offers protection against Plasmodium falciparum, the deadliest and most prevalent malaria parasite.

Studies have demonstrated that the vaccine prevents up to 39 percent of malaria cases overall, and 29 percent of severe cases.[2]

In October 2021, WHO made the landmark recommendation for widespread use of the vaccine in children in sub-Saharan Africa and other regions.

This recommendation was informed by the findings of the Malaria Vaccine Implementation Programme (MVIP), which conducted pilot programmes in Ghana, Kenya and Malawi to assess the feasibility of administering the the four-dose RTS,S vaccine.

The MVIP coordinated the introduction of the vaccine through routine national immunization programmes in the three countries, implemented under the leadership of the ministries of health of Ghana, Kenya and Malawi.

Contributing to the RTS,S malaria vaccine introduction in Ghana and Malawi

As a contribution to MVIP’s efforts, the Access and Delivery Partnership (ADP) provided targeted technical assistance in Ghana and Malawi that aimed at facilitating the effective introduction of the new vaccine.

In Ghana, the Sustainable Access and Delivery of New Vaccines in Ghana (SAVING) Consortium, led by the University of Health and Allied Sciences, was established to assess and address capacity gaps in the national institutions that play key roles in the introduction and delivery of new health technologies in the country. The pilot roll-out of the RTS,S vaccine provided an opportunity to put in place integrated planning and multisectoral coordination between the key national institutions.

ADP is supporting the SAVING Consortium to bring together national stakeholders, including the Ghana Food and Drugs Authority, the Ministry of Health and the Ghana Health Service, to adopt an implementation research approach combined with capacity-building, to solve implementation and operational barriers to the effective introduction of the new malaria vaccine across the country.

During roll-out of the RTS,S vaccine in Ghana, monitoring and supervision was provided by district officers to validate RTS,S data and coach staff. Photo: Ghana Health Service

ADP also supported the creation of a digital communication platform for the consortium, which enables members to remotely engage in integrated planning, coordination and capacity-building.

“Within each country, the ADP approach is bringing different institutions together to address common implementation challenges,” said Professor Margaret Gyapong, Director of the Institute of Health Research at the University of Health and Allied Sciences.

“In Ghana—through the ADP-supported SAVING Consortium—we are building implementation research capacity for pharmacovigilance [drug safety] and related areas to ensure that challenges to access and delivery of new health technologies are identified and addressed."

Prof Margaret Gyapong. Photo credit: edctpforum.org

"We have been supported in various ways to review our national medicines policy and implementation plan, and to strengthen capacities to monitor and respond to safety issues,” added Prof. Gyapong.

In Malawi, ADP built on the pharmacovigilance mechanisms developed for the RTS,S vaccine by the national malaria vaccine programme to help expand the drug safety monitoring systems across the wider health system. And as part of its broader support to strengthening the regulatory system, ADP has worked with the Pharmacy and Medicines Regulatory Authority to establish a national pharmacovigilance centre, bolster its safety monitoring, and improve reporting channels and tools for health care providers.

If successfully introduced and scaled up in Ghana and Malawi, the vaccine will have the potential to avert over 1 million cases and prevent almost 4,000 deaths per year among children under the age of 5.[3] If it were to be scaled up across sub-Saharan Africa to reach children living in areas of high malaria transmission, the vaccine has the potential to avert up to 33 million cases[4] and 96,400 deaths[5] annually.

“The implementation of wide-scale use of RTS,S can pose significant challenges for national malaria programmes,” explained Dr. Corinne Merle, a scientist with ADP partner the Special Programme for Research and Training in Tropical Diseases.

“The lessons learned from Ghana and Malawi will be invaluable for other countries to address these challenges and prepare for the mass introduction of the vaccine. ADP’s activities to monitor vaccine safety and strengthen implementation research capacities of ministries of health will help facilitate vaccination scale-up.”

As the introduction of the vaccine ramps up across the continent, ADP will be widely sharing the lessons from Ghana and Malawi’s experiences with other national malaria programmes.

The lessons learned from the RTS,S vaccine roll-out by MVIP will also be useful to inform the planning and implementation of other vaccine programmes, including for the COVID-19 vaccines in low- and middle-income countries across the world.

Further information:

SAVING consortium

WHO, ‘Malaria vaccine implementation programme’

WHO, ‘Malaria vaccine: WHO position paper – March 2022’, Weekly Epidemiological Record, 2022, 97 (‎09)‎: 60–78

WHO, ‘Over 1 million African children protected by first malaria vaccine’, 21 April 2022

WHO, ‘WHO recommends groundbreaking malaria vaccine for children at risk’, 6 October 2021

This is part of a collection of impact stories highlighting the work of the Access and Delivery Partnership in ensuring access to health technologies for those in need. For more information and to read additional impact stories, please visit the ADP website.

Footnotes

[1] World Health Organization, ‘Malaria’, 26 July 2022, https://www.who.int/news-room/fact-sheets/detail/malaria. [2] World Health Organization, ‘Malaria: The malaria vaccine implementation programme (MVIP)’, 2 March 2020, https://www.who.int/news-room/questions-and-answers/item/malaria-vaccine-implementation-programme. [3] Based on incidence data from the Institute for Health Metrics and Evaluation, University of Washington, ‘Global Burden of Disease study 2019’, https://vizhub.healthdata.org/gbd-results/. [4] Ibid. [5] World Health Organization, ‘Full Evidence Report on the RTS,S/AS01 Malaria Vaccine: Background paper’, WHO, Geneva, September 2021, https://cdn.who.int/media/docs/default-source/immunization/mvip/full-evidence-report-on-the-rtss-as01-malaria-vaccine-for-sage-mpag-%28sept2021%29.pdf.