By Mary Hearty

Kenya’s Ministry of Health is scaling up malaria vaccination in an additional 25 sub-counties within the eight lake-endemic counties starting on March 7, 2023, to protect more children against the disease.

Kenya is one of the three countries—alongside Ghana and Malawi—where the RTS, S malaria vaccine is already in use, following the 2019 start of pilot introduction in parts of the country.

Since then, Kenya has provided more than one million doses of the four-dose malaria vaccine to children in 26 sub-counties across eight counties, and close to 400,000 children have received at least one dose of the vaccine.

The eight counties include Homabay, Kisumu, Migori, Siaya, Busia, Bungoma, Vihiga, and Kakamega.

The malaria vaccine expansion follows the Kenya National Immunization Technical Advisory Group (KENITAG) recommendation for expansion within Kenya’s lake-endemic region and the 2021 World Health Organization (WHO) recommendation for broader use of the vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission.

“We are thrilled to announce today that more children in Kenya will be able to benefit from the life-saving protection offered by the world’s first malaria vaccine,” said Susan Nakhumicha Wafula, Kenyan Cabinet Secretary for Health.

“Over the past three years, we’ve seen a dramatic reduction in the number of malaria cases and hospitalizations from malaria in areas where the vaccine has been administered. We are excited to now be able to offer this additional malaria tool to more of our children.”

Since September 2019, Kenya’s National Vaccines, and Immunization Programme (NVIP) working collaboratively with the Division of National Malaria Program (DNMP) has provided the malaria vaccine as part of routine immunization.

The areas where the vaccines are available have witnessed a substantial drop in children being hospitalized and reductions in child deaths.

When the malaria vaccine was launched in Homabay County in 2019, the lake-endemic malaria region had a malaria prevalence of 27% which has now dropped to 19% according to data from the Kenya Malaria Indicator Survey (KMIS).

This can be attributed to the integrated malaria prevention strategies including the utilization of long-lasting insecticide-treated nets, indoor residual spraying where available, prompt diagnosis and treatment, and the malaria vaccine as an additional and complementary malaria prevention tool.

This had been made possible by funding from the US-based Open Philanthropy to PATH for the initial expansion of vaccine use in the pilot areas of Kenya, Ghana, and Malawi through 2023, using vaccine doses donated by GSK, the manufacturer.

Dr. Lucy Mecca, Head of the National Vaccines and Immunisation Program (NVIP)
Photo Credit NVIP

“In the coming years, our objective is to continue to expand malaria vaccination to other parts of the country, as more supplies of the vaccine become available,” said Dr. Lucy Mecca, Head of the National Vaccines and Immunisation Program (NVIP).

“We will continue to expand the availability of the vaccine beyond 2023, including by applying—along with other countries—for support from Gavi, The Vaccine Alliance, for subnational use of the vaccine in areas of greatest need,” she added.

Dr. Mecca noted that the western Kenya region recorded close to 80% coverage for the first dose, the second dose at around 77%, the third dose at 72%, and the fourth dose at 36%.

A child gets four malaria vaccine doses. In Kenya, the first dose is given at six months of age, and the fourth dose at two years of age. The vaccine has been well accepted in communities, with demand remaining high even when additional visits to clinics by caregivers and children are required.

“We have a problem with the fourth dose which is a little bit low. This is similar to one of the vaccines we give in our routine immunization, the second dose of measles which is given at 18 months. This is one of the things that we really need to advocate for to ensure that all the doses are administered,” Dr. Mecca explained.

According to Dr. Deen Omar, Head of the Division of National Malaria Program (DNMP), the vaccine is needed more than ever to help us prevent unnecessary loss and suffering.

“We welcome the malaria vaccine as one of the WHO-recommended interventions to prevent malaria in children and are cognizant of the fact that a combination of tools including long-lasting insecticide-treated nets, indoor residual spraying, and malaria chemoprevention strategies are needed along with the malaria vaccine to combat malaria,” he added.

Expansions in Kenya, and similar expansions in Ghana and Malawi, are following a phased approach as additional vaccine supplies become available. Phased introduction in additional countries will begin as early as late 2023. Some 12 countries in Africa have already applied for funding from Gavi to introduce the vaccine.

“As we welcome this additional tool to fight malaria and embrace the decision to reach many more communities and children, our objective is to continue to deploy malaria vaccination to other parts of the country, as more supplies of the vaccine become available,” Dr. Adam Haji, Medical officer and Head of Malaria Vaccine Implementation program in Kenya at WHO said on behalf of Dr. Abdourahmane Diallo, WHO Kenya country representative.

“WHO is aware of the global limitation in vaccine supply and to address this, it has developed an allocation framework to ensure equity and fairness for access to the limited vaccine supply while working with manufacturers to increase capacity to meet global demands.”

This WHO-coordinated pilot programme has been made possible by a collaboration involving in-country and international partners, including PATH, GlaxoSmithKline (GSK), and The United Nations Children’s Emergency Fund (UNICEF).