By HENRY OWINO (Senior Science Correspondent)

Citizens across Kenya have positively embraced the world’s first malaria vaccine, despite some skepticism around its efficacy, nagging safety concerns among the communities receiving it and the challenge of bad weather and the Covid-19 pandemic.

The vaccine, known as RTS,S (Mosquirex), is being given as part of a pilot programme in three African countries: Kenya, Malawi and Ghana.

In Kenya, the pilot began in September 2019 and more than 300, 000 children between the ages of six to 24 months are expected to receive four doses of the vaccine by 2021. To date, more than 100,000 children have received it.

Kenya’s Ministry of Health says the vaccine will be added to the routine vaccination schedule, if the current pilot is a success.

Sicily Kariuki former Health CS during the launch of the malaria vaccine pilot in western Kenya on September 2019.

But the vaccine only provides partial protection against malaria, meaning it is to work hand in hand with other measures, including insecticide treated bed-nets, indoor spraying and anti-malarial drugs.

“The vaccine has shown to reduce 4 out of 10 cases of malaria, prevented 3 in 10 cases of severe malaria and 6 in 10 cases of severe malaria anemia,” said Dr Ambrose Agweyu, Head of Epidemiology and Demography at the KEMRI- Wellcome Trust Research Programme. This is based on the findings of three clinical trials from 2009 to 2014, which enrolled 15,500 children across seven sub-Saharan nations, he said.

The vaccine is being administered in eight counties in western Kenya: Homa Bay, Migori, Kisumu, Siaya, Busia, Vihiga, Kakamega and Bungoma where transmission is the highest in the country. Studies show that malaria accounts for 70 percent of all hospitalized patients from these communities, and the majority are children aged 6 months to 4 years.

Health workers have faced multiple obstacles in rolling out the vaccine, such as challenges posed by the Covid-19 pandemic, misinformation in social media, and resistance from young parents.

Overall, however, the vaccine has been well received by these communities, according to Phoebe Ogwang’, a community health worker administering the vaccine in Rarieda Constituency, Siaya County.

“Residents say the vaccine is an answer to their dire need against the fight of malaria that claims lives of their children,” she said, adding that most parents are very receptive to the vaccination.

Mrs Ogwang’ believes the vaccine could change the trajectory of child survival in high-burden areas and improve health and reduce burden on health facilities.

Elan, the first child to receive malaria vaccination in Kenya and his mom Noreen, left, alongside other children who recieved the vaccine

Siaya County, situated to the northeast of Lake Victoria in Nyanza region, western Kenya, has among the highest prevalence of malaria in the region. Currently, 40 percent of the population is at risk of malaria, according to the Ministry of Health reports.

“Our children die at very tender ages due to malaria caused by mosquitos’ bites,” said Mary Akello, a 42-year-old mother of 6 children from Sega, Ugenya Constituency, north of Siaya County.

“If the government has decided to come up with a permanent solution of vaccine, it is a welcome idea. We cannot afford to turn our backs to such a treatment opportunity,” she said.

“Twenty-five million out of a population of 44 million Kenyans are at risk of malaria. Currently, we have an estimated 3.5 million new clinical cases and 10,700 deaths each year. And those living in western Kenya have the highest risk of malaria,” said Dr Berhards Ogutu, Chief Research Officer at the Kenya Medical Research Institute (KEMRI), Kisumu and Senior Clinical Trialist with Malaria Clinical Trial Alliance of the INDEPTH-Network.

Providing Back-up

Mrs Ogwang’ attributes the support for the vaccine to the failure of the most widely used antimalarial treatment, artemisinin-based combination therapy (ACT). Malaria parasites are becoming increasingly resistant to the treatment.

Dr Charles Mbogo, a public health entomologist at the KEMRI Wellcome Trust in Nairobi says ACT was introduced in Africa in the mid-1990s, but malaria parasites began developing resistance to it in 2006.

Baby Bayley receives her vaccine at Vihiga County Referral hospital as her mom Yvene Ingosi looks on.

Other antimalarial drugs, including mefloquine and the chloroquine and sulfadoxine–pyrimethamine combination, are also no longer effective and are no longer on the market as a result.

“Mosquitos are also increasingly resistant to the repellants and insecticides being used against them,” said Peter Otieno, Area Chief, West Sega Location. “Because of these reasons, residents have welcomed the vaccination idea as a lasting solution to malaria in the region.”

Challenges with Delivery

The vaccine programme is, however, facing many challenges in terms of delivering the vaccine to these communities, says Chief Otieno.

Heavy rainfalls have made most roads impassable and the cold, wet weather makes access to health facilities difficult for parents with babies, he said.

“Nurses are often compelled to call off vaccinations mid-way due to rains. This happens almost daily in the afternoon since early September this year,” Chief Otieno said regretfully.

Severe disruptions from the Covid-19 pandemic have further affected the programme. For example, fear of hospitals as the breeding grounds for Covid-19 has contributed to low turnout. Residents claim health clinics and hospital environments are the most dangerous places to visit.

Heavy rains making most roads impassable and houses flooded.

Dr Elizabeth Omondi, a reproductive health expert at Siaya County hospital said that healthcare services that include immunization of children have been recording low turnout of patients since the advent of Coronavirus.

“Mothers are not visiting hospitals due to the fear of Coronavirus,” Dr Omondi lamented.

According to Dr Ogutu, another issue is that it is possible for the malaria vaccine to be given to children above the required age bracket of 6 months to 2 years. This is because some parents whose children were born at home and have no birth documents to support their actual age may lie in order to get their child vaccinated.

Resistance among Young Parents

While many parents are accepting of the malaria vaccine, however, many others are not.

According to Siaya country health worker Mrs Ogwang’, mature parents with three or more children generally have no issues with the vaccine but new and young parents are completely opposed, mainly due to misunderstanding about the vaccine and the people receiving it.

“We have explained to parents why only a few counties are selected for the vaccine pilot in Kenya, but they are still skeptical. For instance, parents claim the vaccine is under clinical trial and not yet fully approved hence they only selected a few counties for piloting,” she said.

Health workers consult at a hospital as they monitor vaccination activities in Kakamega County.

“Poor communication and misinformation spreading on social media platforms is to blame,” said Mrs Ogwang’. “The rumour is that western Kenya children could be used as free sacrificial guinea pigs for malaria vaccine trials.”

Nonetheless, Siaya County Officials are working to address these problems.

Dr Samuel Owino, Chief Officer of Health in Siaya County, said nurses and community health workers who are administering the vaccine have also been re-trained to learn more about vaccine storage using cold chains, data monitoring, stock management and vaccine delivery. The rapport between nurses and parents helps develop mutual trust, friendship and improved service delivery.

Twins Victoria and Victor held by mom Maureen were among first beneficiaries of the vaccine at Nyawara health centre in Siaya County.

To debunk fake-news and misinformation, Siaya County Government Officials teamed up with various local leaders and community radio stations to set records straight. The public are also being sensitized through local community radio stations, community leaders, and religious leaders, Chief meetings and in open places such as markets.

“The national government had only sensitized the public on malaria vaccine during its launch and stopped there. So, information never trickled down to the local citizens on the ground, leaving parents in darkness and doubting the whole vaccine procedure,” Dr Owino said.

They are also making changes to provide safe clinic services during the Covid-19 pandemic and working with parents and communities to bring children in for immunization.

“Our mission is clear,” said Dr Owino. “We must continue to protect our communities from life-threatening diseases.”

Around 400,000 children across Kenya, Ghana, and Malawi, including 128,000 in Kenya, have received at least one dose of the vaccine, according to Dr Rudi Eggers, the WHO Representative in Kenya. “Considering that more than 400,000 people die from malaria globally each year, mostly children under five years, it makes this vaccine a potential game-changer,” he said.

When the pilot program concludes, it will inform WHO recommendations on the broader use of the vaccine across Africa, such as how best to reach children with the four doses of vaccine, identifying the reduction in illness and death that can be achieved, and whether the is safe for routine use.

This story was produced by ScienceAfrica. It was written as part of Reporting Malaria, a media skills development programme run by the Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.