How new malaria vaccine will work

Health ministry officials announced yesterday Uganda could include the new, ground-breaking anti-malaria vaccine in plans to spread out immunisation of children against the leading killer disease starting next year.

The announcement comes 48 hours after the World Health Organisation (WHO) publicly endorsed the R21/Matrix-M as the latest addition to global efforts to combat the disease that is responsible for most deaths worldwide, with sub-Saharan African countries, including Uganda accounting for the majority of fatalities.

Speaking during an interview on Monday, Dr Jimmy Opigo, the manager of Uganda’s malaria control programme at the ministry, said: “We received this news with enthusiasm. It is another tool for the malaria fight. There is a higher production capacity which addresses the problem of access. This one is also cheaper.”

Uganda’s decision to adopt the new, cheaper vaccine for mass use is now anticipated a week after a joint meeting of the WHO’s Strategic Advisory Group of Experts on Immunisation, and the Malaria Policy Advisory Group held a week ago in Geneva, Switzerland gave the green light.
With the UN’s global health agency recommending use of the prevention measure early this week, the R21/Matrix-M becomes the world’s second malaria vaccine, following earlier approval of the RTS,S/AS01 for immunisation two years ago in 2021.

According to information from the agency, the vaccine has demonstrated a noticeably higher level of efficacy when given just before the onset of the high transmission season.
“In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to 4 or 5 months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75 percent during the 12 months following a 3-dose series,” the WHO said in a statement on Monday.

It added: “A fourth dose wgiven a year after the third maintained efficacy. This high efficacy is similar to the efficacy demonstrated when RTS,S is given seasonally.”
The global health agency also said at a price ranging between $2 (Shs7,400) and $4 (Shs15,000) per dose, the R21/Matric-M is more cost-effective compared with “other recommended malaria interventions and other childhood vaccines.” 

This means that Uganda would spend a maximum Shs60,000 per child for the prescribed four-dose complete vaccination.
In comparison, the RTS,S, costs about $10 (Shs37,000) per dose. Meaning at four doses, government would spend more than double the amount (Shs148,000) for full vaccination of each child with RTS,S.
The R21/Matrix-M was developed by the University of Oxford, UK and is under production at the Serum Institute of India. 

On the other hand, the RTS,S/AS01 was developed by a public-private partnership between drug conglomerate, GSK and PATH’s Malaria Vaccine Initiative, with support from the Bill and Melinda Gates Foundation. 
Both vaccines were developed targeting children below five years who are more susceptible to infection on account of having lower immunity.

Dr Patrick Tusiime, the commissioner for communicable disease control and prevention at the Health ministry, yesterday said an average Ugandan spends at least Shs30,000 per malaria episode. He also said many people suffer one or more episodes annually in a country where millions still live on less than $1 (Shs3,700) a day.

According to the Health Sector Performance Report 2021-2022, malaria is the leading cause of admission and death in Uganda’s hospitals, killing 16 Ugandans daily. It is also responsible for an estimated annual economic loss of $500 million (Shs1.9 trillion) due to treatment costs and work time absences, according to data from the health ministry and other research reports.

Dr Opigo said Uganda was allocated 800,000 doses of the RTS,S/AS01 free of charge (fully covering only 230,000 children), under the Global Alliance for Vaccines and Immunisation. No commitment has, however, been made in respect to the new vaccine, Dr Opigo said. 

“With this new vaccine, we now have a chance to cover all eligible children because initially we were rationing. However, funding for it has not been announced,” he said, adding that there is no clear indication yet that the government is going to procure. 
Dr Michael Baganizi, the head of the immunisation programme at the health ministry, when asked which vaccine they would go with of the two, said: “Currently, that decision hasn’t yet been made since the WHO guidance has just come in.”

“The country has a National Independent Technical Advisory Group which usually guides after evaluating the scientific evidence available and considering all other surrounding factors such as cost, and availability. That is likely to be the next step,” he said. 
Dr Catherine Maiteki, the deputy manager for the malaria control programme of the ministry, said: “The vaccine is safe and effective in preventing severe disease. The vaccine doesn’t prevent malaria [infection], but when a child who has been vaccinated encounters malaria, their body is primed for the fight.”

“The vaccine protection lasts for about one year. So, they (vaccinated children) will not come down with severe forms that will lead to death, anaemia and kidney failure. So, we call upon the public to embrace this vaccine and move with us to save our children,” she said.
The vaccine will be given to children below five years. “We will start at six months for the first dose, then the second dose at seven months, the third dose at eight months and the fourth dose at 18 months,” Dr Maiteki added.

How the vaccines work
According to information from the Global Alliance for Vaccines and Immunisation, both the RTS,S/AS01 and the new R21/Matrix-M vaccines work by flagging the malaria parasite to the body’s immune system at an early stage in the parasite’s lifecycle, before it has a chance to proliferate. 
“By packaging a protein from the malaria parasite together with a protein from the hepatitis B virus, which usually triggers a strong immune response, the vaccines can train the immune system to target the parasite when it is at its most vulnerable, immediately after it enters its new host,” Gavi said in a statement on Tuesday, October 3. 

Which vaccine is better?
R21/Matrix-M was shown to reduce symptomatic cases of malaria by 75 percent during the 12 months following a 3-dose series, according to WHO. While for RTS,S, the WHO indicated that in a separate study, “vaccine efficacy was reasonably high over the first six months following completion of the initial three monthly doses (67.6 percent) but waned over time to essentially zero in the last six-month interval at trial’s end… The two vaccines, R21 and RTS,S, have not been tested in a head-to-head trial. 

There is no evidence to-date showing one vaccine performs better than the other. The choice of product to be used in a country should be based on programmatic characteristics, vaccine supply, and vaccine affordability” . -World Health Organisation.