Malawi and the World Health Organization are rolling out a new malaria vaccine for young children that backers say will reduce deaths from the mosquito-borne disease.
The RTSS vaccine was pilot tested on more than one million children in Ghana, Kenya and Malawi and recommended a year ago by the WHO. Despite a low effectiveness rate of 30%, the vaccine has raised hopes that some of the more than 400,000 people who die annually from malaria can be saved.
Malaria remains a huge public health problem in Malawi, with about one third of its 20 million people getting infected each year.
According to the ministry of health, the disease kills five Malawians every day, most of them children under the age of five or pregnant women who were not presented early enough for care.
The health ministry says the first phase of the vaccination campaign will target 330,000 children, who were not reached during vaccine trials.
The vaccine, sold by GlaxoSmithKline as Mosquirix, is meant for children under the age of five and requires four doses.
"Malaria is major problem in children. They are the ones at highest risk of dying," said Dr. Charles Mwansambo, Malawi's secretary for health. "That's why even when we were doing the earlier studies, we found that once we get maximum benefit, we should target this age group. The main reason is that they are the ones that are most likely to die from malaria."
Last year, the government launched a nationwide anti-malaria initiative known as Zero Malaria Starts with Me, aimed at eliminating the disease by 2030.
Mwansambo said the vaccine is a key part of that initiative.
"It actually prevents about 33 percent of deaths. Meaning that if you add the 33 to those that we can prevent using insecticide treated nets, if will also add on those [we can] prevent by indoor residual spraying, it [can] add up to something significant that will end up eliminating malaria," he said.
However, the Bill and Melinda Gates Foundation, backers of the vaccine, have raised concerns about whether the vaccine is worth the cost.
In July, the Associated Press quoted Philip Welkhoff, director of malaria programs for the Gates Foundation, as saying the foundation will no longer offer direct financial support for the vaccine, although it will fund an alliance backing the vaccine.
He said Mosquirix has much lower efficacy than the foundation would like and that the vaccine is relatively expensive and logistically challenging to deliver.
Dr. Neema Kimambo, a WHO representative in Malawi, said the malaria vaccine itself is not a silver bullet but part of a combination of all interventions to fight the disease.
"Where it [vaccination] was done, we have seen how it has reduced under-five deaths and we believe that as we expand now, we are definitely to save more lives of children under five," she said.
Maziko Matemba, a health activist and community health ambassador in Malawi, said he hopes the malaria vaccine efficacy will improve as time goes by.
"I have an example with COVID-19. When we had AstraZeneca, the efficacy when it started — as you know it was also a new vaccine — it was less that certain percentage and people said no it was less than this. But over time, we found that the efficacy has gone up," Matemba said. "So we are monitoring the launch of this new vaccine with keen interest.
"I know that other partners are saying the worthiness of investment is not worth it, but looking at the way we are coming from, Malawi in particular, this could be one of the tools to prevent malaria."
Besides WHO, other partners supporting Malawi in the fight against malaria include USAID, UNICEF, the Global Fund to Fight AIDS, Tuberculosis and Malaria and a global health nonprofit organization, PATH.