From Fred Ezeh, Abuja
Last week, the Nigerian health system was boosted by the arrival of nearly one million doses of the R21/Matrix-M brand of malaria vaccine, in the first batch of expected malaria vaccines donated by Gavi, the Vaccine Alliance.
This was after years of efforts by the federal government to secure the vaccine, to strengthen the fight against malaria in Nigeria that is accounts for 31 per cent of global malaria deaths.
Significantly, the malaria vaccine has brought the number vaccines in the routine immunisation schedule of the Federal Ministry of Health to 27, and it’s expected that 15 other vaccines will be added to the routine immunisation schedule soon.
Malaria is preventable and curable. Insecticide-impregnated mosquito nets, seasonal chemoprevention, and other interventions significantly reduce the risk of infection. Also, prompt diagnosis and treatment, delivered in the community, is highly effective at preventing severe disease.
Sadly, in Nigeria alone, over 500 people, mainly children and pregnant women, die every day from malaria. The government had, over the years, adopted several strategies to combat malaria, including the distribution of long-lasting insecticidal nets, the use of Artemisinin-based Combination Treatments (ACT) for the treatment of uncomplicated malaria, as well as the introduction of the Seasonal Malaria Chemoprevention (SMC) for pregnant women and children below the age of five years. Yet, thousands of lives are lost annually to malaria.
Malaria burden in Nigeria
Report from the National Malaria Elimination Programme (NMEP) indicated that malaria prevalence is on steady decline compare to what was obtained some decades ago. However, there’s still the need to up the precautionary measures, to assist in the fight and also protect more people from the dangers of the malaria.
Currently, malaria prevalence is very high in Bayelsa, Kebbi, Zamfara, and Sokoto States, and this is because they grow rice in large quantities, and also have dams. This might also be the reason for the decision to use the States as a pilot for the newly procured malaria vaccine. However, the case is low in states like Lagos and Kwara, among few others.
Nevertheless, the 2023 malaria report obtained from NMEP indicated that the number of fever cases in the year 2023 increased from about 2.4 million in January 2023 to 3.6 million in October 2023, before decreasing to 2.8 million in December.
The testing rate was above 94 per cent for all the months in 2023 except October with 93.4 per cent achievement. The reporting was, however, in line with the national performance target, which was that per cent of suspected fever cases receive parasitological testings using Rapid Diagnostic Test (RDT) /Microscopy.
Testing rate among states ranged from 59.2 per cent in Abia state to 99.9 per cent in Kaduna state. Most states without donor support reported low rate, but still achieved 80 per cent. 21 states reported a parasitological testing of a fever of 90 per cent.
Test Positivity Rate (TPR) using RDT in 2023 ranged from 45.6 per cent in Akwa Ibom State, followed by 50.8 per cent in Oyo state to 90.3 per cent in Imo State. Nationally, the TPR using RDT in the year 2023 was lowest in January, with 68.4 per cent and highest in October, with 77.7 per cent. TPR from Microscopy was highest in July with 75.3 per cent, and lowest in December with 69.32 per cent.
The data further indicated that there was an increase in the number of persons with confirmed uncomplicated malaria from 1.6 million, in January to 2.5 million in July 2023 and highest in August, with nearly 3 million cases. The proportion of confirmed uncomplicated malaria given ACT was above 97 per cent for all the months, but highest in August and December with 99.2 per cent, respectively.
The proportion of confirmed uncomplicated malaria given ACT ranged from 77.3 per cent in Rivers State to 100 per cent in Sokoto, Borno, Kogi, Katsina, and Ebonyi States. 34 States (92 per cent) had a proportion of less than 90 per cent.
Global fund efforts
Nigeria is regarded as the Global Fund’s largest investment portfolio, with over US$4.8 billion invested in the country since 2002, for the fight against various diseases, particularly malaria, HIV and tuberculosis (TB), including US$1.2 billion in the previous cycle, and the new grants.
Executive Director, Global Fund, Peter Sands, said the organisation, being the world’s biggest provider of external funding for malaria, invested over $125 million in fighting malaria in Nigeria recently, working hand-in-hand with NMEP, partners like the U.S. President’s Malaria Initiative and the World Health Organization (WHO), as well as many other civil society and community organizations.
He said: “We have made significant progress. Despite Nigeria accounting for more than a quarter of malaria cases in the world, the malaria mortality rate has fallen by 55 per cent since the beginning of the century. The health workers I met during my recent visit to Kano told us that the introduction of seasonal malaria chemoprevention improved the situation compared to even a few years ago. But we must do more and do so now.
“That sense of urgency intensifies when we consider all the factors fueling the threat. Climate change is obviously changing malaria’s epidemiology, affecting its geographical spread and making it more volatile.
Early in the year, the Global Fund, the government of Nigeria, and health partners came together to sign eight new grants worth $993 million. The new grants will support the fight against HIV, TB, and malaria, while strengthening health systems and pandemic preparedness across the country over the 2024-2026 periods.
Benefits of the vaccine
Undoubtedly, the newly introduced malaria vaccine has become a life-saving measure for millions of children and pregnant women that die annually due to severe malaria attacks. It strengthened the routine immunisation system in Nigeria, providing an opportunity for the new generation to enjoy a healthy life. Herd population has also been strengthened.
However, aside the benefits to the national economy and productivity, individuals and households would also benefit from the vaccine, considering the fact that malaria is regular ailment in Nigeria which is often treated through out-of-pocket expenditure due to poor health insurance systems.
With the rising inflation, an average malaria drug costs about five thousand naira and above for one-off treatment. That’s a huge figure when multiplied by over 50 million malaria cases reported annually (N2.5bn).
Officials of the Federal Ministry of Health and National Primary Healthcare Development Agency (NPHCDA) said they long desire the vaccine to be included in the routine immunisation schedule of the country, after proper examinations and certifications by the NAFDAC.
Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said the arrival of the vaccines mark the beginning of a new trajectory in the fight against malaria, commending Gavi, the Vaccine Alliance, WHO, UNICEF and other development partners for the great role they have played over the years to the realistic of the dream.
He said: “Undoubtedly, Nigeria has a high malaria burden, and we are committed to bringing down the burden, hence the rethinking malaria conference that was held early in the year. As we try to improve the primary healthcare services, we won’t relent in tackling several other communicable and non-communicable diseases.
“We have enjoyed the support of the President, and we promised that more progress will be recorded with the support and collaboration of all stakeholders through the platform of the Sector-Wide Program Coordination.”
Check this story for part (2)
Welcome, malaria vaccine! (2)
