Vaccine hope for malaria eradication

The news of the World Health Organization (WHO) recommending widespread use of a ground-breaking malaria vaccine for children of sub-Saharan Africa and other regions at risk has triggered new hopes for the global eradication of the disease. The vaccine can be expected to bolster India's fight against malaria and advance the target year of making the country malaria-free by 2030. The WHO recommendation is based on the results of a pilot project of injecting the vaccine in three sub-Saharan African countries- Ghana, Malawi, and Kenya. Over 8 lakh children have been vaccinated under the pilot project launched in 2019. The WHO Director-General Tedros Adhanom Ghebreyesus has stated that using the vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives. According to WHO estimates, about 2.6 lakh African children under the age of five die from malaria every year which explains the launching of the pilot project malaria vaccine for children in three sub-Saharan countries. It recommends that in the context of comprehensive malaria control the RTS, S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden. WHO claims that the vaccine work against P. Falcipuram, the most deadly malarial parasite and data from the pilot project shows that the vaccine is feasible to deliver and has a favourable safety profile. The World Malaria Report (WMR) 2020 released by WHO indicates that India has made considerable progress in reducing its malaria burden and the Annual Parasitic Incidence (API) reduced by 27.6% in 2018 compared to 2017 and by 18.4% in 2019 as compared to 2018. The report also brought to the fore that the country achieved a reduction of 83.34% in malaria morbidity and 92% in malaria mortality between 2000 and 2019. Malaria deaths in the country, according to WHO estimates, reduced by 74%, from about 35000 in 2000 to 9,000 in 2019. This is a huge achievement given the fact that at the time of Independence, the country recorded 75 million malaria cases and 0.8 million deaths. With about 5.6 million cases India accounted for 88% of malaria cases and 86% of malaria deaths in the South East Asia region in 2019 that leaves no scope for complacency despite the control measures producing encouraging results. India, however, has not reconciled to WHO estimates and claims that only 77 died from Malaria in 2019. Within the country, Odisha, Chhattisgarh, Jharkhand, Meghalaya, and Madhya Pradesh disproportionately accounted for nearly 45.47 per cent of malaria cases and 70.54 per cent of falciparum Malaria cases in 2019 while official data shows that 63.64% of malaria deaths were also reported from these states. Strategies to control malaria include passive surveillance at the healthcare centres when people come for treatment of other diseases and active surveillance carried out every fortnight by health workers. The shortage of health workers is still a major issue in some states and increasing the human resources of the Health and Family Welfare Departments is crucial to intensify the active surveillance. Besides, the distribution of Long-Lasting Insecticidal Nets (LLINs) in high burden areas is another key strategy to reduce endemicity in high endemic states. About five crore such mosquito bed nets were distributed in Northeastern states, Chhattisgarh, Jharkhand, Madhya Pradesh, and Odisha up to 2018-19 and another 2.25 crore LLINs distributed last year. Regular monitoring and inspection of distribution can help detect the incidence of such nets not reaching the targeted beneficiaries. Worldwide 40 countries have been certified malaria-free by the WHO with El Salvador being the latest entry in the list after China in 2020. With cases still in lakhs, India has to improve its vector-borne disease control programme and public health outreach to bring down the cases to nil to be certified as malaria-free at the earliest.

Prevalence of indigenous cases

As 116 districts of the country are found to be malaria-free with no reporting of cases over the past three consecutive years, focused attention in high burden areas can take the country to achieve the desired goal. It remains to be seen if the country includes malaria vaccine as part of its eradication programme. With the history of malaria cases rising after the drastic decline, awareness on the use of mosquito nets, measures to check the growth of the mosquito population must continue in full scale. The challenge is to sustain the drastic decline of cases in the country. The malaria vaccine is expected to prompt health experts and strategists world over and more particularly in high-risk regions to rethink strategies for ensuring a malaria-free world. It is time that states in India intensify active surveillance to consolidate gains.