By Mazhar Shahen – Art in Tanzania internship

Medical and Public Health

In Tanzania, over 90% of the population lives in areas where there is a risk of malaria. In Africa, Tanzania is the third largest population at risk of malaria. Most of the victims of the disease are children, with around 80,000 deaths annually caused by malaria. In Tanzania, the Kagera Region, located on the western shore of Lake Victoria, has the highest risk of contracting the disease. The Arusha Region is a lower-risk area. However, climate change and people migration have caused an increase in the migration of mosquitoes, exposing malaria-free regions to the disease. 

MALARIA

Malaria is a life-threatening disease caused by the transmission through an infected female Anopheles mosquito. The infected mosquito is a carrier of the Plasmodium parasite. The parasite is released into the human bloodstream through the mosquito bite. The parasite survives in tropical and subtropical climates. After the parasite enters the human bloodstream, it travels to the liver to mature and develop. The parasite’s maturity takes several days, after which it returns to the bloodstream to travel to the red blood cells. Once the red blood cells are infected, the parasite begins to multiply within 2-3 days, causing the infected red blood cells to rupture. 

Malaria is an acute febrile disease that typically presents with fever symptoms when infected. Symptoms appear in a non-immune person 10-15 days after the infection. Early symptoms are mild fever, chills, and headache. Since it is mild, malaria is more complicated to detect early on. If not treated, the plasmodium parasite can progress to severe illness, usually leading to death.

Severe malaria in children could lead to severe anaemia, respiratory distress, and/or cerebral malaria. Adults are at risk of multi-organ failure. 

In 2019, the World Health Organization (WHO) reported that half of the world’s population is at risk of malaria. Most of the cases and deaths are in sub-Saharan Africa. This suggests that the African community urgently needs a malaria vaccine. Malaria control has been better, with the number of cases dropping significantly over the last decade and the number of children dying from malaria being halved. 

MALARIA VACCINE

Vaccines are a hot topic in the world we live in. Vaccines help us strengthen our immune system against specific diseases, which protects us from those illnesses. Vaccines are usually needle injections, but can also be given by mouth or sprayed into the nose.

WHO claims that the malaria vaccine can reduce malaria cases by 75% and sets us on the goal of eradicating the illness. Malaria is responsible for 219 million cases each year, with an estimated 660,000 deaths from the disease.

Tanzania has the third-largest population at risk of illness in Africa, with 90% of the population at risk of contracting malaria. Tanzania has 10 to 12 million cases of malaria annually, with most of them being children. The number of cases has been controlled a lot better over the decade, leading to a significant decrease, and the number of children dying from malaria has halved. However, due to climate change and the migration of people, malaria cases are rising in areas that were considered low-risk in the past. This is complicating the fight against malaria. 

Vaccine RTS, S acts on Plasmodium falciparum, the most deadly malaria parasite in the world and specifically in Africa. The vaccine is the first and only successful vaccine for malaria, which has helped in the reduction of children’s deaths in Africa. This vaccination is part of the Malaria Vaccine Implementation Program (MVIP), established by the WHO to deliver the vaccine in selected areas of Africa, with the assistance of each country’s government. The 3 African countries currently in pilot introduction are Ghana, Malawi and Kenya. The goal is to supply the whole region by 2023. Vaccine RTS, S is considered a safe vaccine, and no proven direct side effects exist. The pharmaceutical giant GSK will conduct several Phase 4 studies in the three African countries chosen for the pilot. 

In 1987, the discovery of a synthetic peptide polymer (SPf66) in Columbia enabled the development of the first vaccine candidate. Tanzania was the second country, after Colombia, to participate in the clinical trials of SPf66. This indicates that historically, Tanzania has an advantage as researchers will have a deeper pool of information in Tanzania than in other African countries. Researcher George M Bwire states in his article that the inclusion of Tanzania in the Malaria Vaccine Implementation Program for the current RTS, S vaccine is crucial.

REFERENCES

1. Agnandji, S. T., Agnandji, S. T., Asante, K. P., Lyimo, J., Vekemans, J., Soulanoudjingar, S. S., . . . Abdulla, S. (2010). Evaluation of the Safety and Immunogenicity of the RTS,S/AS01E Malaria Candidate Vaccine When Integrated in the Expanded Program of Immunization. The Journal of Infectious Diseases, 202(7), 1076-1087. Retrieved 2 11, 2021, from https://academic.oup.com/jid/article-abstract/202/7/1076/837083
2. Bwire, George & Sanga, Anna. (2019). Malaria control in Tanzania: Current status and future prospects. 2664-8490..
3. Dimala, C. A., Kika, B. T., Kadia, B. M., & Blencowe, H. (2018). Current challenges and proposed solutions to the effective implementation of the RTS, S/AS01 Malaria Vaccine Program in sub-Saharan Africa: A systematic review. PLOS ONE, 13(12). Retrieved 2 11, 2021, from https://ncbi.nlm.nih.gov/pubmed/30596732
4. Galactionova, K., Tediosi, F., Camponovo, F., Smith, T., Gething, P. W., & Penny, M. A. (2017). Country specific predictions of the cost-effectiveness of malaria vaccine RTS,S/AS01 in endemic Africa. Vaccine, 35(1), 53-60. Retrieved 2 11, 2021, from https://sciencedirect.com/science/article/pii/s0264410x16311033
5. Malaria vaccine implementation PROGRAMME (MVIP). (n.d.). Retrieved February 12, 2021, from https://www.who.int/news-room/q-a-detail/malaria-vaccine-implementation-programme
6. Malaria in Tanzania. (n.d.). Retrieved February 12, 2021, from https://malariaspot.org/en/eduspot/malaria-in-tanzania/
7. White, N. J. (2011). A vaccine for malaria. The New England Journal of Medicine, 365(20), 1926-1927. Retrieved 2 11, 2021, from https://nejm.org/doi/full/10.1056/nejme1111777