By Ruth Wanjala, Senior Communications Officer, PATH

The mosquito, smaller than a thimble, is one of the world’s deadliest creatures. This tiny insect can be responsible for fever, chills, seizures, vomiting, anemia, and/or respiratory distress in children through the transmission of the even smaller Plasmodium parasite, which causes malaria. Malaria is a preventable and treatable disease yet, in 2021, there were an estimated 247 million cases throughout the world. Babies and children under five have a higher risk of severe infection and account for most recorded deaths. In 2020, one child died every minute due to malaria in Africa.

While these statistics are sobering, for the first time, there is hope. The RTS,S malaria vaccine is a new four-dose vaccine recommended to prevent malaria in children. It was prequalified by the World Health Organization (WHO) in July 2022 and is currently being rolled out in Ghana, Kenya, and Malawi. We finally have a new tool to help prevent a deadly disease that has impacted millions of lives around the world.

MOMENTUM Routine Immunization Transformation and Equity has worked closely with the Government of Kenya to expand their RTS,S vaccination program. In Kenya, 5 percent of deaths for children under five are caused by malaria. The Government of Kenya introduced the RTS,S malaria vaccine in 2019 across eight counties and has administered more than 1 million doses of the vaccine to children.

During the pilot introduction of the vaccine, the Kenya National Vaccines and Immunization Program (NVIP) prioritized strong communication with caregivers, stakeholders, and health workers to ensure four key messages were understood by all priority populations: 1) the vaccine is available in malaria endemic counties; 2) the vaccine is a four dose vaccine given at 6, 7, 9, and 24 months; 3) caregivers need to bring their children for all four doses of the vaccine to get the best protection; and 4) in addition to vaccination, children and caregivers need to continue using other recommended malaria interventions.

Thanks to these efforts, there was strong uptake of the vaccine. However, uptake dropped off for the fourth dose, which is scheduled to be given 6-9 months after the third dose.

In January 2023, MOMENTUM, working closely with the Kenya NVIP, WHO, and PATH, expanded distribution of the RTS,S vaccine to an additional 25 sub-counties across Kenya. As MOMENTUM worked with partners planning for expansion, they knew they needed to focus on encouraging uptake of the fourth dose. Project staff worked with national and county teams to support 24 trainings for health care workers and community health volunteers. Trainees gained knowledge and practical skills on vaccine service delivery and demand creation – particularly on the need to improve fourth-dose coverage. In collaboration with PATH and WHO, MOMENTUM worked with counties to strengthen their community engagement, defaulter tracking, use of immunization diaries, and SMS reminders to improve fourth dose coverage.

At the launch of the expansion of the RTS,S vaccination campaign in Vihiga county, Dr. Patrick Amoth, Director General for Public Health in the Kenya Ministry of Health, urged caretakers to complete the vaccination series for children: “We are urging all our caregivers in the lake endemic regions to bring their children to receive this malaria vaccine where it is available and make sure to complete all the required four doses to get the best protection.”

As the project monitors the expansion of the malaria vaccine, it will pay particular attention to this fourth dose coverage and overall acceptance of the vaccine. Additionally, the project will continue to support Kenya’s national program to roll out the RTS,S vaccination in additional sub-counties within malaria lake endemic areas.

While the expansion is happening in Kenya, what about other countries? MOMENTUM, in collaboration with the WHO, reviews applications countries make to Gavi, The Vaccine Alliance for RTS,S vaccine introduction. MOMENTUM provides technical support to strengthen the quality of applications before submission to Gavi for approval. Additionally, the project has contributed to the development of social and behavior change tools and guidance to support countries with RTS,S vaccine introduction.

In 2015, the WHO set an ambitious goal to reduce global malaria incidence and mortality rates by at least 90 percent by 2030. With the introduction of the RTS,S vaccine, this goal is looking more and more possible. MOMENTUM and its partners are committed to help ensure we reach, if not surpass, this goal, and protect all children from malaria.