What is happening in Nigeria?

The country with the highest malaria mortality rates globally, Nigeria, has become the first to administer the R21/Matrix-M vaccine. This makes it the second malaria vaccine approved by the World Health Organization (WHO). This follows the RTS,S/AS01 vaccine developed by Ghana, Kenya, and Malawi was the first to be approved and other African countries have started administering it to infants as well.  

Malaria is a mosquito-borne parasitic disease that disproportionately affects Africa, accounting for 94% of all global cases and 95% of malaria-related deaths. Each year, approximately 1 million people die from the disease, and as many as 1 billion are affected across 109 countries in Africa, Asia, and Latin America. The symptoms of malaria range from mild, such as chills and fever, to severe and life-threatening conditions, including confusion, seizures, and difficulty breathing. Children are the most vulnerable, with nearly half a million African children dying from malaria annually.

The primary methods of preventing malaria include avoiding mosquito bites through protective measures like insecticide-treated nets and taking prophylactic medications. Given the significant burden of the disease, the development of vaccines has been a critical focus.

This vaccine, developed by Oxford University, the Serum Institute of India, and Novavax, is specifically designed for children aged 5 to 15 months. Approved by the WHO in April 2023, the vaccine is seen as a breakthrough in combating malaria in high-burden regions. Nigeria received 846,200 doses of the R21 vaccine through a collaboration with Gavi and UNICEF.

Interestingly, malaria was once endemic to Europe but was eliminated by 1975, despite rising temperatures. This success is attributed to non-climatic factors such as changes in behaviour, improved farming practices, better irrigation and drainage systems, and expanded access to healthcare. The introduction of the R21 vaccine could be a game changer in terms of addressing malaria and its deadly effects, particularly in high-burden African countries like Nigeria.

The historical cases in Europe’s malaria elimination suggest that combating malaria will require not just medical innovation but also improvements in infrastructure, public health policies, and community engagement.

What is in it for you?

For readers in Nigeria, the approval and deployment of the R21 malaria vaccine in Nigeria is a major asset in combating the disease on a larger scale. Where over 97% of the population is at risk of malaria, a risk likely to intensify with climate change, this vaccine complements existing measures like insecticide-treated nets, indoor spraying, and malaria chemoprevention. Every vaccine administered to a child, and every parent informed brings the nation closer to possibly eradicating malaria.

The successful elimination of malaria in Nigeria would set a precedent for tackling other vector-borne diseases, particularly in climate-vulnerable regions. This is a major step forward in protecting the most vulnerable, particularly children.

For readers globally, climate change risks changing the scope of the issue – rising temperatures, increased rainfall, and higher humidity levels are enabling mosquitoes to thrive beyond their traditional equatorial habitats, reaching higher altitudes and regions previously unprepared for malaria outbreaks. According to a 2023 WHO report, this expansion is driving a resurgence in areas that had previously controlled or eliminated malaria, while others find no significant correlation between climate change and malaria incidence. After the 2011 floods in Pakistan, for example, malaria cases increased fivefold, showing how climate can worsen outbreaks.

What happens next?

The vaccine rollout in Nigeria will take various stages requiring four individual doses with the first dose administered to infants at 5 months old and a final vaccine at 15-23 months old. While vaccines play a critical role in advancing malaria eradication, many other solutions have been floated. Organisations like Target Malaria, where entomologist Krystal Birungi works have explored genetically modified mosquitoes to reduce transmission. Climate change complicates eradication efforts by creating more mosquito breeding grounds, potentially increasing malaria rates. Addressing these environmental factors will be essential alongside medical interventions.

Nigeria is the first country to receive the R21 vaccine, but Liberia, Niger, and Sierra Leone are expected to follow later this year. By 2026, African countries will require between 20 to 60 million doses annually, posing logistical challenges, including the need for adequate electricity to store the vaccines at the correct temperature.

The Polis Team in Istanbul