Breast cancer survivors in the country have urged the National Assembly to give cancer research grants and support policies some priorities, to stem the tide of cancer-related sicknesses and deaths in Nigeria.
The concerned stakeholders, who spoke at the second Omolara Jolaoso Memorial Lecture to commemorate the World Cancer Day 2016 in Lagos, said that the agony of surviving the disease or deaths, which is common, would drastically reduce with improved research and clear-cut policy on care and survivorship.
Founder/ president of Breast Cancer Association of Nigeria (BRECAN), Betty Anyanwu-Akeredolu, said that aside from poor awareness and ignorant, cancer patients still present late for treatment because they don’t have money to pay “in a health system that is cash and carry.”
“That is why we need to have policies in place that will support our women. Government needs to come in. We can’t wait for our women to die; we have to work on intervention, particularly cancer researches and effective cancer care services,” Anyanwu-Akeredolu said.
She added that the reason why at least 90 per cent of all breast cancer cases in the United States survive is due to priority given to care and research.
She said: “We are beneficiaries of what their (US) researchers are doing over there because they are been extended to us. So, I go to the US Congress to lobby against cutting research funds, because researchers are working day and night on how they can find a cure and also improve our lives.
“But I don’t have access to our own National Assembly complex to tell them about research funds to save our women from die of breast cancer,” she said.
Anyanwu-Akeredolu, herself a breast cancer survivor, said further that the onus is Nigerians to live a healthy life and demand from the government adequate funding for improved infrastructure for breast cancer care, lobby for policy legislation to guide impactful interventions and stimulate the interest of next generation of breast cancer researchers in Nigeria.
Breast cancer is currently the commonest female malignancy and in fact the leading cause of cancer death in the country. It was estimated that at least one woman dies of breast cancer every 10mins.
Global Cancer Facts and Figures for African countries, being 15 per cent of the world population, represents eight per cent of the new cases, but 12 per cent of breast cancer deaths because of poor survival due to late stage at diagnosis and limited treatment.
Professor of Medical Oncology, Seattle Cancer Care Alliance, Seatle, Washington, United States, Dr. Julie Gralow, said that Nigeria need to put in place a comprehensive cancer control programme that also caters for survivors with good survivorship plan.
Gralow noted that as care services improve in the country, the population of survivors are also bound to improve and would need continuous support to deal with long-term effects of cancer treatment even years after.
She informed that there are over 14million cancer survivors in America today and a dedicated National Cancer Institute Office of Cancer Survivorship established in 1996 was promoted their course.
Nigeria, in line with global commitment launched the Polio Eradication Initiative (PEI) in 1996. This was eight years after the World Health Organization (WHO) launched the initiative in 1988. The launch of the global initiative was to attain global eradication of the poliovirus by the year 2000. While many countries achieved the aspiration without much constraint, the road leading to the interruption of the transmission of indigenous wild poliovirus (WPV) in Nigeria was not an easy one. It was fraught with a lot challenges. However, with perseverance, innovations and commitment, the nation overcame these challenges and was formally delisted as a polio-endemic country by the WHO Director-General on 24th September 2015.
Nigeria commenced battling the polio scourge in 1996 with the formal inauguration of the Polio Eradication Initiative (PEI) in the country; and over 350,000 cases reported globally in several countries. As at 2014, only three countries remained in the world that have never interrupted indigenous transmission of the WPV; these were Pakistan, Afghanistan and Nigeria. Nigeria is now out of that list.
Our country has had several challenges, ranging from unfounded rumours on the Oral Polio Vaccine (OPV), suspension of the polio eradication efforts in some States; to the killing of innocent vaccination team members in the course of trying to prevent our children from getting paralyzed. But we were never deterred by these unfortunate events; indeed we grew in our collective resolve as a country, developed innovative strategies to surmount these challenges and built a formidable programme, which subsequently provided a platform to tackle other public health challenges like the Ebola Virus Disease epidemic of July 2014.
Despite the historical public health feat achieved by Nigeria in PEI, however the programme and the nation must sustain the tempo and maintain the momentum, as our ultimate goal is to achieve eradication in the next 17 months. In the interim, a lot of emphasis will be placed on improved surveillance system for the acute flaccid paralysis (AFP), the proxy for the detection of the poliovirus; maintaining high quality of our routine immunization (RI) and the polio campaigns by sustaining and scaling up innovative strategies; but above all, re-positioning of our Primary Health Care (PHC) system for delivery as the critical platform to improve the health outcomes of Nigerians, a key stimulant for national development.
To achieve polio eradication in the next 17 months, surveillance would continuously be improved, while maintaining high quality polio campaigns and also scaling up innovative strategies such as health camps, deepening of partnership with Traditional and Religious Leaders as well as deploying the polio infrastructure to strengthen routine immunization and the broader health system.
The programme therefore needs sustained funding. The commitment of all stakeholders – Local Government Areas (LGAs), health workers, Civil Society Organisations (CSOs), communities etc., is critical to achieving certification by 2017. While also requiring functional PHC system to deliver on essential services, optimize results and provide a platform for improved health system and health outcomes not only for polio but other vaccine-preventable diseases and non-communicable diseases (NCDs). This is a gift Nigerians and indeed the entire African region deserves. In the last three decades, PHC has consistently remained the cornerstone of our national health system, and a veritable platform for the attainment of Health for All Nigerians. While key achievements have been attained, there are significant systemic challenges of PHC implementation ranging from the governance arrangement to service delivery. These account for suboptimal service delivery at the PHC level with concomitant inefficiency resulting into not too impressive health outcomes. Programme implementation is hamstrung by weak co-ordination within and between the three levels of government. These challenges are further compounded by limitations in coverage and access.
There is the need to institutionalize provision of essential package of care at the PHC level, increase geographical and financial access to health care services, improve the quality and increase demand of the services, and provide financial protection for the vulnerable groups. The Federal Ministry of Health (FMoH), working with the States and PHC stakeholders is addressing the challenges of the huge out-of-pocket expenses (OPE), which currently stands at over 60 per cent among others, and have made concerted efforts to make the National Health Act operational. Stakeholders are upbeat with optimism that provision for the Basic Health Care Provision Fund (BHCPF) in the Act, has the potential to significantly increase the resource envelope for PHC and ensure some predictability in the availability of funds.
There is also the National Strategic Health Development Plan 2009 – 2015, which is the overarching policy framework for Health Sector programmes, being supported by all stakeholders in the sector. In addition, there is the Ward Minimum Health Care Package, which serves as guidelines for implementation of PHC focusing on making one PHC facility functional in each of the 9572 political wards in the country with a view to scaling up Universal Health Coverage in the country; and also addressing the huge OPE.
At the macro level, there have been concerted efforts towards having one authority coordinating PHC system at the State level in order to enhance efficiency, thus the Primary Health Care Under One Roof (PHCUOR) initiative. This has resulted in the establishment of 32 PHC Agencies.
The National Primary Health Care Development Agency (NPHCDA) is currently assisting in the functionality of these boards. It is expected that the State PHC Agencies will ensure that all the essential components of PHC will be integrated under the new governance structures: the State Primary Health Care Development Boards/Agencies at the State level and the Local Government Health Authorities at the local government level.
The Agency under the oversight of the FMoH has now embarked on PHC revitalization with a vision of building a resilient health system on the principle of equity and social justice through functional PHC systems. We therefore call on all stakeholders, particularly States and LGAs to own and drive the implementation of PHC services in their various localities, as this is critical to our current effort to reposition PHC as the platform to improve health outcomes of all in Nigeria. *Dr. Ado J.G. Muhammad (OON), is the Executive Director/CEO of the National Primary Health Care Development Agency (NPHCDA)
Dangote Foundation, Bill & Melinda Gates Foundation commit to boosting nutrition, routine immunization in Nigeria Determined to boosting routine immunization (RI) against childhood killer diseases and ensuring that Nigeria is ultimately certified polio free by end of 2017 by the World Health Organisation (WHO), the Dangote Foundation and Bill & Melinda Gates Foundation (BMGF) have signed a new memorandum of understanding (MoU) with Borno, Kaduna, Sokoto and Yobe States.
According to a joint statement by the foundations, strengthening RI takes sustained financial and human resource commitment and it is important that the changes being made during the short MoU period must be “habit forming” changes that are kept in place well after these MoUs end.
The statement noted that the goal of these MoUs is to change the State’s own RI programmes and health system for the long term; the total cost of the six MoUs is $42 million between 2013 and 2018; and the Foundations and the states will provide $14 million each while the federal government will provide the vaccines.
Also, the foundations have signed new MoUs for cold chain with Katsina and Zamfara states.
Dangote Foundation and BMGF have entered into a one-time, 15-month tripartite MoU with Zamfara State and Katsina State to strengthen their cold chain system.
The foundations in a joint statement said: “This is not an in-depth RI MoU like we have established in other northern states. Under the terms of the last round of the Governors’ Immunization Leadership Challenge, the two Foundations committed to recognizing Zamfara State and Katsina State each with $1 million in grant award funds ($500,000 from each Foundation) for their success in remaining polio free in 2013.
“Dangote Foundation and BMGF’s funding will support the purchase of cold chain equipment, while the states have committed to releasing funds to support equipment installation, operation, and maintenance. The two Foundations’ money has been released to United Nation Children Fund (UNICEF) to enable them to do the procurement. The procurement includes walk-in coolers for satellite cold stores, as well as the solar direct drive dual refrigerators to be used at the facility level.”
The Dangote Foundation and BMGF has also announced a combined commitment of $100 million over the next five years (2016-2020) towards ending under-nutrition in Nigeria. This commitment is expected to improve the lives of at least five million families by 2020 and was announced by Alhaji Aliko Dangote and Bill Gates, last week, during a press conference in Abuja.
Meanwhile, there has been huge progress in the fight against the wild poliovirus (WPV) and Nigeria was able to interrupt the transmission. July 24, 2015 marked one year since the last child in the country was paralyzed by WPV, in Sumaila Local Government Area in Kano State.
According to stakeholders, the key now is to keep up the efforts so the trend is not reversed but an estimated 250,000 children in Borno State have not been immunized due to insecurity.
While it is an important indication of progress to have 1.5 years without a case of WPV, Nigeria needs to go through July 2017 without a case anywhere in the country to be declared polio-free. Surveillance must be maintained at global-level standards so that we are not missing anything.
Also, despite rapid economic growth, Nigeria is home to the highest number of stunted children in Africa and the second highest globally. Almost one in five Nigerian children are acutely malnourished and more than one in three children suffer from stunting. With its vital role in child health, growth and cognitive development, better nutrition will be essential to unleashing the potential of Nigeria’s next generation.
Guided by the belief that all lives have equal value, the BMGF works to reduce inequity around the globe. We fund new ideas and encourage innovative partnerships so shared resources will do the greatest well for the most people. In developing countries, we focus on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty.
The foundation invests in proven approaches to improving nutrition, such as focusing on that 1,000-day window, immediate and exclusive breastfeeding, and food fortification and supplementation. Its long-term goals are to prevent 1.8 million malnutrition-related deaths by 2020 and to develop and test new solutions to address the burden of malnutrition that cannot be alleviated using existing interventions.
Dangote Foundation, the philanthropic endeavor of Aliko Dangote is the largest private foundation in sub-Saharan Africa.
Aliko Dangote believes that supporting social and economic change through investments and interventions that improve the lives of the less fortunate can make a positive difference in the growth of a nation. His vision is one where no Nigerian child should suffer and die of under nutrition and disease. Dangote Foundation’s goals are to: help reduce the number of lives lost to malnutrition and disease; support income generation activities and education programs that help lift people out of poverty; and be responsive to people who are affected by natural disasters globally, by providing emergency relief.
Bill Gates said: “Nutrition is one of the highest impact investments we can make in Nigeria’s future growth and prosperity. We know that well-nourished children are more likely to grow up to be healthy, fend off preventable diseases, achieve more in school and even earn higher income as adults.
“This partnership builds on our foundation’s strong commitment to Nigeria – one of several countries where we are working closely with the government, the private sector and civil society to improve health and development outcomes.”
Dangote said: “In the spirit of our new partnership, we encourage even more deliberate and significant commitments from the Government of Nigeria at all levels to step up investments in nutrition. It is time to make strategic investments in interventions to eliminate malnutrition in Nigeria. This will be achieved through a massive scale-up of interventions, matched with effective coordination of efforts and innovative sustainable solutions. We have to ensure that children who are already malnourished receive help and are prevented from dying while we improve the conditions that led to them being malnourished in the first place.”
In a joint statement, the two foundations said they would begin a joint planning process to determine the details of the partnership. Programmes will include community-based approaches and proven interventions linked to behaviour change, fortification of staple foods with essential micronutrients, the community management of acute malnutrition and investments in the local production of nutritious foods. A key objective will be improving the livelihoods of households by supporting nutrition-sensitive agricultural programs that can increase family income, improve diets and empower women and youth.
The two foundations also welcomed the increased political attention to under-nutrition in Nigeria and noted that leadership will be critical to future progress.
Gates
Meanwhile, in late 2012 in Kano, and mid 2014 in Bauchi, Dangote Foundation and the BMGF, entered into MoUs with the states to build a systematic statewide approach to strengthening routine immunization and by extension, a significant part of the primary health care system.
Dangote Foundation and BMGF contribute to a ‘basket fund’ that pools our resources with each State, with progressive responsibility for the budget passing to the State. Annual work plans support all areas of the statewide programme, and have a knock-on effect in strengthening some of the systemic issues that hinder primary health care (budgeting, coordinated work planning with all partners aligned, accountability frameworks, performance management).
The third year of our collaboration in Kano was just completed, with a fourth year extension agreement that was recently formalized on January 20, 2016. In Bauchi we are one and a half years into the three-year MoU.
Traditional Rulers and Leaders have played a critical role in the success of the fight against polio. During the course of the last several years they (Northern Traditional Leaders’ Committee) have contributed in two substantial ways: (a) they’ve provided the polio program with badly needed credibility in the face of a concerted campaign to distort fears about vaccine safety and rumors of a ‘Western’ plot. The Emir of Kano, for example, created a sensation when he went to the urban Local Government Area of Ungogo in 2014 and consumed an entire vial of Oral Polio Vaccine in front of a huge crowd to make the case that there are no impure elements in the vaccine; and (b) they have been the single most effective partner in reducing incidents of ‘non-compliance’ – that’s when families refuse to allow children to be immunized during the campaign by the house-to-house team.
Over several years, the incidents of non-compliance have reduced significantly, and now comprise less than one per cent of the approximately 19 million children missed for immunization during a campaign in northern Nigeria. In some areas of certain states, such as Sokoto, Kaduna and Kano, non-compliance accounted for more than 25 per cent of missed children five years ago.
In 2009, the Federal Government and the Nigeria Governors’ Forum signed what is called the “Abuja Commitments”. These Commitments outline specific actions that the State Governors and the Local Government (LGA) Chairmen are supposed to do every month/quarter to ensure polio eradication. These include public actions such as holding meetings with traditional leaders and actively participating in the polio campaigns.
Managing Director, Promasidor, Mr. Olivier Thiry(left); President, Nutrition Society of Nigeria, Prof. Ngozi Nnam; and Head of Marketing, Promasidor, Festus Tettey recently at the unveiling of cowbell Tina Infant Formula in Lagos.
Nutritionists in the country have called for proper dietary education among mothers, particularly the young ones. the experts, who spoke at a symposium organised by promasidor, said that nutrition education was important to break old traditions of feeding babies that are still common till date.
Consultant paediatrician, massey street children’s hospital, dr. abieyuwa emokpae, said one of those traditions is to lure babies to sleep all through the night, citing that many mothers are still in the habit of giving pap to make babies sleep all through the night.but according to emokpae, “at the infant stage, it is not appropriate for babies to sleep all through the night, because they need to feed from time to time.
“in fact, this is dangerous and it can cause the baby to die during sleep because their digestive system is not strong enough to digest such foods,” he said.
President, nutrition society of nigeria (nsn), prof. Ngozi Nnam, stressed that breast milk remains nature’s perfect food for infant adding that nutrition wisdom is vital, especially after the baby is above six month. Nnam said: “human milk contains hundreds to thousands of distinct bioactive molecules that protect babies against infection and inflammation, and colostrum, which is the first human milk, produced by mothers at birth serves as the first immunisation for babies, because it contains a lot of anti-infective substances.”
Nnam urged mothers to put their infants to breast feed possibly 30 minutes after delivery, because it is the best baby food, and that is why nutritionists advocate for exclusive breast-feeding.
She said: “exclusive breastfeeding is a complete nutritional source for the infant for the first six months of life, as nutrients in breast milk is adequate in quality and quantity to provide all the needs of the infant and for easy digestion, nnam added.
In her presentation titled: ‘the nutrition wisdom of infant feeding choices’, the nsn president said when babies are exclusively breastfed, they hardly pass stool for sometimes one week, because they digest and utilize all the nutrients in the breast milk.
She stressed that breast milk is essential all through the baby’s first year, as most brain cells and connections are formed during this period, and up to 60 per cent of the nutrients are used up by the brain and that is why it is very important to pay attention at this age.
“Inadequate of these nutrients especially iron, iodine, magnesium, vitamin b12, and folate fat leads to insult on the infant’s brain, which reduces iq by 13.5 points leaving this effect permanent and irreversible.” in regards to the theme, nnam said, nutrition wisdom is important to ensure adequate supply of nutrients to support rapid growth and development of the infant to eliminate malnutrition.
Nutrition wisdom also affords mothers to make informed feeding choices; this protects the infant from developing chronic diseases like diabetes, cardiovascular and obesity among others in adulthood.
In his welcome address, managing director, promasidor, olivier thiry, said that the importance of exclusive breastfeeding, where possible, cannot be over emphasized, but promasidor is introducing a cost effective alternative food supplement to mothers who for a reason or the other cannot breast feed.
Indian pharmaceutical firm claims that it has developed the world’s first vaccine against mosquito-borne Zika virus, the News Agency of Nigeria has reported.
An Aedes Aegypti mosquito, which transmits the Zika virus is photographed on human skin in a labPunch/AFP
The Head of the Biotech International Limited, Dr. Krishna Ella, said at a news conference that it had already filed for a patent for the Zika vaccine.
“On Zika, we are probably the first vaccine company in the world to file a vaccine candidate patent about nine months ago,” he said.
Ella said the firm, which is based in the southern Indian state of Andhra Pradesh’s capital Hyderabad, had sought the Indian government’s help for carrying out human and animal trials for the two candidate vaccines, which have been developed by its scientists, using a live Zika virus.
The claims came a day after the World Health Organisation said that the Zika virus poses a global public health emergency requiring a united response.
The virus has been linked to cases of microcephaly, in which babies are born with underdeveloped brains.
There have been around 4,000 reported cases of microcephaly in Brazil alone since October.
However, till date, there has been not a single reported case of Zika virus attack in India, though the government was said to have tested a number of samples.
On Sunday, a Danish woman, Anja Ringgren Loven, a Philanthropist an founder of African Children's Aid Education and Development Foundation ( ACAEDF) who lives with her partner and son in Uyo rescued a little boy who had been abandoned by his family because they claimed he was a 'witch'. She took him into her care, fed him, gave him clothes and he is currently receiving some medical attention. This was what she shared on her Facebook page.
Today she gave an update on the boy whom she named Hope.
We should be proud to be Danes. We are a loving people and we're taking good care of each other. We are always together when there is need our help. When natural disasters hit, famine ravaging and civil wars devastate affects us deeply. We Danes are among the world's most generous. We are the best to donate money to charity, help others and do volunteer work. More than every other of us Danes gives money to charity and help people we don't know. And we must be proud!
Right now we danes hung out in the foreign media. Incorrect or not, media account certainly not the true picture of US DANES. For when it comes to love there are no countries can match us! So let us give the media something new to write about. Something to really show them who we danes are!
Just 2 DAYS HAVE DINNØDHJÆLP RECEIVED 1 million dollars to help little hope!!! Let me repeat that: 1 million Danish kroner is donated to dinnødhjælp in just 2 DAYS!!!
My feelings are sitting without his clothes! I'm so overwhelmed! I'm so grateful and touched by all the love, care and huge support there just pouring here to Nigeria all the way from Denmark! I want as long as I live thank you all every day! I forget simply never! With all the money we can besides giving hope the very best treatment now also build a doctor clinic on the new land and save many more children out of torture! It's just so great! The building must be called hope clinic - donated city Denmark!! They say thanks is just a poor words, but for me means thank you life! And to those who says otherwise, then we can today together prove to the whole world that charity indeed still exists in Denmark! heart emoticon
Hope's condition is stable now. He's taking food for himself, and he responds to the medicine he gets. Today he has had powers to sit up and smiling at us. He's a strong little boy. To see him sit and play with my own son is without doubt the greatest experience of my life! I just don't know how to describe it in words. This is what makes life so beautiful and valuable and therefore I will let the pictures speak for themselves:
Today we "groundbreaking" ceremony at the construction site. Ground breaking ceremony where we are so lucky to the Danish Ambassador here in Nigeria participates as a guest of honour and the keynote speaker. I can't believe our ambassador and his sweet wife comes entirely from the capital Abuja to our little village where dinnødhjælp builds a new orphanage and participating in our ceremony. It's so big and I am very pleased to see the ambassador again. Today during the ceremony I will think of our architect Martin from engineers without borders and his working group as in more than half a year now worked every day for putting together and draw dinnødhjælps orphanage in cooperation with our Nigerian engineers. I very much look forward to show you all the outcome when the construction is finished. About 1 years running little hope around on dinnødhjælps new orphanage and play with all the other children.
A case of the Zika virus being transmitted between sexual partners reported on Tuesday in Texas has raised new concerns about the transmission of the disease, which is typically spread by mosquitoes and can cause birth defects.
The patient, whose gender has not been released, was the first person confirmed to have been infected with the virus in the US. Cases of Zika being spread by sexual contact have only rarely been reported, and health authorities had previously treated the idea that sexual transmission was possible as theory rather than documented science.
The US Centers for Disease Control and Prevention confirmed on Tuesday that the patient had contacted the virus after having sexual contact with someone who had travelled to a country where Zika is present.
The Dallas County health department said the sexual partner had travelled to Venezuela, but that the patient had not left the country, and had been infected in Texas.
"Dallas County Health and Human Services has received confirmation from the Centers for Disease Control and Prevention of the first Zika virus case acquired through sexual transmission in Dallas County in 2016," the department said a statement.
Zachary Thompson, the health department's director, said the case proved that Zika could be transmitted sexually.
“Now that we know Zika virus can be transmitted through sex, this increases our awareness campaign in educating the public about protecting themselves and others,” he said. “Next to abstinence, condoms are the best prevention method against any sexually-transmitted infections.”
A total of 31 people in the US are believed to have been diagnosed with Zika in the US in the past 12 months, but all of those cases originated in Central and South America, where the virus is more prevalent.
Symptoms are typically mild in adults, but babies whose mothers have contacted the disease can be born with smaller heads and brains.
Brazil has been the country worst-affected by Zika, though the virus has been reported in more than 20 countries.
The World Health Organization has declared the spread of Zika virus an international public health emergency and has freed funds to combat the disease.
“This is an extraordinary event,” said WHO Director General Margaret Chan at a press conference on Monday. “It poses a public health threat to other parts of the world and a coordinated international response is needed.”
Margaret Chan cited the pattern of the disease’s spread, the lack of a vaccine, and the large global population of mosquitoes that can carry the virus as factors that contributed to the declaration.
The declaration, only the fourth in WHO’s history, comes just days after the organization said the number of cases could hit 4 million by the end of the year. The virus has spread rapidly throughout the Americas infecting people in more than 20 countries.
Officials in Brazil, the hardest hit country, have estimated 1.5 million infections.
The Zika virus is spread to people through mosquito bites and causes genetic mutation in babies. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week.
Mosquirix is one of the most widely anticipated vaccines to have been developed. It is the first vaccine for malaria – a disease that kills more than 1,200 childrenevery day– and has been clinically proven to provide protection against the disease. So, given that it has passed the toughest regulatory hurdles required of it, why is it only being made available in a handful of countries?
Demand for the vaccine is likely to be high. With more than 200m cases a year, malaria is endemic in almost every country in sub-Saharan Africa, as well as large parts of Asia and Latin America. Last week, two advisory bodies to the World Health Organisation, the strategic advisory group of experts on immunisation and the malaria policy advisory committee, recommended against its immediate widespread use, and many people may have been left wondering why.
But it was a smart call. While there is a potential to save many lives with this vaccine, we have reason to tread carefully. Rather than being a simple solution, Mosquirix comes with complex caveats and some outstanding questions that the clinical studies were not able to address. While some may argue that any delay in getting the vaccine out to people could end up costing lives, experts first want certainty that, in a real-life setting, it indeed brings the benefits we expect, based on what was shown in the trials.
Clinical trials found Mosquirix to be both safe and effective, providing 39% efficacy at preventing clinical cases of malaria over the course of a four-year trial. While this is low for a vaccine, it is worth remembering that given the large number of people at risk, providing protection in just four out of 10 cases could still go a very long way. Moreover, since there can be more than one episode per child, the trials found that the vaccine prevented on average 1,774 cases of malaria per 1,000 children.
However, what happens during the controlled setting of a clinical trial does not necessarily translate into a real-world situation, and here lies the concern.
To begin with, Mosquirix requires four doses. That’s a lot for a vaccine. What’s more, trials suggest that its already low efficacy is further reduced if the fourth dose is not administered, down to about 28% protection against clinical malaria and reducing its impact on severe cases of malaria to nearly zero. That is worrying because, typically, the more doses required of a vaccine the higher the dropout rate.
It then becomes a question of how reliably the vaccine can be administered – and, again, Mosquirix presents challenges. To achieve maximum effect, it should be given to children from five months, with the fourth dose given around the age of two. This is out of sync with the typical immunisation schedule for children in poorer countries, who are brought in for routine vaccination when they are six to 14 weeks old.
That doesn’t mean it can’t be done. In light of how big a priority malaria is for these countries they may well indeed make it work. After all, we have seen this happen with the human papillomavirus (HPV) vaccine, another much sought after vaccine for developing countries, which is given to school-age girls to prevent cervical cancer.Delivering the vaccine will require unprecedented efforts to inform and mobilise people to bring their children to health clinics at the prescribed time to complete all four doses. But, with many of the countries in question already struggling to improve routine immunisation rates, it remains to be seen how reliably four doses of Mosquirix can be deployed.
But even if high coverage can be achieved, there is still a danger that news of the vaccine will give people a false sense of security and lead to a reduction in the use of other malaria interventions, which would be tragic. Insecticide treated bednets and anti-malarial medicine have already led to a 37% global decrease in malaria cases since 2000, and a 60% decline in the malaria mortality rate.
Mosquirix is no magic bullet and at best may prove to be a useful complementary tool in reducing malaria, but only one of many already being used.
All this combined is why the WHO has been so cautious, recommending that we proceed with just a few demonstration projects in three to five settings, and involving around 1 million children. This is a sensible approach; it is due diligence. With so many lives at stake, it is critical that we shed more light on these unknowns, so that we fully understand the impact of this vaccine before, or even if, we should make it more widely available.
Dr Seth Berkley is CEO of Gavi, the vaccine alliance. Dr Mark Dybul is executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria
The world's first vaccine against malaria should be rolled out in limited 'pilot' demonstrations in Africa, an advisory group to the World Health Organization (WHO) in Geneva said on 23 October. The demonstrations — involving up to 1 million children — are needed because the vaccine is ineffective against malaria unless children receive four doses spread out over 18 months, and even then offers only modest protection.
“If we can’t get four doses of this vaccine into children, we’re not going to be using it,” Jon Abramson, a paediatric infectious disease specialist at Wake Forest School of Medicine in Winston-Salem, North Carolina, and chair of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, said in a press briefing.
The decision to recommend the vaccine pilots — which the WHO’s director-general is expected to formally endorse in November — follows 28 years of development by the London-based drug firm GlaxoSmithKline (GSK) and other backers including the Bill & Melinda Gates Foundation in Seattle, Washington; together they have spent US$565 million on the drug.
Imperfect results
“I think the reason they’ve gone forward with the pilot is that there’s nothing else available right now,” says Adrian Hill, a vaccinologist at the University of Oxford, UK.The imperfections of the vaccine, called RTS,S, are well known: trials in more than 15,000 children, who were followed for up to four years in seven countries in sub-Saharan Africa, found that a series of four shots reduced the number of malaria cases by only 36% in young children, and by 26% in infants1. Still, even its modest effect could be significant because malaria kills nearly half a million people annually, most of whom are children in sub-Saharan Africa, and all other candidate vaccines are in much earlier stages of development.
The advisory group recommended a series of 3–5 pilot demonstrations in areas with medium to high incidence of malaria, involving up to 1 million children in total. These will reveal whether parents bring their children back for all four doses of the vaccine: without the final dose, RTS,S provides no more protection against malaria than do controls, Abramson said.
The pilots will also investigate safety issues associated with the vaccine, such as the potential to develop meningitis. They are needed to ensure that precious funding is not wasted, he said. “If this vaccine is not effective and we use it widely, we have spent a ton of money where it could be better placed.”
The demonstrations could start in 2016 and are expected to last 3–5 years. As data roll in, SAGE will review its position: a final decision on whether to recommend deploying the vaccine more widely could come during this period.
Seth Berkley, head of Gavi, the Vaccine Alliance, in Geneva, Switzerland, says that his organization will soon decide whether to help pay for the pilot demonstrations. Gavi has in the past supported similar pilots to determine the feasibility of delivering other vaccines in resource-poor settings.“It certainly is possible that the board will say yes to this, but there’s no guarantee,” says Berkley.
Resource crunch
Even if the WHO does eventually recommend the vaccine for widespread use, it is not clear what the uptake would be. Although African malaria-control officials welcome RTS,S, they say that they would need more funding to deploy the vaccine. Budgets for malaria prevention and treatment using measures such as insecticide-treated bed nets and artemisinin-combination therapies are already stretched thin.
Speaking to Nature before the WHO announcement was made, Philip Rosenthal, a malaria researcher at the University of California, San Francisco, said that the vaccine was exciting, but added, “I am worried that the WHO’s approval will be misinterpreted, and lead decision-makers to shunt resources away from other malaria-control measures.”
GSK says that it will charge $1–10 per shot, covering the company's manufacturing costs and a return of 5%, to be re-invested in new vaccines for malaria or other diseases common in the developing world. But on top of the price of the shots, funding will also be needed to deliver them to children and for programmes to disseminate information.
“One challenge is to be sure that mothers understand that their children can still get malaria even with the vaccine, so that means their children must continue to sleep under bed nets,” says James Tibenderana, development director at the Malaria Consortium in Uganda. It is also important for parents to know that when their children have a fever, they must still go for a malaria test, he says.
The vaccine is composed partly of a fragment of circumsporozoite (CS) protein, which is found on the surface of the parasite. Those who are immunized with RTS,S — sold as Mosquirix — build up some immunity to malaria.
But different parasites have slightly different CS proteins — and the study showed that fewer than 10% of parasites infecting some 5,000 children in the trials matched the CS protein sequence in the RTS,S vaccine. If the vaccine could be re-engineered to include bits of several surface proteins, it would be more effective, says Dyann Wirth, an infectious-disease researcher at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, who led that study.
That re-development could take years, however, although some researchers have been discussing the possibility, according to David Kaslow, who oversees the vaccine’s development at the non-profit health organization PATH. “It’s not trivial to tweak the vaccine to match the prevalent strains in an area,” he told Nature, “but it’s not impossible.”
Hill says that SAGE’s decision to pilot the vaccine sends the right message to other researchers. “Stopping this dead would have been a very bad signal,” he says. “What the field needs is other players to come forward and accelerate their more modern vaccine candidates toward licensure.”
