By Emmanuel Abi Couson
Egypt is the latest country in Africa that has been certified malaria free by the World Health Organization (WHO), making them the fifth country in continent to achieve that feat after Mauritius in1973, Morocco in 2010 as well as Algeria in 2019. And Capo Verde, a tiny Island complete the list when it was certified malaria free by Who in February this year.
Malaria is transmitted throughout Nigeria, with 97% of the population at risk of malaria.
The duration of the transmission season ranges from year-round transmission in the south to three months or less in the north. Plasmodium falciparum is the predominant malaria species.
As Africa’s most populous country, Nigeria carries the highest burden of malaria globally, accounting for approximately 27% of the global malaria burden and 31% of malaria deaths worldwide.
According to the 2023 World Malaria Report, nearly 200,000 deaths from malaria occurred in Nigeria.
Children under five and pregnant women are the most affected, with a national malaria prevalence rate of 22% in children aged 6-59 months as of 2021.
In some regions, such as Kebbi State, this rate is as high as 49%.
Nigeria’s Federal Ministry of Health has been leading critical malaria control interventions, including the distribution of Long-Lasting Insecticide-Treated Nets (LLINs) and Seasonal Malaria Chemoprevention (SMC).
The introduction of the malaria vaccine marks another powerful tool in the country’s comprehensive strategy to combat the disease.
“The arrival of the malaria vaccine is a monumental step in our national efforts to reduce malaria morbidity and mortality,” said Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare. “With the support of UNICEF, Gavi, and WHO, we are on a path toward achieving our goal of a malaria-free Nigeria.”
The malaria vaccine, which requires four doses, will be administered to children under one year of age as part of Nigeria’s Routine Immunization schedule.
The first phase of the rollout will begin in Kebbi and Bayelsa States in November 2024, where malaria prevalence is particularly high, with over 800,000 doses set to be distributed during this phase.
In response to the malaria situation and to guide implementation, the National Malaria Elimination Program (NMEP) had earlier initiated the High Burden High Impact (HBHI) approach with technical support from the WHO and technical partners to address the malaria situation in Nigeria.
The current 2021–2025 National Malaria Strategic Plan (NMSP) is based on the vision of achieving a malaria-free Nigeria with a goal of reducing malaria morbidity to less than 10 percent parasite prevalence and mortality attributable to malaria to less than 50 deaths per 1,000 by 2025.
The Government of Nigeria secured credits from three multilateral banks (the World Bank, African Development Bank, and Islamic Development Bank) totalling $364 million to fund health sector interventions in 13 states of the Federation for five years (2020–2024) for malaria.
A high level ministerial meeting to end malaria in Nigeria was also held in May 2024 with key thoughts being greater use of new and current tools and increase in resource mobilization for malaria in Nigeria.
All these are efforts geared towards operationozation of the strategic plan which expires by next year. How far will the country have gone by 2025 will be measured after the Malaria Indicator Survey, but by benefit of hindsight I do not see us achieving anything significant.
Now with UNICEF and Gavi stepping in to providing the crucial roles of supporting the procurement and distribution of the vaccines, the country is assured of more resources and technical support.
The cost of vaccines, transport and administration are supported by Gavi and the Government of Nigeria, with UNICEF responsible for procurement and shipment, and working with WHO to support administration.
“This is a landmark moment in our collective mission to save lives and protect children from preventable diseases like malaria,” said Cristian Munduate, UNICEF Representative in Nigeria. “The introduction of this vaccine will be life-changing for millions of Nigerian families, especially in the regions most affected by malaria.”
Gavi, emphasized the critical role of global collaboration in the fight against malaria: “Malaria remains one of Nigeria’s and Africa’s deadliest diseases, taking the lives of hundreds of thousands of children under the age of 5 each year. Rolling out this vaccine, alongside the other powerful tools we have to fight this disease, represents a major step forward towards our goal of a malaria-free future. We look forward to working with the government of Nigeria, WHO, UNICEF, the Global Fund, civil society and other partners towards a successful rollout,” said Tokunbo Oshin, Director of High Impact Countries, Gavi, the Vaccine Alliance.
The malaria vaccine introduction aligns with Nigeria’s National Malaria Elimination Programme, which envisions a malaria-free future for the country. By combining the vaccine with existing interventions like LLINs and SMC, Nigeria is better positioned to make significant strides in reducing malaria transmission and deaths.
“We are confident that this vaccine in combination with other preventive measures will drastically reduce the burden of malaria in Nigeria and help us move closer to achieving the goal of a malaria free Africa” said Dr. Walter Mulombo, WHO Representative in Nigeria.
‘We look forward to working with the government of Nigeria, WHO, UNICEF, the Global Fund, civil society and other partners towards a successful rollout,” said Tokunbo Oshin, Director of High Impact Countries, Gavi, the Vaccine Alliance.
Looking Ahead The malaria vaccine introduction aligns with Nigeria’s National Malaria Elimination Programme, which envisions a malaria-free future for the country. By combining the vaccine with existing interventions like LLINs and SMC,
The Government of Nigeria receives funds for malaria control from the Global Fund, USs President’s Malaria Initiative and others. It has also secured loans from the World Bank, the African Development Bank, the Islamic Development Bank. The country has similarly been funded by DFID (now called Foreign, Commonwealth & Development Office (FCDO) as well as a number of nongovernmental players. Private sector companies in the extraction industry have also implemented malaria control programmes
Populations with low access to treatment. North Eastern Nigeria: Due to insurgencies and attacks on health workers, there are operational challenges for delivering malaria intervention services
Also rural communities: Some hard-to-reach rural communities require special measures (boats or camels) to access. Routine service is difficult.
From all these combine strategies of LLINs, SMC, vaccines as well as the plethora of technical and financial support for the fight against malaria in Nigeria… When will the WHO certify Nigeria free coupled with the fact that Dr Walter Mulombo, Who Representative in Nigeria could only say “We are confident that this vaccine in combination with other preventive measures will drastically reduce the burden of malaria in Nigeria”
