Nigeria’s malaria vaccine supply threatened as financier withdraws

Nigeria’s plan to kick off malaria vaccination by the first quarter of 2023 could fail as the Bill and Melinda Gates Foundation, the biggest financier of the project, has withdrawn financial support for an initial batch of donation to African countries.

The decision to withdraw support is due to concerns that the efficacy rate of the vaccine is lower, expensive and tougher to handle the logistics to deliver, Philip Welkhoff, the Gates Foundation’s director of malaria programmes said, according to the Associated Press.

Despite spending over $200 million and several decades pushing the vaccine to market, Welkhoff said it was no longer sustainable to inject more funds in a project that will not address the short-term supply constraints.

The vaccine, sold by GlaxoSmithKline as Mosquirix, is about 30 percent effective and requires four doses.

The patent transfer was made between GSK and the Serum Institute of India, which is the largest vaccine manufacturer in the world, for prompt manufacturing to meet the demand.

Gavi, the Vaccine Alliance has secured more than $155 million to support the introduction, procurement and delivery of the malaria vaccine for Gavi-eligible countries in sub-Saharan Africa.

At least four countries including Nigeria have officially expressed interest in vaccines but Ghana, Kenya and Malawi will be the first three to get the supply.

The federal government has set up processes to ensure that Nigeria is among the first to receive the supply, which is expected to be limited due to initial high demand, Perpetua Uhomoibhi, national coordinator of National Malaria Elimination Programme told BusinessDay earlier in April.

She said the government was working with development partners to develop a framework that will guide the introduction of the vaccine and ensure it is integrated into the current childhood immunisation programme administered from six months of age.

“If we’re trying to save as many lives with our existing funding, that cost-effectiveness matters,” Welkhoff said, saying the decision to quit support was made years ago after deliberations, including whether the fund would be better spent on other malaria vaccines, treatments or production capacity.

In terms of production, the foundation is worried that GSK can only produce about 15 million doses per year until 2028 when at least 100 million doses are required yearly to protect about 25 million children born in Africa every year, according to estimates by the World Health Organization (WHO).

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Welkhoff, however, said the Gates Foundation would maintain support for Gavi, the Vaccine Alliance, which is investing nearly $156 million into making the shot initially available in three African countries: Ghana, Kenya and Malawi.

“We’re supporting the roll-out via the Gavi funding, but we decided we would not dedicate additional direct funding to extend the supply of the vaccine,” he said.

Observers are worried that the move discourages others who are considering financing the malaria vaccine or even be a disincentive for people working on other vaccines.

Those familiar with the process say combining the vaccine’s use with other measures, like distributing drugs during malaria’s peak season could dramatically reduce cases and deaths.

Based on the WHO’s estimate, the malaria vaccine can significantly reduce child illness and death from malaria, and save an additional 80,000 African children annually.

Alister Craig, dean of biological sciences at Liverpool School of Tropical Medicine, lamented the lack of alternatives, saying the next vaccine likely to be approved will come in about five years. And even though BioNTech, the producer of Pfizer COVID-19 vaccine, plans to apply the messenger RNA technology it used for the coronavirus to malaria, the process is still in its infancy.

Although malaria prevalence in Nigeria declined from 42 percent in 2010 to 23 percent in 2020, the disease is still endemic in the country. Nigeria accounts for 27 percent of the global malaria cases and 23 percent of global malaria deaths based on the 2020 World Malaria Report by WHO.

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