Bill & Melinda Gates Foundation

That Hole in Immunization Cards in Tanzania? It Must Go

October 20, 2011

Each passing day, hundreds of mothers line up at clinics all over the country to take their young children for life-saving immunizations. The list of vaccines they receive is long. Polio, tuberculosis (BCG), measles, and the pentavalent vaccine—diphtheria, pertussis, tetanus, Hepatitis B, and Haemophilus influenza type b (DPT-HB-Hib).

The coverage is also impressive.

According to the 2010 Tanzania Demographic and Health Survey report, at least 96 percent of all children in the country received these vaccines. It is very uncommon today to hear of a child who has died because of polio or diphtheria or, for that matter, who has contracted such diseases.

The last polio case in Tanzania was reported in 1996, which means the disease is becoming rare or is almost gone.

It’s only when you study the immunization card that you see the big hole.

You don’t have to adjust your reading glasses to see that there is no malaria vaccine on the list.  It is not by mistake. We don’t have a malaria vaccine. Yet malaria is the number one killer among children in Tanzania, contributing to more than a third of all deaths of children below five years of age.

Kwanini hakuna chanjo ya malaria—Why is there no malaria vaccine?

This is the question mothers – indeed thousands of people – are asking in Tanzania. And this is the same question scientists and the malaria research community have been grappling with over the past two decades. Finally, and for the first time in the history of our war against this deadly scourge, there is hope.  

Scientists at GlaxoSmithKline Biologicals, in collaboration with the PATH Malaria Vaccine Initiative (MVI) and African researchers, are in the final stages of testing the world’s most advanced malaria candidate vaccine, RTS,S. A large Phase III trial of this candidate involving 15,460 infants and children  is being conducted at 11 sites in seven African countries, including Tanzania.

Major funding for clinical development comes from a grant by the Bill & Melinda Gates Foundation to MVI. The vaccine candidate has demonstrated a potential to cut by half episodes of the disease, and provide substantial protection for young children and infants in areas hardest hit by malaria.

The first set of results from the Phase III trial of RTS,S have just been released and they show the malaria vaccine candidate to provide young African children with significant protection against clinical and severe malaria with an acceptable safety and tolerability profile.

The final analysis will be done in 2014 and, if all goes well, Tanzania and the world may have the long-awaited malaria vaccine as early as 2015.

With promising signs there is light at the end of the tunnel, Tanzania must prepare for informed and sound decision-making about the possible role of a future malaria vaccine. 

Yet history is not in Tanzania’s favour when it comes to changing policy upon the availability of a new product. For instance, it took almost a decade to change malaria treatment policy from Chloroquine (CQ) to Sulfadoxine-pyremethamine (SP).

A similar lack of action could lead us to the same sad experience, costing millions of lives and hefty amounts of money. 

There is no sense in waiting years to make decisions about the use of malaria vaccines when our policy leaders should begin these deliberations now, in time to act if - and when- this promising malaria vaccine candidate becomes available.

This time, we have an opportunity to do it right and prepare ahead of time.

The Tanzania Food and Drug Authority, the National Malaria Control Program, the Expanded Programme on Immunization, the Medical Stores Department, scientists, technocrats—all stakeholders— should put all hands on deck and work together to prepare our systems and sort out finances, logistics and distribution, today.

The bottom line: if a malaria vaccine becomes available tomorrow, we need to be ready.

We are closer than ever to fixing that hole on our child immunization cards. Thousands of Tanzanian lives are at stake.

Let the conversations begin – and let’s hold our elected officials and other policymakers accountable for sound and timely decisions, even before a vaccine is formally approved for use in our country. Our children are begging us to do no less.

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