As the world prepares to mark World Malaria Day on April 25, what is the situation with malaria around the world and in Ghana right now?
Malaria continues to be a disease of significant public health importance, even more so in sub-Saharan Africa which contributes the highest burden of malaria disease and death. Ghana is no exception, and in fact we are one of 11 countries with the highest burden of malaria in the region. Malaria is still the number one cause of out-patient visits in the country. However, on the bright side, we are starting to see a reduction in the number of deaths at our health facilities.
When it comes to malaria, children under the age of five and pregnant women are the most affected, and in Ghana we have more children under the age of five dying and falling ill due to malaria than in other age groups. Among the general population, everyone is at risk in Ghana, but some regions see a higher burden of malaria. In the past, we used to see the highest burden in the northern regions, but now we’re seeing it more in the western regions. I think this shift is probably because we’ve put in more interventions in the north where we’re seeing a reduction in the burden of malaria.
This World Malaria Day also marks the two-year anniversary of the pilot introduction of the RTS,S malaria vaccine in Ghana. What have you seen in communities regarding the malaria vaccine?
Vaccine introduction is going on in the targeted regions, and we’ve seen a gradual increase in uptake of the vaccine.
Although uptake of the vaccine is somewhat below our target—we are at about 70% of uptake of the first dose—it’s progressing steadily. One of the challenges with the malaria vaccine is making sure that parents come back for the fourth dose, when the child is two years old. The other challenge is that in Ghana, we’re seeing hesitancy towards vaccines in general, linked to a fear of the unknown and a fear that vaccines might contain something they are not supposed to.
As with other vaccines in the country, the Ministry of Health is carrying out continuous education and sensitization of caregivers and other decision-makers, to encourage uptake.
What’s been the most memorable part of being involved with the roll-out of this vaccine?
I still remember when we gave the first dose; that was quite memorable! We had to go through several hurdles to get to that point, and it was great to finally see the vaccine being rolled-out.
As a public health physician, I know that vaccines can have a positive impact on disease. They can be easier to administer and lead to greater compliance than other preventive methods. For example, once you give a vaccine to someone there is very little expected of the person to do afterwards in order to get the needed results – unlike distributing insecticide-treated nets when you need people to sleep in them before you get the results. So as a malaria programme manager, I am happy to have an efficacious vaccine to promote.
How is the COVID-19 pandemic affecting malaria prevention and control efforts in Ghana?
The COVID-19 pandemic has had both positive and negative impacts on our work.
On the positive side, it led us to realize we could do things differently and still do them well. We moved several meetings and trainings online, for example, which saved us financial and human resources.
But there have been some negative impacts as well. When COVID-19 started, schools were closed down in Ghana, which interfered with our plans to distribute insecticide-treated nets through schools.
For some time, it was also more difficult to implement some of our interventions that require physical contact, including seasonal malaria chemoprevention for children under the age of five. In some parts of the country, access to computers and the internet, as well as computer literacy, can be difficult, so we had to find ways to organize in-person trainings and meetings, but in smaller groups and with appropriate personal protective equipment and that cost us more.
Human resources were also a challenge. Some health workers fell sick with COVID-19, while others had to devote their time to fighting the pandemic, leading to other health areas being neglected. Most of us were called to support the fight against COVID-19. In my case, for example, I led the contact tracing in Ghana. All hands were on deck, but eventually we ensured that the work of malaria control was undertaken.
What strategies have you used to manage some of these challenges?
Thankfully, the National Malaria Control Programme of the Ghana Health Service was able to put in place measures to make sure that COVID-19 didn’t significantly cause us to veer off our set targets and objectives for the year. In some cases that involved shifting to virtual meetings, organizing smaller, socially distanced meetings, changing the dissemination of information from group gatherings to use of community microphones. We put in place preventive protocols and found ways to ensure that the work could continue.
We also constantly engaged with, and advocated with, our superiors to ensure we had the resources we needed. We also engaged with communities to help them understand that despite COVID-19, malaria had not gone away, and that if we did not act, people would die from malaria. In many communities, we used personal address systems to send out information about malaria and about on-going interventions they could take advantage of.
To me, the key thing is to have a plan in place for how you manage other diseases in the face of COVID-19, or in the face of future emerging diseases.
What are your priorities for the malaria vaccine as part of malaria control over the next year?
For me, the priority is to learn whether the vaccine is effective when given as part of routine immunization and whether the safety signals in the phase 3 trials are something we should worry about. If the data show that the malaria vaccine is helping to further reduce the burden of malaria, then it’s something we’ll be happy to push for.