vaccination and prevention in Kenya and the DRC

This disease kills one child every minute in the world and Africa is the most affected by this disease. Our correspondents in Kenya and the Democratic Republic of Congo describe to us how the authorities and NGOs are trying to stop this scourge.

In 2022, the World Health Organization (WHO) estimates 249 million cases of malaria and 608,000 deaths from malaria in 85 countries. This Thursday, April 25, 2024, World Malaria Day, the Correspondents’ Club is leaving for Africa. The region alone accounts for 95% of deaths worldwide linked to this disease transmitted by mosquitoes.

In Kenya, it caused 12,000 deaths in 2022, according to the WHO. The country is participating in the pilot phase of a vaccine against malaria, more than 400,000 children have already been vaccinated. The authorities have decided to extend vaccination to more regions. But specialists warn that it remains a complementary tool for prevention.

The Democratic Republic of Congo is the second country most affected in the world by the parasite transmitted by mosquitoes. According to the Severe Malaria Observatory, malaria caused 70,700 deaths in 2022 in the country. Discussions are underway to introduce a vaccine validated by the WHO, in the meantime, NGOs are doing curative and preventive work.

Kenya: “There is no miracle solution in the fight against malaria“

The pilot phase of a malaria vaccine was launched in 2019, in Kenya, Ghana and Malawi, in children under 5 years old. According to the WHO, initial results show a 13% drop in malaria-related mortality among children. In Kenya, it has been deployed in counties where the disease is endemic, around Lake Victoria in the west of the country. It is accessible free of charge. More than 400,000 children have already been vaccinated and in these regions, health facilities say they have seen a considerable drop in hospitalizations for severe cases of malaria in children.

In 2023, Kenya has therefore decided to extend vaccination to more regions. However, specialists emphasize that it remains a complementary tool to prevention, such as the use of mosquito nets or insecticides. “There is no miracle solution in the fight against malaria”according to Willis Akhwale, special advisor to the End Malaria Council, a Kenyan public-private partnership in the fight against malaria. “A whole set of measures is necessary. Yes, the vaccine helped reduce the number of serious forms in children who received it. But the question to ask is: when these children grow up, what form of malaria will they have? African countries must continue to conduct their studies and monitor developments before the vaccine can be said to be a silver bullet.”he explains.

A new mosquito arrives in cities

Despite all its efforts and the rollout of the vaccine, a new mosquito worries authorities in Kenya. IThis is Anopheles stephensi, a malaria vector, native to Asia. It was spotted in two regions of northern Kenya in late 2022. It is worrying because it risks bringing malaria to urban areas which are currently spared. Currently, malaria-carrying mosquitoes in Kenya proliferate mainly in rural areas. Anopheles stephensi thrives in cities. However, the populations in these cities, notably Nairobi, are not exposed to malaria, therefore not immunized and could develop serious forms.

This new mosquito could therefore threaten the fight against malaria even though Kenya had managed to reduce its prevalence nationally from 11% in 2010 to 6% in 2020. Particularly because the government regularly organizes mosquito net distribution campaigns and insecticide spraying.

DRC: difficult access to care and lack of medical staff

According to the Severe Malaria Observatory, the number of confirmed malaria cases in 2022 in the Democratic Republic of Congo is 29,300,000. The number of presumed deaths in the same year is 70,700. The Democratic Republic of Congo is on the second top of the podium of the countries most exposed to this disease transmitted by mosquitoesThis is for various reasons. Firstly structural, with a large part of the population living in rural areas, the road is often long to reach health centers. This leads to a delay in diagnosis and therefore in treatment. Then there is the lack of medicines and tests, due to their difficult delivery to areas often lacking paved roads.

But there is also the economic barrier, care is often too expensive for one of the poorest populations in the world. And, another determining factor, “We must also raise the availability and level of competence of the health personnel who are on the front line in terms of care. If you do not have adequate or sufficient personnel in the structures, this strongly impacts the quality of the supported”according to Doctor Louis Albert Massing, medical coordinator at Médecins sans frontières (MSF). According to the doctor, the climate and the environment are also determining factors, with highly humid and wooded areas favoring the proliferation of mosquitoes.

“Drawing lessons from pilot countries“before introducing a vaccine

Discussions are underway to introduce one of the two vaccines validated and recommended by the WHO. But in February 2024, the Vaccine Alliance and WHO communicated that “the DRC wants to learn lessons from pilot countries to guarantee a successful introduction on its territory”. In the meantime, NGOs, like MSF, are doing curative and preventive work with different communities, particularly in at-risk areas. “We are developing preventive actions that have an impact on the multiplication chain of pathogens, with larvicidal actions, with indoor spraying and sanitation of the environment and homes”explains Doctor Louis Albert Massing. And all this is done in support and in partnership with the Congolese Ministry of Health.