Introduction and rollout of malaria vaccines in Cameroon and Burkina Faso: early lessons learned
Authors: Adidja Amani, Franck Mboussou, Benido Impouma, Joseph Cabore, Matshidiso R Moeti
Journal: The Lancet Global Health (2024)

The prequalification of two vaccines against Plasmodium falciparum by WHO—RTS,S/AS01, approved in 2022, and R21, approved in 2023—represents a breakthrough in malaria prevention for the African continent. Of the global malaria burden, Africa accounts for 94% of cases and 96% of deaths, representing 233 million cases and 580 000 deaths in 2022.1WHOWorld malaria report 2023.https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023Date: Nov 30, 2023Date accessed: February 1, 2024Google Scholar Alarmingly, 78·1% of these deaths were children younger than 5 years. The pilot implementation of RTS,S/AS01 in Ghana, Kenya, and Malawi under the Malaria Vaccine Implementation Programme marked a major breakthrough in malaria prevention efforts. As of Feb 22, 2024, 20 countries in Africa have been approved by Gavi, the Vaccine Alliance, to receive support for malaria vaccine roll-out. Cameroon and Burkina Faso have introduced malaria vaccines into their routine immunisation programmes. Cameroon introduced the four-dose RTS,S/AS01 vaccine into its routine national immunisation programme on Jan 22, 2024, in 42 health districts that are most at risk of malaria in all 10 regions of the country. This first phase targets 249 133 children. As of Feb 19, 2024, over 12 000 children have been vaccinated with the first dose, representing 34·6% of the target population of the related period.2WHO Regional Office for AfricaIntroduction du Vaccin contre le Paludisme au Cameroun—rapport de situation au 07 Février 2024—tableau de bord sur l'Introduction du Vaccin contre le Paludisme au Cameroun (in French).https://worldhealthorg.shinyapps.io/cameroon_vaccine_deployment_preparedness/_w_a37e0e29/#tab-7004-1Date: Jan 22, 2024Date accessed: February 19, 2024Google Scholar Burkina Faso introduced the RTS,S/AS01 vaccine on Feb 5, 2024.3WHO Regional Office for AfricaBulletin d'information special introduction vaccin antipaludique RTS,S—7 Janvier 2024.https://www.afro.who.int/sites/default/files/2024-02/Newsletter%20Sp%C3%A9cial_Introduction%20vaccin%20palu%20RTSS%20au%20Burkina%20faso_Final_1.pdfDate: Jan 7, 2024Date accessed: February 9, 2024Google Scholar The vaccine is being rolled out in 27 prioritised districts in seven out of 13 regions. The target population is 248 986 children. As of Feb 20, 2024, 6557 children have received the first dose of the vaccine, representing 36% of the monthly target. Updated data on vaccination progress are provided on a weekly basis by the Expanded Program of Immunization with their partners, including WHO. Vaccine delivery was delayed in two regions (ie, the east region and the Sahel) facing security challenges, requiring the use of a special flight to transport the vaccines. The experience of introducing malaria vaccines in Cameroon and Burkina Faso yields valuable lessons for successful introduction in other countries. First, a commitment from national authorities at all levels, extending from the central to peripheral tiers, in addition to adherence to WHO's recommendation of fully integrating malaria vaccines into routine immunisation, is key. However, it is imperative to amplify risk communication and community engagement efforts beyond routine immunisation practices to stimulate vaccine demand. Second, early monitoring of readiness for malaria vaccine introduction is crucial, ideally commencing 12–18 months before the planned launch. The WHO African Region provided support, deploying 61 staff members for field grid mapping, and making strategic investments in data systems by developing a toolkit for readiness assessments, which was deployed in Cameroon. Burkina Faso received its initial malaria vaccine shipment on Dec 28, 2023, just 39 days before the official launch, posing constraints on the setup time for the WHO monitoring readiness tool. However, an interim mechanism of extracting data on malaria vaccination from the routine immunisation data system was established to allow weekly monitoring of the malaria vaccine uptake. Integrating malaria vaccine data management into routine systems and establishing an interim reporting mechanism for monitoring vaccine uptake in the initial months of introduction is advised, in addition to the readiness monitoring tool. Third, partnership is key to new vaccine introduction. The launch of the malaria vaccines in Cameroon and Burkina Faso had technical and financial support from partners, including Gavi and additional technical assistance providers. Coordination among partners is essential, ensuring support is provided in a synergistic manner. Introducing malaria vaccines is a chance to boost immunisation in Africa. Governments are urged to act on commitments, such as the Addis Ababa Declaration, prioritising universal immunisation, increasing investments in vaccines, and improving delivery.4WHO Regional Office for AfricaHistoric commitment from African heads of state to advance immunization in Africa.https://www.afro.who.int/news/historic-commitment-african-heads-state-advance-immunization-africaDate: Jan 31, 2017Date accessed: February 22, 2024Google Scholar The WHO Regional Office for Africa, through the Accelerated Malaria Vaccines Introduction and Roll Out in Africa initiative, pledges to provide a collaborative platform for partners, donors, and stakeholders to contribute collectively to the goal of eliminating malaria in Africa by 2030.5WHOGlobal technical strategy for malaria 2016–2030, 2021 update.https://www.who.int/publications/i/item/9789240031357Date: July 19, 2021Date accessed: January 30, 2024Google Scholar We declare no competing interests. We express gratitude to the Ministries of Health of Cameroon and Burkina Faso. The information used in this Correspondence can be obtained from the publicly accessible platform, worldhealthorg.shinyapps.io/cameroon_vaccine_deployment_preparedness/_w_a37e0e29/#tab-7004-1.