Never mind the vaccine deniers, sceptics and conspiracy theories. Only a few days ago a surgeon in Manchester was struck off from the British medical practitioners register for claiming that the Covid-19 virus was a hoax and for his persistent anti-vaccination campaign especially against the mRNA vaccine on social media.
How ironic that the two scientists who developed the revolutionary new technology that led to the mRNA Covid vaccines, Professors Katalin Kariko and Drew Weissman then working at the University of Pennsylvania in the US, similarly a few days ago were jointly awarded this year’s Nobel Prize for Medicine.
Us mere mortals must navigate the complexities, prejudices, disinformation, vagaries and downright malice whether to get ‘vaxed’ or not, especially as the latest new Covid variant BA.2.86 with an unusually high number of mutations rears its head in several countries.
But then human ingenuity and capacity is such that distractions and disruptions, sometimes bordering on the delusional, are doggedly cast aside by evidence-led advances in vaccine technology, virology and transmission containment. Indeed, September was a defining month in pursuit of global good health, especially in breakthrough research and recommendations relating to vaccines to eradicate entrenched scourges such as malaria, dengue fever, TB and meningitis which continue to take their toll especially on vulnerable population cohorts in low-and-middle-income-countries (LMICs), including in South Africa.
Take for instance malaria. In 2021, says the World Health Organisation (WHO), an estimated 619,000 people, many of whom were children, died of a highly preventable disease.
The Covid pandemic in fact saw an upward trajectory in malaria deaths and in the incidence of cases to 247 million in 2021.The Global Technical Strategy for Malaria 2016–2030 (GTS) calls for reductions in malaria case incidence and mortality of at least 40% by 2020 compared to a 2015 baseline.
South Africa led a cohort of eight SSA countries that met the 40% case incidence GTS target in 2021. South Africa also reduced its malaria burden by 33.7%. The number of indigenous malaria cases in the country decreased from 4,463 in 2020 to 2,958 in 2021, albeit the number of deaths from malaria increased from 38 to 56.
The good news is that WHO recently endorsed the use of a cheap new vaccine, R21/Matrix-M, the second only Malaria vaccine after RTS,S/ AS01, developed by Oxford University.
"I used to dream of the day we would have a safe and effective vaccine against malaria, now we have two," stressed a jubilant Dr Tedros Adhanom Ghebreyesus, director-general of WHO.
While both vaccines are deemed to be equally effective, the key difference is the upscaling and cost. The new R21 vaccine costs US$2-4 per dose and the required course is four doses.
This is half the cost of the RTS,S vaccine. Already the Serum Institute of India, the world's largest vaccine manufacturer, has been lined up to produce 100 million doses a year, scaling up to 200 million doses.
According to Dr Matshidiso Moeti, WHO regional director for Africa, "this second vaccine holds real potential to close the huge demand-and-supply gap. Delivered to scale and rolled out widely, the two vaccines can help bolster malaria prevention, control efforts and save hundreds of thousands of young lives."
Indeed, the much-anticipated meeting of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) in September also recommended the go-ahead for two other new ground-breaking vaccines to combat dengue and meningitis.
The dengue vaccine named "Qdenga", tailored for children aged 6 to 16 living in dengue hotspots, says Kate O'Brien, Director of the Department of Immunisation, Vaccines and Biologicals at WHO, has the potential to shield youth from a significant public health menace.
Dengue poses a significant public health burden in endemic countries and is poised to increase further both in terms of incidence and geographic expansion, due to climate change and urbanisation.
The recommendation of the new Men5CV vaccine against meningitis, comes at a time when countries marked World Meningitis Day on October 5, to raise awareness of the disease and to assess the progress towards the Global Road Map to Defeat Meningitis by 2030 as approved by the World Health Assembly (WHA).
But the overriding consensus among health officials and NGOs concur that vaccines are central to the success of the Road Map. These include the Haemophilus influenzae type B (Hib), meningococcal A conjugate (MenA), and pneumococcal conjugate (PCV) vaccines, especially for the countries in the African meningitis belt.
Even in the absence of vaccines, progress is being made. In August, a clinical trial led by Professor Amina Jindani, Emeritus Professor of Tuberculosis Therapeutics at St George’s, University of London, found that a higher dose of the antibiotic rifampicin given for a shortened treatment time of just four months, compared to the standard WHO-recommended six months, was safe with no increase in side effects or toxicities.
“In the absence of an effective vaccine, I believe that making TB treatment as accessible as possible and reducing its duration from the current six months are our best options for eradicating the disease across the world," explained Professor Jindani.
TB has the highest death rate of all infectious diseases – above and beyond Covid-19. There are an estimated 10 million new cases of TB every year, with 4.3 million thought to be undiagnosed. The idea is to develop a more tailored approach to the treatment of TB based on disease severity.
While cultural, ideological and even libertarian sentiments together with efficacy and safety issues tend to dominate the headlines, the real challenge for effective implementation of global health coverage including immunisation are the issues of accessibility, equity and cost in particular for the LMICs.
We saw what happened during the Covid pandemic when new terminologies such as vaccine inequality entered the lexicon of global public health.
International health strategies and alliances at are meaningless if they are couched in the rhetoric of aspirations, pious platitudes and broken promises.
They need to be backed by pragmatic, realistic and sustainable funding structures with the requisite oversights, assessments, audits, monitoring and transparency especially in procurement. Covid-19 exposed both the ingenuity of humanity in doing good, but also its pernicious propensity to profiteering.
In the case of malaria, Gavi, the Global Vaccine Alliance, working with WHO and Unicef, is showing the way approving technical and financial support to roll out the new R21 vaccine to 18 countries, of which 12 will be in SSA, by mid-2024, and the RTS,S vaccine in early 2024.
Parker is a writer based in London
Cape Times