Malaria: Uganda and Rwanda battle misinformation and lack of education in race to roll out vaccine

On Thursday Simon Loput’s two-year-old daughter Jane became ill with a fever. As soon as possible the young father and his wife rushed to a nearby hospital in Uganda’s northern Nabilatuk District where their worst fears were confirmed: Their toddler had malaria. Simon’s ability to react quickly had come from experience, the mosquito-borne disease has plagued his community for generations.

“My daughter is improving now but it’s still frightening. Our hospitals are not very comfortable as there is very little space in the wards,” he told The Independent via video call. “It’s also disturbing in terms of money because sometimes the medicines in the hospital are not enough, so I had to spend a lot to buy the drugs my daughter needs.”

The day before tragedy struck the Loput family, the World Health Organisation (WHO) approved the rollout of the world’s first malaria vaccine in sub-Saharan Africa and other areas with moderate to high levels of transmission. Known as RTS,S, or Mosquirix, the vaccine was developed by GlaxoSmithKline (GSK), a British pharmaceutical company headquartered in London. In development for over 30 years, the efficacy of RTS,S is low at 39% and only acts against P. falciparum – the most dangerous malaria parasite globally. Nonetheless it’s a significant step towards eradicating a disease that caused more than 409,000 deaths in 2019, the majority of which were children under five.

Growing up, Simon contracted malaria several times, memories which still conjure fear in the 34-year-old. It took the life of his childhood friend who lived next door. The schoolboy contracted the disease while his parents were away and by the time he was taken to hospital it was too late, he died a few hours later. “There were many malaria deaths,” says Simon, “you could never get used to it, it was always very sad.”

Now news of the vaccine has brought a ray of hope to the Nabilatuk District. Uganda has the third highest rate of malaria cases globally and the eight highest mortality rate from the disease according to the Severe Malaria Observatory. Although it will be some time before it’s rolled out, parents like the Loputs hope it will drive down the personal costs of malaria treatment and ensure their children’s education continues uninterrupted – treating malaria can take anything from a few days to a few weeks depending on the severity.

Still, vaccine hesitancy remains a key concern for many working in the field, especially after the levels of misinformation in circulation amid the coronavirus pandemic. RTS,S is not one jab, it’s four: each to be givenover a specific period once a child turns five months old. In Kampala, the capital of Uganda, Dr James Tibenderana, Technical Director for the Malaria Consortium, believes messaging is key. “The erosion of trust between communities, health practitioners and governments has been so extensive throughout the pandemic, extra work will have to be done to reassure people that this new vaccine is safe and is not aligned with coronavirus misinformation”, he says.

Talks between the African Union and the WHO to determine when RTS,S will become widely available began shortly after the announcement on Wednesday. The cost of each dose is not yet clear although GSK has said it’s committed to producing 15 million doses annually at no more than 5% above the cost of production.

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Over 500 kilometres south of Kampala, in the Rwandan capital Kigali Divin Murenzi, 23 D, recalls the disbelief his family experienced when his younger brother contracted malaria three years ago. “He came home from school saying he felt bad. We said he must be tired and that he should go to bed. We didn’t even think it could be malaria”, he told The Independent. Alain, the brother, survived but Divin says this life-threatening disease needs more attention. Growing up in Rwanda’s western Rubavu district, misunderstandings about the severity of malaria were rife. “Of course people hear about malaria, but they don’t know the dangers of it. This vaccine is a good thing, it’s going to protect our communities, but we also need to work on education,” he added.

UNICEF estimates that every two minutes a child under five dies of malaria. Coronavirus lockdowns and fears of infection have also worsened the situation for those experiencing symptoms over the past year and a half. National governments already fighting for access to Covid-19 vaccines now have to allocate time and resources to rolling out RTS,S. GAVI, the vaccine alliance, will consider in December how to finance the vaccine programme.

On that timeline Dr Tibenderana estimates that Ugandan children should start to receive RTS,S in the third quarter of 2022. But he is keen to highlight the vaccine will only be the first step in a much longer journey towards eradication of the disease due to its complexity.

“This is an important game changer, but in terms of malaria elimination we need a more efficacious vaccine that really can block transmission. Either that or some more work on gene-drive mosquitoes,” he says.

In the Nabilatuk District, Simon believes his community is ready to banish malaria to the pages of history. “Just like anything new there can be some hesitancy, so we have to give people time, but I think once people are reassured about the malaria vaccine, they will be okay with it.”