Marian Wentworth is the President/CEO of Management Sciences for Health (MSH). In this interview with Dateline Nigeria, she speaks on how the development of a Malaria Vaccine will help in efforts the combat the disease.
Dateline Nigeria: After decades of trials, the World Health Organization (WHO) has recommended a new malaria vaccine for children. How important is this development for Africa, especially Nigeria which has one of the greatest malaria burdens in the world?
Marian Wentworth: If I recall the statistics correctly, Nigeria represents more than a quarter of global malaria-related deaths. So anything about the importance of malaria means it is important to Nigeria, for sure.
I am extremely excited about the new vaccine. It’s been a longtime coming. Malaria is a very, very difficult target, because malaria is caused by a parasite, not a virus or bacteria. So it has been scientifically extraordinarily challenging to develop this vaccine, bit very, very excited that we finally have one.
It took so long to develop a vaccine for malaria, when you consider how rapidly a vaccine was developed to tackle COVID-19. Does this say something about Africa’s weak health infrastructure and its reliance on developed countries to fight major diseases affecting it? What is the lesson here?
I think the first lesson is the one that I referenced in my previous answer, which is that malaria, scientifically is a very difficult target. Targeting a parasite with different life stages and different biology, it is extraordinarily difficult and there were so many who said could not be done. Nonetheless scientists worked for many, many years to come up with a vaccine candidate and there are a few more in the pipeline that may come to fruition.
There is a second thing to remember about the covid vaccine and the speed with which they were produced, which is that they were going after a virus that is very closely related to other viruses that were already studied for years. On top of that there were more than a hundred vaccine developers who were working on the coronavirus because it was a global problem all at once that come on suddenly. And so there was a fairly sudden scientific response. Many, many and many of those vaccines are still not available or approved today.
So that tells you not only about the commitment to covid but it actually tells you about one other thing that is true about vaccines – part of the scientific process is random chance. Are you going to choose the scientific avenue that works or are you going to choose one of the dozens or hundreds that don’t work? That’s one of the facts of science that you cannot control the timing except insofar as you are willing to spend lots and lots of money that may never give you a result.
Estimates suggest that about $630 million dollars annually would be needed to vaccinate children in 41 malaria endemic countries. Where is all that fund going to come from?
Well the first question is how can we afford not to? The level of death and family loss, compounded with the impact on the economy of those deaths and those losses is inestimable. I can’t speak to the accuracy of that particular costing analysis, but certainly vaccinating across 40+ countries is a tremendous undertaking. There are several financing mechanisms that will help, and that includes GAVI has made a commitment to supporting the malaria vaccine as part of its rollout and there is WHO endorsement of the commitment. Governments themselves – where they are able – should also be extraordinarily committed to protecting, especially children who suffer particularly disproportionately from this disease.
While the discovery of a malaria vaccine has been described as a public health breakthrough, Africa’s weak health systems still pose the risk of diluting the prospect of eradicating malaria in the continent. What would be your advice to governments in the continent as they prepare to roll-out the malaria vaccine, especially reflecting on your experience with the roll-out of the COVID-19 vaccine?
Well, like the covid vaccine there are multiple public health interventions required to truly get to either epidemic control… and you know across the continent we worked hard on other strategies like treated bed nets, like seasonal malaria chemoprophylaxis in places where that makes sense, like malaria treatments, like protection for pregnant women, like vector control – culling mosquitos and keeping mosquitos from coming in – and now we add vaccines. I think it is extraordinarily important that we add vaccines to what is already tremendous commitment on the part of government, and on the part of donor organisations to combat this terrible disease. If you look, there have been some specific areas that have had the chance to eliminate malaria for periods of time, and there have been others that have tried but have not done that yet. It is my hope that adding the vaccine to our existing efforts will tip us over the edge and we will see far more parts of the continent controlling malaria.
It’s one thing to introduce the vaccine, and another to get it accepted. Isn’t there the risk that people would go for anti-malarial they’ve been using and which they find comfortable rather than trying out the vaccines? How do we mitigate against this?
I think the first thing to remember about vaccines or any intervention is we have to effectively communicate the relevance of the intervention to families, to parents, to communities at large. I have been perhaps a broken record or driving some people crazy by saying that we have failed to communicate until we talk to me in my language, about my context through some trusted advisers or somebody I trust. I think those three things are extraordinarily important in terms of communication – my language, my context. And let me say more about context: maybe I am pregnant, maybe I am thinking about getting pregnant or I am thinking about my wife having children, maybe I have immune compromise, people in my area, maybe I am taking certain kind of medications, we have to explain how the vaccine fits in with my life, and then the person who explains it probably can’t be Marian Wentworth sitting in Virginia, it has to be somebody I know to be trusted. And that may be a government leader, a scientist, a faith leader. The person that is trusted can be of many kinds of background. But again it is my language, my context from my trusted adviser.
You talk about faith leaders and others who are quite influential. So what are you doing to make them a part of this?
What is important for me, working from my global perspective is to reiterate what I said to you or to anyone I can. My language, my context from my trusted adviser. And those of us who address or examine phenomena that we call vaccine hesitancy recongise the importance of local leaders. Those of us who work on preparedness plan, like pandemic preparedness plan recognize the importance of local leaders. And MSH, when we work in a particular area it is very important for us to do a scan of key stakeholders – and that include local leaders – to bring them into the work we do, to learn from them, to start with what they know. This is part of our DNA, our core.