Medical Care Development, Inc.

A novel, vaccine-centric program for sustained malaria elimination in Africa

Infectious and parasitic diseases

A targeted intervention strategy using a novel vaccine and current control methods will eliminate malaria from Zanzibar and Bioko islands, developing strategies for continent-wide application.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Malaria killed >450,000 people in 2018, mostly children in Africa. Zanzibar and Bioko represent two African island populations at different stages of malaria elimination: Zanzibar has 85%. However, in both locations, malaria retains its foothold due to constant re-introductions from mainland populations. This project aims to demonstrate that malaria elimination is possible in Zanzibar and Bioko by using targeted strategies to implement drug treatments, mosquito control and use of a new malaria vaccine, and to control malaria in mainland sites identified as the sources for seeding malaria onto the islands. This ambitious project will strengthen current health infrastructures ensuring long term stability. Elimination of malaria will serve all community members and release health ministry funds for other programs. The program will serve as a model for future Africa-wide deployment of this targeted, integrated implementation approach to malaria elimination.

Problem Statement

In 2017, malaria caused 219M clinical episodes and 435,000 deaths worldwide, and was responsible for $12B GDP loss in Africa [3, 9]. This was the third consecutive year with no decrease in morbidity and mortality despite ~$3B annual investment. About 90% of deaths were in Africa. In Zanzibar and Bioko, over 1.5M people are at risk of malaria; young children and pregnant women are particularly vulnerable. These islands are malaria microcosms of a continent containing over 1.3B people. Until now effective and sustained elimination has been impossible. Zanzibar has reduced cases to ~800 p.a. in a 1.3 M population; these cases result from constant reintroduction from mainland Tanzania. Building upon excellent progress by the Zanzibar Ministry of Health, we will treat and vaccinate households where a case of malaria is identified. We will track back to the mainland to where this individual has visited and/or lives, and undertake intense focal malaria control there, culminating in treatment and vaccination, stopping reintroduction at the source.Malaria prevalence in Bioko is ~10% in a population of 250,000, but with prevalence =1% in some locations; most infections are largely attributable to importation from the mainland where transmission is very intense. Here, the strategy will be to identify and treat individual cases, and introduce vaccination to the ongoing control program on Bioko Island, but because tracing to mainland households will be impossible, we will supplement island activities with control (drugs and possibly vaccines) at the border for travelers to and from mainland Equatorial Guinea.

Solution Overview

We will demonstrate that a unique new tool, a malaria vaccine, combined with new and existing strategies can be used to eliminate malaria from Zanzibar and Bioko. We will target malaria cases, and uniquely identify mainland “source sites” that are responsible for seeding malaria to “sink sites” on the islands, and target treatment and prevention activities at the source and sink sites and during travel between the two. We will implement use of a malaria vaccine (PfSPZ Vaccine) to prevent malaria infection. This new tool will supplement treatment and prevention measures to interrupt malaria transmission. This unique approach (targeting the sources of infection away from the site of detection plus preventing malaria at both ends with PfSPZ Vaccine) will reduce and then eliminate malaria risk for >1.5M people living in Zanzibar and Bioko, and establish new and flexible control and elimination algorithms for health ministries in Africa. Success will be the decline and then sustained absence of malaria in selected geographical locations, measured using standard malaria diagnostics in cross sectional surveys and during visits to healthcare facilities. All results will be subjected to external monitoring and data will be published in international peer reviewed journals. Success will also be measured in terms of uptake of the new approach into the three ministries of health involved in the project and the ability over the final year of the project to scale up the work at the two locations and at other sites in Equatorial Guinea, Tanzania and other countries in Africa.

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