By Sam Mednick
For more than a decade, people in the small town of Nanoro in Burkina Faso haven’t had to travel far for good medical care. The village has one of the most robust diagnostic labs in the country, where residents have easy access to X-rays, blood tests, and treatment.
But it’s a rarity for a rural town in the impoverished West African nation to have electricity, let alone such a well-equipped lab. It’s only possible in Nanoro because of the vast investment in the country’s malaria programs and the town’s participation in years of vaccine trials.
“Before the implementation of the trial site people had to travel 100 kilometers [to the capital of Ouagadougou] to have lab exams, to have X-rays … [that’s] not good because you can die on the way,” said Halidou Tinto, director of research in parasitology at the Institute for Health Sciences Research in Nanoro and head of the vaccine trial.
While Tinto says the lab has saved countless lives, he wants everyone in Burkina Faso to have at least the same access to health care that people in Nanoro do and is hoping the success of the latest malaria vaccine will be part of the answer, allowing the government and donors to shift money from malaria to prop up other areas of the country’s fragile health system.
Earlier this month, the World Health Organization approved the use of the world’s first malaria vaccine and the first vaccine produced for any parasitic disease for children in sub-Saharan Africa and other at-risk regions.
The historic announcement has been more than three decades in the making and proved 40% effective in reducing cases of clinical malaria and 30% effective in reducing severe cases during pilot programs in Ghana, Kenya, and Malawi, where more than 800,000 children have been vaccinated since 2019. Two WHO global advisory bodies found the vaccine to be safe and a cost-effective prevention method.
The malaria vaccine could be a game-changer for Burkina Faso and its health system as the country is one of the 11 worst malaria-affected globally, according to WHO. Last year, at least ten people died daily from the parasite — nearly 4,000 people — according to Dr. Gauthier Tougri, coordinator for the country’s anti-malaria program.
“We have limited resources. … Malaria hides all other problems for the time being.”
— Halidou Tinto, director of parasitology research, Institute for Health Sciences Research in Nanoro
What little money is available for health — the government spent less than 2.5% of its gross domestic product on health care in 2018, far from the target of at least 15% established by the Abuja Declaration — goes to fighting malaria.
While combating malaria is a priority for the government and international aid groups, it’s left a gap in addressing other areas of health, such as building more clinics, fighting other diseases, training staff, and ensuring universal health coverage.
A lofty investment
Between 2015 and 2020, the government invested more than $77 million into malaria programs, more than any other sector of health, said Tougri. Last year 34% of the national budget was allocated for malaria, nearly double the amount five years before, he said.
This money is in addition to investments from international organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, one of the main donors for malaria initiatives in the country, which has invested approximately $508 million in malaria since 2002 — 60% of its total funding for the country, according to Lilian Pedrosa, senior portfolio fund manager for Burkina Faso at The Global Fund.
The funding goes to a variety of programs including prevention and awareness, increasing the use of mosquito nets, as well as training health staff, and purchasing laboratory equipment, according to Pedrosa.
An even more promising development than the recently authorized vaccine are results from another malaria vaccine trial currently in phase three, with an even higher efficacy rate. Developed by scientists at the Oxford University’s Jenner Institute, phase two of the trial showed a 77% efficacy rate making it the first vaccine to meet WHO’s goal of 75% against the disease.
According to Tinto, phase three trials are currently underway in Burkina Faso, Kenya, Mali, and Tanzania, and they could prove even more effective than the recently authorized vaccine. If so, another, more effective malaria vaccine could become available within years, added Tinto, who wants to push for the vaccine’s emergency use authorization after one year, similar to the authorization COVID-19 vaccines received from WHO.
Piggybacking on malaria
The government is trying to capitalize on the malaria investment to strengthen its health system where it can. Three years ago, the ministry began combining malaria campaigns with awareness for other diseases, in what it calls intensified integration efforts, explained Tougri.
“The other diseases don’t get enough funds, [so] we use malaria funds to sensitize [people] about malaria and other diseases [as well] … if not, we may overcome malaria, but tuberculosis or AIDS might continue killing more people,” said Tougri.
Last year when health workers gave children the seasonal malaria drugs, they also screened them for malnutrition, something that hadn’t been done previously, he said. This year, for the first time, the ministry is combining malaria awareness with nutritional screenings, as well as vaccinations for mothers and children, in three key regions, according to Tougri.
Leveraging resources for other health areas
For low-income countries that can’t invest in multiple sectors at once, health experts argue that well-funded programs such as malaria be maximized to strengthen other areas’ preparedness by sharing resources and technical support with other parts of the health ministry.
“Given how well funded, structured, and established the malaria program is, it could share some of its financial resources or seek to mutually implement certain programs with other health agencies. For instance, with public health emergency response structures,” said Donald Brooks, CEO at Initiative: Eau, a United States public health aid group focused on waterborne diseases. In exchange, the beneficiary agency could assist the malaria program in areas where it has competence, he said.
Collaboration is also key and would lead to a more effective response while strengthening other parts of the health system. It would be easier, however, if Burkina Faso’s health ministry wasn’t so political and hierarchical, because power, resources, and money are tightly guarded by each department and some might not be willing to share, Brooks added.
‘Malaria hides all other problems’
If malaria can be tackled and funds shifted elsewhere, it could help fill in existing gaps for HIV and tuberculosis, and contribute to building an adequate health workforce, said The Global Fund’s Pedrosa.
“Resilient and sustainable systems for health are necessary for accelerating progress toward universal health coverage, and they help countries fight new pandemics like COVID-19 and prepare for emerging threats to global health security,” she said.
The approval of this latest vaccine could reduce the number of severe malaria cases by a third, said Tinto, freeing up resources for other areas. For example, once malaria is dealt with, money should go to helping researchers develop simple, affordable point of care tests, for a range of other conditions and diseases such as dengue fever, said Tinto.
“We have limited resources and we have to choose some priorities,” he said. “Malaria hides all other problems for the time being.”