When Eugene Andoh was told that the National Malaria Elimination Programme had set in motion a plan to eliminate malaria in the country, he beamed, made the sign of the cross, and declared, “This must be big news to me. It is something that I have always prayed for.
“I lost my twin brother to malaria when we were just over a year old. I have seen pictures of the two of us, and there are times I missed him a lot,” Andoh explained.
Growing up, malaria made him “paranoid,” he said, and throughout his life, he has taken every available precaution to avoid it. “But growing up at Takoradi, there was no way I could avoid it.” Takoradi, a harbor city in Ghana’s Western Region, is malaria-endemic. “I can only be thankful to God that something is being done about it,” he added.
Setting high targets for success
In 2022, Ghana recorded over 5.2 million confirmed cases of malaria, with 151 malaria-associated deaths, according to the NMEP’s strategic plan document.
That’s already a staggering improvement from 2012 when Ghana recorded 2,799 malaria deaths. There are other signs that Ghana is on the right track: the countrywide prevalence rate – which measures the total number of cases divided by the total population – declined from 27.5 percent in 2011 to 8.6 percent in 2022.
Confirmed malaria cases per 1,000 people dropped from 192 in 2019 – the year Ghana began rolling out the world’s first malaria vaccine as part of the three-country pilot program – to 159 just a year later.
Under the new strategic plan, the NMEP is aiming high, targeting a 90 percent reduction in malaria mortality by 2028, using 2022 as the baseline. They also plan to reduce malaria case incidence by 50 percent by 2028 and eliminate malaria in the 21 districts considered to have a very low malaria burden by 2028.
However, Dr Keziah Malm, Programme Manager of the NMEP, said that the strategy’s target does not amount to “a full-nationwide elimination. Rather, we have zoned the country into areas with very low and high malaria [rates]. We are doing this in stages, and so we call it a sub-national elimination.”
“We will continue to do all we have been doing as a country to fight malaria. In addition, for the areas that we have marked as ‘very low’ and ‘low,’ we will carry out surveillance on the parasite,” Dr Malm said, adding that the organization has added two districts with very high malaria burdens to surveillance plans for 2024.
The NMEP also intends to implement seasonal malaria screening in areas including Upper East, Upper West, Northern Savana, and Oti. The screening activities were intended to last four months during the high transmission season, but due to extended rains, they have been extended by another month.
Rolling out the elimination program
The elimination program is being implemented alongside introducing malaria vaccination for children. Ghana, Malawi, and Kenya are part of the Malaria Vaccine Implementation Program (MVIP), which kicked off in May 2019.
John Bawa, Chief of Party of the global health organization PATH, which is working with the NMEP, said, “The malaria vaccine is currently deployed in seven out of the 16 regions, covering all 93 districts in these regions. Central, Volta, Oti, Upper East, Ahafo, Bono, and Bono East regions.”
Bawa said Ghana started rolling out the revolutionary jab, commonly known as RTS,S, in a phased manner and has, to date, deployed over 1 million doses. Each child receives four doses of the vaccine, beginning at six months of age.
Dr Kwame Amponsa-Achiano, Program Manager of the Expanded Program on Immunization, part of the Ghana Health Service (GHS), said that in 2023, “We were able to reach a lot of children with malaria vaccines in regions such as Central and Bono East, with RTS,S-1 coverage rate of 101,029 children, representing 87 percent, and 44,663 children representing 92% respectively. At the district level reach, most of the children were vaccinated in Awutu Senya East – 11,293 children, representing 98 percent. [In] Gomoa East, 10,684 children, representing 87 percent, and Atebubu-Amanten, 5,622 children representing 95 percent.”
Dr Amponsa-Achiano confirmed that the vaccination is already showing an impact. “The vaccination has contributed to reducing all-cause mortality among eligible children by 13 percent, [with a] 22 percent reduction in hospitalized severe malaria cases, and 17 percent reduction in hospitalization with a positive malaria test in the pilot countries (Ghana, Malawi, and Kenya).
“In Ghana, under five-mortality due to malaria is generally on a decreasing trend across the vaccinating districts since 2019. Similarly, under-five malaria admissions have reduced in the [vaccine] implementing regions, especially in Bono and Central regions. This is within the context of other malaria elimination interventions that are concurrently being deployed, such as bed-net use and seasonal malaria chemoprevention,” he added.
As all these efforts continue, basic issues threaten to hobble transformative progress. Professor Tsiri Agbenyega, head of the Malaria Research Group of the Kwame Nkrumah University of Science and Technology (KNUST), said, “We are not going to eradicate malaria unless we solve our water and sanitation problems.”
Meanwhile, the elimination strategy itself depends on available resources, according to Dr Malm. She said the NMEP will ask its partners, including USAID, for support. They will also appeal to the private sector to help the program.
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Main photo: Malaria vaccination and control exercises in Buduburam in the Gomoa East District of Ghana. [The Global Fund/Nana Kofi Acquah]
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The article was first published in VaccinesWork.