In Moïssala, in the Mandoul region in the south of the country, the Chadian health authorities and Médecins Sans Frontières teams are conducting an innovative malaria prevention campaign this year. The R21/Matrix-M™ malaria vaccine has now been added to the seasonal malaria chemoprevention (SMC) programme that is conducted each year. The aim is twofold: to better protect children and, through a comparative study, to determine the most effective approach to deploy these new tools in the fight against malaria on a large scale in areas with high seasonal transmission.
Malaria mortality dropped by nearly 50% in the early 2000s, thanks to faster diagnostic tests, better availability of treatments, and the development of prevention programmes such as SMC and the use of insecticide-treated mosquito nets. However, mortality remains extremely high, especially among young children in Africa. According to the latest WHO malaria report, nearly 600,000 deaths were caused by malaria in 2023, with Africa remaining the most affected region, accounting for 95% of deaths. Among the victims, 76% were children under five years old.
Severe forms of malaria can lead to critical conditions, anaemia, coma, seizures, respiratory, liver and kidney complications, and in the long term, potential impacts on cognitive development.
Dr. Kouchakbe Manikassé, director of Moïssala Hospital
The paediatric unit of this district hospital sees “the number of children needing hospital care multiply by four or five each year during the seasonal peak,” which lasts from June to October.
The introduction of two malaria vaccines, recommended by the WHO since late 2023, has brought promising prospects in the fight against this scourge. The RTS,S and R21 vaccines are now part of malaria control efforts in around twenty African countries, including Chad. They are given in four doses to children from five months of age and act against P. falciparum, the most widespread and deadly malaria parasite. In clinical trials, both vaccines reduced malaria cases by more than 50% in the first year after vaccination. The R21 vaccine even reduced the number of cases detected through rapid diagnostic tests by 75%* in areas with high seasonal malaria transmission where SMC was provided. According to Élodie Aché, mother of two children aged five months and two years, this new vaccine “is a very good system.” She says, “Several members of my family have had malaria, including my two children. Children with malaria have seizures, and we have to go to the health centre to treat them.” How to roll them out more widely under real-life conditions is now a major challenge.
To address this, the Chadian health authorities and MSF are conducting a study in Moïssala. By combining the administration of the R21 vaccine with SMC this year, teams are comparing this strategy with the integration of R21 into the routine immunisation programme (EPI). The goal is to assess the effectiveness in terms of reducing the number of cases, as well as vaccination coverage, adherence to the vaccination schedule, acceptability, operational feasibility, and cost-effectiveness of the two approaches.
Combining SMC and vaccination in a single campaign could help improve coverage for the third dose and the booster dose, providing optimal protection during the rainy season.
Dr. San-Maurice Ouattara, MSF epidemiologist (Epicentre)
While vaccination can be a game changer, other prevention activities and access to rapid diagnosis and treatment remain essential in the fight against malaria. The SMC and vaccination campaign began in Moïssala in June and will run until October. Last year, it reached around 145,000 children.
*Source: WHO
