OPT-MVAC

The challenge

Malaria vaccination is being introduced across multiple countries in sub-Saharan Africa. Although it promises to save the lives of thousands of young children, delivering malaria vaccines poses significant practical challenges. In particular, four doses of vaccine have to be administered – more than for any other vaccine. Although some doses can be administered during clinic visits for other vaccines, additional visits must be scheduled at unfamiliar times, including during the second year of life. Additional efforts may therefore be needed to ensure that infants complete the schedule.

Given the major impact of malaria in affected countries, malaria vaccination has generally been welcomed by most populations. Efforts to increase coverage could be used to enhance uptake of other childhood vaccines, particularly those administered in the second year of life, such as the second dose of measles vaccine (MCV2).

The project

The OPT-MVAC project team previously worked on a project to increase the uptake of seasonal malaria chemoprevention (SMC) in areas where preventive malaria treatment is provided during months when malaria transmission peaks. Its approach was to use implementation research methodologies to identify and address practical barriers to the delivery and take-up of SMC.

In the OPT-MVAC project, the team is using a similar approach to optimise the delivery of malaria vaccination and to leverage these efforts to improve the coverage of other vaccines. It is focusing on countries in West and Central Africa where malaria is highly seasonal. Here, there is interest in intensifying malaria vaccination efforts ahead of the malaria season to maximise the number of children protected. These efforts also provide an opportunity to check children’s vaccination records and to provide catch-up vaccination when necessary.

The project will carry out an initial investigation to understand why caregivers have not had their children vaccinated against malaria. These insights will be used to design interventions to address key barriers and increase uptake, with a focus on intensification before the malaria season. The project will also draw on learnings from SMC programmes, which typically reach a very high proportion of households.

A household survey will be conducted at baseline to measure vaccine coverage and repeated after the intervention to assess its impact. In each country, activities will be coordinated by a locally led country steering committee. The project uses an innovative approach: providing small grants and technical assistance to national immunisation programmes to enable them to study their local contexts and introduce tailored interventions.

These activities will initially focus on year 1 of vaccination, before being repeated in year 2 of the vaccination schedule. In a subset of countries, the work will provide a foundation for measuring malaria vaccine effectiveness, while a detailed costing and cost-effectiveness analysis will be carried out in a further four countries.

Impact

The OPT-MVAC project will help strengthen vaccine delivery across a wide area of sub-Saharan Africa, which accounts for a significant proportion of the malaria disease burden. It will:

• Identify barriers and potential enablers of malaria vaccination.
• Place country teams central to activities so that solutions are tailored to local contexts.
• Strengthen implementation research capacity within national immunisation programmes, expertise that can be applied to other immunisation challenges.
• Strengthen connections within and between countries to promote the sharing of learnings.

With malaria still one of the biggest causes of child mortality in sub-Saharan Africa, and malaria vaccines known to reduce mortality by more than 10%, the project could save tens of thousands of lives a year by increasing vaccine coverage.