How many lives could be saved by a working malaria vaccine?
Data visualisation demonstrates how a new malaria vaccine could significantly reduce mortality rates.
Malaria has largely been eradicated around the globe but the disease remains endemic in Africa. Of the 54 countries, only two — Morocco and Algeria — are considered malaria free. The World Health Organisation (WHO) estimates that there were 249 million malaria cases globally in 2022 and 608,000 malaria deaths in 85 countries. Of these, 94% of the cases (233 million) and 95% (580,000) of malaria deaths were in Africa.
Because of their low immunity, pregnant women and children under 5 are disproportionately affected, as well as travellers from countries that have never been exposed to malaria. In fact, 80% of all deaths in the region were children under 5.
Such a high disease burden and mortality rate raise doubts about our progress toward achieving Sustainable Development Goal (SDG) Target 3.3. This target aims to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, while also combating hepatitis, water-borne diseases, and other communicable diseases by 2030.
For a long time, the hope of eradicating the disease has largely rested on finding a vaccine. Other prevention strategies like using insecticide treated nets have failed to reduce the disease burden significantly.
In January 2024, a new vaccine with an efficacy rate of 36% was rolled out in some countries.Leveraging our expertise in developing actionable data for crucial health issues through the Outbreak project, we embarked on analysing data to forecast when Africa and the world might achieve freedom from malaria. Recently, Code for Africa has been instrumental in supplying essential data and visualisations to enhance knowledge and support decision-making processes.
This includes a cholera project, where data and visualisations were provided to give knowledge and aid decision-making on the 2018 outbreak in Tanzania; and Outbreak which is a platform with data analysis seeking to improve data-driven decision-making by providing a set of interactive tools and data journalism that provides actionable insights into epidemiological factors, healthcare system factors, demographic vulnerability and access to WASH and basic services. Assets from both projects were used by journalists in their various works here, here, here for cholera as well as stories and fact-checks for Covid-19.
Before we look at the numbers, we need to give a few disclaimers. According to the World Malaria Report 2023, there are threats that are undermining gains in the global fight against malaria. These include climate variability which can impact the behaviour and survival of the malaria-carrying Anopheles mosquito; extreme weather events leading to increases in the transmission and burden of the disease; conflict and humanitarian crises; as well as resource constraints and biological challenges such as drug and insecticide resistance.
A working solution
To meet the 2030 target, a number of solutions have to align, some of which are malaria chemoprevention, a new generation of dual-ingredient insecticide-treated bed nets, and a working malaria vaccine. WHO has recommended broad use of the RTS,S/AS01 malaria vaccine, and a second safe and effective malaria vaccine, R21/Matrix-M. RTS,S/AS01, has reduced early childhood deaths by 13% in Ghana, Kenya and Malawi.
Back to crunching the numbers, in January 2024, Cameroon rolled out a world-first malaria mass vaccine, offering the RTS,S vaccine free of charge to all infants up to the age of six months old. In early February, Burkina Faso became the second country in Africa to integrate the malaria vaccine into its routine immunisation schedule.
The malaria report notes that global malaria progress has stalled in recent years, and stresses that getting back on track will require major changes in the malaria response. One question would be: How many lives could be saved by a working malaria vaccine?
According to research done at the Center for Vaccine Development and Global Health, University of Maryland School of Medicine “the results of Phase 3 testing showed that among children aged 5–17 months who received 4 doses of RTS,S/AS01, vaccine efficacy against malaria was 36% over 4 years of follow-up.”
With the above in mind, we used data available to predict mortality numbers in a world with a working vaccine. According to the WHO, Ghana, Kenya and Malawi have delivered the malaria vaccine in pilot areas through the Malaria Vaccine Implementation Programme (MVIP) since 2019.
Based on this, we performed an estimation of the malaria-adjusted mortality rate assuming a hypothetical scenario where everyone in these three countries was vaccinated. This Malaria Adjusted mortality rate is obtained by subtracting the historical mortality rate and the estimated preventable deaths, which is calculated by multiplying the historical mortality rate and the vaccine efficacy (36% according to this clinical trial).
As a result, the chart above shows the lives that could have been saved if the vaccine was used, based on mortality rate data (deaths per 100,000) from 2010 to 2020 for the three countries mentioned. This means that in the last year of record (2020), the preventable deaths would have been 20 for Ghana, 3 for Kenya, and 14 for Malawi. Cumulatively, preventable deaths throughout the data period of 2010–2020, would have been 320, 35 and 162 per 100,000 for Ghana, Kenya and Malawi respectively.
From the above, we can see that a working malaria vaccine can save many lives. However, vaccines are not a silver bullet; only a combined strategy, that includes the use of mosquito-treated nets and medication will considerably reduce the number of cases and deaths.
Want to interface more with the Malaria data? Find it here.
This data blog was co-written by CfA DataLab project manager Emma Kisa and CfA DataLab data analystArame Thiam. The blog was edited and reviewed by CfA copy editor Kiprotich Koros, with CfA UI designer Sakina Salem as visualisation reviewer.
Code for Africa (CfA) is the continent’s largest network of civic technology and data journalism labs, with teams in 21 countries. CfA builds digital democracy solutions that give citizens unfettered access to actionable information that empowers them to make informed decisions and strengthens civic engagement for improved public governance and accountability. This includes building infrastructure like the continent’s largest open data portals at openAFRICA and sourceAFRICA. CfA incubates initiatives as diverse as the africanDRONE network, the PesaCheck fact-checking initiative, the sensors.AFRICA air quality sensor network, and the research and analysis programme CivicSignal.
CfA also manages the African Network of Centres for Investigative Reporting (ANCIR), which provides the continent’s best muckraking newsrooms with the newest possible forensic data tools, digital security, and whistleblower encryption to help to improve their ability to tackle crooked politicians, organised crime, and predatory big business. CfA also runs one of Africa’s largest skills development initiatives for digital journalists, and seed funds cross-border collaboration.
