In the midst of intense preparations, Dr. Yao Kossia, Deputy Director of the Directorate for the Coordination of the Expanded Program on Immunization (DCPEV), stands poised before refrigerators holding precious vaccines, ready for deployment in the first districts.
We spoke to Dr. Kossia ahead of the launch to delve into this crucial initiative. She provides insights into the rollout of the new vaccine, communication strategies to inform the public, and the logistical and financial challenges facing the program.
VaccinesWork: Can you explain the magnitude of the malaria problem in Côte d’Ivoire, particularly in terms of incidence and mortality, and how this impacts families? What are the current prevention measures, and how will the new vaccine help improve the situation?
Malaria poses a major public health challenge in Côte d’Ivoire. Data from 2018 to 2021 shows an increase in incidence rates from 155 per thousand to regarding 300 per thousand in the general population, and even higher among children under five. In 2021, this figure reached regarding 600 per thousand for children under five.
Concerning mortality, particularly among children under five, estimates indicate over 1,000 children die of malaria in Côte d’Ivoire each year, averaging regarding 3 children per day. This underscores the urgent need to address this critical public health problem in our country.
« [Le paludisme] is a cause of school and work absenteeism since parents have to accompany their sick children. So, it is a loss of income. It is also estimated that households lose regarding 43% of their monthly income due to malaria.
– Dr. Yao Kossia, Deputy Director of the Expanded Program on Immunization of Côte d’Ivoire
Preventive measures have primarily centered on insecticide-treated mosquito nets, chemoprevention for pregnant women using sulfadoxine-pyrimethamine, and environmental sanitation, which are vital for vector control.
It is crucial to acknowledge the evolving resistance of vectors to insecticides in our country, with rates ranging from 25 to 80%. This resistance poses a significant challenge to malaria control efforts. This overview highlights the complexity of the malaria problem in Côte d’Ivoire.
It contributes to school and work absenteeism as parents must care for sick children, leading to income loss. Additionally, households are estimated to lose regarding 43% of their monthly income due to malaria.
The introduction of the malaria vaccine serves as a complementary intervention to existing measures, aiming to strengthen them and reduce the incidence and prevalence of malaria.
Can you tell us regarding the first steps in the introduction of the new malaria vaccine? Which districts are involved, how and when will children be vaccinated, and what is the schedule of doses? And most importantly, can you reassure us regarding the safety and efficacy of this vaccine?
We have chosen 38 high-incidence districts for the initial phase of routine introduction. This means the vaccine will be integrated into our regular vaccination program. At our health centers, along with existing vaccines, the malaria vaccine will be administered to children in these 38 districts.
The target group comprises children aged 0 to 23 months, although the vaccine is given starting at 6 months. As we launch the vaccination program on Monday, July 15, 2024, all children aged 6, 7, 8 months, and so on, up to 23 months, will receive the vaccine in four doses.
Kouyaté Aïcha holds her son Aboulaye, who received the first dose of the R21 vaccine as Côte d’Ivoire launched routine malaria vaccination. Prime Minister Robert Reugré Mambé, Health Minister Pierre Dimba and Gavi Executive Director Sania Nishtar were present.
Credit: Gavi/Miléquêm Diarassouba
The vaccination schedule involves the first dose at 6 months, the second at 8 months, the third at 9 months, and a final dose at 15 months. For children starting late, the schedule will be adjusted accordingly. However, we encourage mothers to bring their children early to complete the four-dose regimen by the age of 23 months. It’s essential to note that all four doses are necessary for effective protection. The vaccine is safe, effective, and free.
What means of communication are you putting in place to inform the population regarding the new vaccine once morest malaria? What message do you want to convey to parents?
Our communication strategy involves both mass media campaigns at the national level and localized communication initiatives in different health districts. We have briefed presenters at local radio stations, bloggers, online press outlets, and community leaders. These efforts aim to encourage widespread adoption of the vaccination program.
As we move forward, interpersonal communication regarding the vaccine will also be implemented in health centers. Malaria is a serious, well-recognized, and widespread disease. Therefore, we urge parents to trust health professionals. The vaccine has been used successfully in several African countries and is safe and effective. It is freely available, as are other vaccines. The cost of the vaccine is covered by the government and partners.
It’s important to highlight that new vaccines are often expensive. The government and partners are committed to making the vaccine accessible. Please make the effort to protect your child. The vaccine has proven effective in reducing severe malaria cases and mortality rates among young children.
What are the main challenges you face in rolling out the malaria vaccine, particularly in terms of district coverage and financing? And how do you ensure coordination and monitoring of the programme to ensure its success?
One primary challenge lies in programmatic implementation. As mentioned earlier, we are initiating the vaccination program in 38 districts out of a total of 113. This leaves 75 districts yet to offer vaccination. Considering the scale of our policy and communication efforts, we face the challenge of overwhelming other districts, sometimes leading to difficulties. To address this, we plan to raise awareness and incorporate remaining districts in a subsequent phase.
“If the government and partners have made every effort to make the vaccine available, make the effort to protect your child. The vaccine has proven effective in reducing severe cases of malaria and reducing mortality in young children.”
– Dr. Yao Kossia
The second challenge you raised is financing, which pertains to the overall immunization program. We receive significant support from Gavi, our major partner, and are preparing for a transition to self-financing following becoming eligible for Gavi support. To ensure continuity, we are developing plans and strategies for the State to take over funding. We are optimistic regarding achieving this transition, as various mechanisms are in place.
Arrival of malaria vaccines, unloading, temperature control and storage in cold rooms at DCPEV in Abidjan, July 12, 2024.
Credit: Gavi/Miléquêm Diarassouba
The expanded program on immunization has a robust coordination framework. The Interinstitutional Coordination Committee monitors EPI performance. When we begin vaccination, the committee will evaluate malaria vaccine coverage performance. Any challenges encountered will trigger recommendations to strengthen program performance on the ground. This robust framework ensures continuous monitoring of the intervention within the broader vaccination program.
How is funding for the new malaria vaccine secured, and what is the role of the various partners in supporting this vaccine?
As this is a new vaccine, we rely on Gavi’s support. Gavi covers part of the vaccine purchase cost, while the State of Côte d’Ivoire contributes the remaining portion. Additionally, operational costs, training, communication, and supervision are essential components, as this is a new intervention requiring adherence to guidelines. Gavi provides financial assistance to cover vaccine acquisition and operational costs.
Our other partners, including WHO, UNICEF, PMI (President’s Malaria Initiative), and others, provide technical support and mobilize additional resources. During budget development, Gavi and the State contributed, but gaps in funding emerged. These partners collaborated to secure necessary resources and fulfill their commitments.
Côte d’Ivoire Launches Routine Malaria Vaccination: A Conversation with Dr. Yao Kossia
At this very moment, in the very heart of this intense preparation, Dr. Yao Kossia, Deputy Director of the Directorate for the Coordination of the Expanded Program on Immunization (DCPEV), stands in front of the fridges containing the precious vaccines, ready to be deployed in the first districts.
We spoke to Dr. Yao Kossia ahead of the launch for a deep dive into this critical initiative. She sheds light on the details of the rollout of this new vaccine, the communication strategies to inform the population, and the logistical and financial challenges facing the program.
VaccinesWork: Can you explain the magnitude of the malaria problem in Côte d’Ivoire, particularly in terms of incidence and mortality, and how this impacts families? What are the current prevention measures, and how will the new vaccine help improve the situation?
Malaria is a major public health problem in Côte d’Ivoire. If I refer to the data for the period 2018-2021, in the general population, the incidence increased from 155 per thousand to around 300 per thousand, and among children under 5, it is even higher. In 2021, it was around 600 per thousand children under 5.
And speaking of mortality, I will focus on children under 5 years old. It is estimated that each year, more than 1,000 children die of malaria in Côte d’Ivoire, or regarding 3 children per day. So, you see that this is really a major public health problem for our country.
« [Le paludisme] is a cause of school and work absenteeism since parents have to accompany their sick children. So, it is a loss of income. It is also estimated that households lose regarding 43% of their monthly income due to malaria.
– Dr. Yao Kossia, Deputy Director of the Expanded Program on Immunization of Côte d’Ivoire
Until now, preventive measures were mainly based on the use of insecticide-treated mosquito nets, chemoprevention in pregnant women with the use of sulfadoxine-pyrimethamine, and also environmental sanitation, which really constitutes a measure to combat vectors.
To also understand the magnitude of the problem, it must be said that in our country, there is an evolution of the resistance of vectors to insecticides. We are talking regarding an evolution of 25 to 80%, while it is also a means of fighting malaria. This is to give an overview of the problem of malaria in our country.
It is a cause of school and professional absenteeism since parents have to accompany their sick children. So, it is a loss of income. It is also estimated that households lose regarding 43% of their monthly income due to malaria.
The introduction of the malaria vaccine will therefore come as a complementary intervention to existing measures to strengthen these measures and increase their impact on the incidence and prevalence of malaria.
