In this interview, we spoke to Dr. Akpaka Kalu, the World Health Organization's team leader for malaria in Africa, about the groundbreaking malaria vaccine rollout announcement.
Please could you introduce yourself and tell us about your role within the World Health Organization (WHO)?
My name is Akpaka Kalu. I am a physician and public health leader, and I am leading the team called Tropical and Vector-borne diseases for the WHO African region.
The WHO has an incredibly important role in communicating scientific information and advice to the public. How important do you think science communication is and how does this make a difference in terms of malaria?
We always say let science lead. Everything we do in public health must be based on evidence and this evidence comes from laboratories, institutions, and researchers.
In the case of malaria, anybody who knows a little bit of the history of the disease knows that the name itself is called mal'aria, 'bad air'. This is to say, initially, it was taught that malaria was caused by bad air. It was then science that showed that it is caused by a plasmodium parasite. That's the power of science.
It is science that has also been leading the discovery of medicines, and now a vaccine. It is science that led us to know that chloroquine was no longer effective and science that led us to artemisinin combination therapy. Science has been the center of malaria control, especially in Africa.
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Can you give an overview of malaria and why this deadly disease mainly kills babies and infants?
We call malaria or the mosquitoes small, but mighty. A little insect causes so much silent devastation. For instance, last Monday I was in the hospital and was tested for malaria. I tested positive and was put on anti-malaria treatment. Can you imagine malaria fighting back against the team leader of malaria in Africa? That is real. I am trying to bring out the devastation that malaria causes. I was traveling in Abuja, Nigeria when I came down with the disease.
In Africa every year nearly 400,000 people die of malaria. It is a silent epidemic and the worst part of it is that people regard it as okay. That it is okay that someone had malaria, and it is okay that someone died of malaria. No child should die of malaria… nobody should die of malaria.
Why? Malaria is preventable and malaria is treatable. So, the death of hundreds of thousands of children and pregnant women from malaria every year in Africa is an indictment of our health systems.
The deaths reflect our failure to prevent malaria and our failure to treat malaria effectively. Moving forward, everybody must commit to zero malaria which is why the theme of the antimalaria campaign globally is ‘Zero Malaria Starts with Me’. Why? Because I have to do my bit, and part of my bit is talking to you and spreading the information. You also have to do your bit.
Malaria is preventable and malaria is treatable. When we deploy the vaccine, it is because we know that malaria can be prevented through vaccination. Malaria can also be prevented by spraying homes with insecticides, sleeping under insecticide-treated nets, and taking some medicine as prevention. That is the message, and it is based on science.
Moving forward, everybody must commit to zero malaria which is why the theme of the antimalaria campaign globally is ‘Zero Malaria Starts with Me’. Why? Because I have to do my bit, and part of my bit is talking to you and spreading the information. You also have to do your bit."
Malaria has had a hold on humanity for years, especially in Africa where 94% of cases are found, but researchers have struggled to develop a vaccine. Why is this?
Malaria is a very complex disease. For instance, the malaria parasite at various stages of its development finds home in both mosquitoes and humans. So if you are developing a treatment, you face the challenge of deciding whether your treatment will target the mosquito or humans carrying the parasite. In the mosquito, the malaria parasite has different stages in different parts of the mosquito. In humans, the malaria parasite also has different stages in different parts of the body including the liver and the blood. The organism is very sophisticated.
Therefore, targeting the organism or producing a vaccine that is effective and can also target at the same time, the parasite in all different parts of the body is difficult. So, the difficulty has been the sophistication of the organism and coming up with a vaccine that targets the parasite concurrently at different stages of its development. But now we have one vaccine that is proven to prevent disease and prevent death. That is why we are committed to deploying it in countries.
It was announced that the RTS, S vaccine has been given the go-ahead to be rolled out across sub-Saharan Africa and other regions with high malaria transmission, what does this mean for science, child health, and malaria control?
The fact that we have a vaccine that has been proven to be effective for us, is a game-changer. We need to ensure that these vaccines are given to children in all moderate to high transmission areas of Africa, of course, subject to availability of supplies. That is the next stage of the work, we need to deploy the vaccine.
COVID-19 has taught us that we can deploy two, three, four vaccines at the same time so we look forward to the next generation of malaria vaccines. In fact, we look forward to even more efficacious ones, we will deploy them too. We will work with member states, with African countries to deploy these vaccines because we believe that a malaria-free Africa makes a malaria-free world.
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This huge milestone is also one step closer to ensuring health is fairer and more accessible to all. How else can the world collaborate and work together to ensure global health equality?
You know when we talk about malaria vaccines, we also talk about appropriate delivery mechanisms and delivery platforms. The RTS, S vaccine will be delivered in Africa through the routine immunization system- the immunization system is part of the national health system.
Treatment of malaria, testing, and treating people with fever, is also done through the national health system. So the health system is the prime platform for delivering health services, not just malaria.
Therefore, investing in strengthening these delivery platforms, investing in strengthening national health systems is also investing in malaria elimination. We must invest in strengthening national health systems in order to be effective in preventing malaria, and in delivering malaria interventions to those who need them be it vaccines or medicines, or indeed vector control interventions.
Over the last year, much of the world has been fixated on the COVID-19 pandemic, and so it is crucially important to continue to raise awareness for other infectious diseases such as malaria that continue to have devastating effects on the worlds most vulnerable populations. What more can be done to help people to pay attention to this disease especially in regions where malaria is not found?
You know COVID-19 hit and basically, the entire world didn't know what to do. Yes, public health actions were being taken slowly. We were learning about the virus, understanding it, and putting proper measures into place. That is what happens when there's a pandemic. But there is a synergy, there is a relationship between being prepared for the next pandemic, and delivering and managing endemic diseases like malaria, it is the same health system that is used for both responses.
Whether a country has malaria or not, surveillance is important, that's part of the health system. It is also important that we strengthen these systems to be able to pick up any disease, be it malaria or COVID-19, or COVID-like illnesses in the future. Countries that do not have malaria have to invest in strengthening their health systems and surveillance systems so that if someone travels to a malaria-endemic place and comes to your country that has no malaria, and becomes sick from malaria, you would be able to pick it up.
For instance, like myself, what if I had traveled to the UK that has no malaria, but I came down with malaria. Will the health system in the UK have been able to make the diagnosis that this is malaria and therefore pick it up and treat me, or do I run a risk of dying? Many have died because the health system did not think of malaria, but of course, that's why travel history is so, so, so important.
All countries are involved because we live in a global village. People travel, people who have visited malarious areas have visited your country. When you get a case of fever or cold, you test for as many infections as possible, especially if travel history guides you towards an infectious disease like malaria.
Please test it. We need national systems that are effective and efficient at detecting any disease, whether you have malaria or whether you are a country that has no malaria.
All countries are involved because we live in a global village. "
What impact has COVID-19 had on malaria?
We are actually very grateful to all the countries in Africa for preventing a catastrophe that we thought would happen with COVID-19. Yes, COVID-19 negatively impacted the delivery of routine health services, especially the first six months.
After that, countries adapted, countries took precautions, and countries reopened the delivery of routine health services, including malaria interventions. We were able to support countries in doing this.
Yes, last year there were probably increases in the number of cases of malaria beyond what was expected. But it did not go to the extent that we had projected, and for that, we have to thank the resilience of countries, leaderships of districts, and, even households in ensuring that they went for their malaria treatments or used their malaria interventions.
Health workers delivered especially in vector control interventions like nets, even during the COVID-19 pandemic. It was an extraordinary achievement, and we congratulate everybody for that in all malaria-endemic communities, districts, and nations.
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Do you believe that a world without malaria is possible in our future and what further research is critical to making this happen?
A malaria-free future is possible. We know this because between the years 2000 and 2019 we had over a 60% reduction in malaria deaths, thanks to the interventions. What we need now is perhaps new interventions that will drive down our curve further because we know that between 2016 and 2020, the curve flattened, the rate of reduction of malaria cases flattened out. Therefore, we believe that we need to work differently to have a different result and achieve the 2030 targets.
That will mean perhaps using technology, analytics, to target interventions, tailoring interventions to look at contexts, adopting problem-solving approaches, rather than using one size fits all, and looking at the distribution of the disease. Perhaps there are parts of each country we need to focus on. So, these are the things we are doing, supporting countries to stratify malaria and tailor interventions to local contexts. Of course, we need new interventions; there is a need for research and development of new insecticides, new medicines, and indeed of new vaccines.
We must remember, Zero Malaria Starts with Me, and starts with you."
Is there anything else you would like to mention?
Everybody has a role to play, especially people in malaria-endemic countries. We are asking for a comprehensive, whole society approach. Malaria is not just a medical problem, it is a socio-economic development challenge. Malaria causes stunting among those who suffer it at a young age. Malaria also causes poor progress in education. Of course, it also leads to death. So we need to work together.
If you are working in agriculture, for instance, that irrigation project changes the ecology. It potentiates the breeding of the mosquito that transmits malaria. Therefore, when developing agricultural projects, it is important to think of how to prevent the unintended impact it will have on increasing malaria transmission.
If you are involved in mining, how do we prevent the unintended consequences of open mining? Which is digging holes that mosquitoes breed in, and so on and so forth. The whole of society, the whole of the government engaging in malaria elimination is the way to go. Communities, of course, need to take charge of their own malaria problem.
Of course, with the support of the malaria leadership in the country, that is the route to go towards a malaria-free future. We must remember, Zero Malaria Starts with Me, and starts with you.
Where can readers find more information?
- To read more information on malaria, click here
About Dr. Akpaka Kalu
Dr. Akpaka A. Kalu – A public health practitioner with over 30 years experience leading health development and disease control in Africa. Dr. Akpaka Kalu holds M.PH and M.B.B.S degrees from the University of Lagos, Nigeria, and the University of Nigeria, respectively. 
He currently serves as the Team Leader for Malaria in the Africa Regional Office of the World Health Organization (WHO). Other leadership positions held by Akpaka in the past include: WHO Representative, South Africa; WHO Representative, Ethiopia; WHO/Africa Region Lead for malaria strategy, information and planning; WHO/Kenya Country Adviser on immunization and polio eradication; and Resident Coordinator, Nigeria Combating Childhood Communicable Diseases Project. In all of these positions, Akpaka left a trail of transformational leadership.
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