Janet Ogundepo
As Nigeria on Thursday makes a significant step in its fight against malaria with the reception of one million doses of the highly anticipated R21 malaria vaccine from GAVI, the Vaccine Alliance, maternal health experts have said it is medically not advisable for pregnant women and lactating mothers to receive the vaccine.
The gynaecologists said the reason for the exclusion was because the clinical trials done to ascertain the efficacy and reaction of the vaccine were not carried out on pregnant and nursing mothers.
In separate interviews with PUNCH Healthwise, the experts emphasised that the vaccine is safe for non-pregnant women and that receiving it before pregnancy could reduce the risk of malaria infections during pregnancy.
To further reduce the high incidence of malaria diseases and malaria-related deaths, Nigeria on Thursday received one million doses of the malaria vaccine.
According to the United Nations Children’s Fund, Nigeria has the highest burden of malaria and accounts for 27 per cent of the global malaria burden and 31 per cent of deaths.
The 2023 World Malaria Report reports about 200,000 deaths from malaria.
Children under the age of five and pregnant women are mostly affected by malaria.
In 2021, a 22 per cent malaria prevalence rate was recorded in children aged six to 59 months.
According to the Federal Ministry of Health, malaria is associated with 11 per cent of maternal deaths and 70.5 per cent of morbidity in pregnancy in Nigeria.
PUNCH Healthwise reports that the World Health Organisation added the R21/Matrix-M malaria vaccine to its list of prequalified vaccines in December 2023.
In 2023, the WHO recommended the vaccine use for the prevention of malaria in children following the advice of the WHO Strategic Advisory Group of Experts on Immunisation and the Malaria Policy Advisory Group.
At the hand-over ceremony in Abuja, the Executive Director and Chief Executive Officer of the National Primary Healthcare Development Agency, Dr Muyi Aina, said, “The vaccine will be administered to children aged five months to 15 months as part of routine immunisation. Each child requires four doses, given at 5, 6, 7, and 15 months of age, to be fully protected. The introduction will be expanded to other states and integrated into our national routine immunisation schedule, as we receive additional doses.
“The second phase will target 19 States and FCT, while the third phase will target the remaining 15 States. Both phases are scheduled for 2025. To ensure a successful roll-out, we have established an elaborate cross-program coordinating mechanism that brings together key stakeholders and expertise in malaria and immunisation space at the national, and subnational levels.”
Prof Aniekan Abasiattai
In an exclusive interview with PUNCH Healthwise, a professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, noted that while the malaria vaccine had been proven to reduce infection rates in pregnancy when administered to women planning to conceive, it was not yet considered safe for pregnant women.
He said, “There are ethical issues when you have trials on pregnant women. In relation to pregnant women, what I know of unless it has changed since science revolves every day, the vaccine is still in its experimental stages. Whether it has now been certified safe to be used during pregnancy is what I am not sure of.
“However, I am aware that the PfSPZ vaccine during the various trials that were conducted has clearly shown to prevent malaria during pregnancy. I think it was administered to women aiming to conceive and when they followed these women through the course of pregnancy, it showed that it significantly prevented those women from coming down with malaria infections.
“So, if it does that, it would prevent the adverse effect of malaria both to the baby and the mother, including maternal deaths.”
He further noted that information about the time and gestation week that the vaccine would be administered was not available.
“Before vaccines can be administered during pregnancy, it has to undergo a certain amount of trials and it has to be proven to be safe before the various drug agencies and bodies recommend its use in pregnancy,” Abasiattai said.
He advised pregnant women to sleep under treated mosquito nets and ensured they protected themselves from mosquito bites.
Prof Chris Aimakhu
The Second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, Prof Chris Aimakhu, stated that the malaria vaccine would not be administered to pregnant women until trials have proven it safe.
“I am not aware that it has been given to pregnant women yet. At least, we haven’t started doing that in Nigeria,” the gynaecologist said.
He, however, noted that once the vaccine was confirmed safe for pregnant women, it could reduce maternal deaths caused by malaria.
“Malaria is still responsible for a huge number of women who have anaemia in pregnancy. It is responsible for women who are sick in pregnancy. So, if you have something that can prevent malaria, it is all well and good. But we are not giving vaccines for malaria yet. We are still giving the preventive anti-malaria drugs during antenatal,” the don said.
Aimakhu also advised women to sleep under insecticide-treated bed nets.
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