“June and July last year we recorded as high as 20–30 cases of malaria per day.” Richard, a clinician at Kabonwuli CHPS explains “ We’re now seeing 5 cases per day, some days, recently, there are no cases.” Kabonwuli CHPS is a health facility in the Northern Region of Ghana, which supports a district selected for the WHO pilot to administer the malaria vaccine in young children in high-risk settings.
Though prevention has reduced infection rates globally, malaria continues to be a primary cause of childhood illness and death in sub-Saharan Africa. There were 229 million malaria cases and 409 000 malaria deaths — more than half of which are among children under the age of 5 — globally, in 2019.1 About 40% of the world’s population is at risk of malaria, but 11 countries contribute most significantly to these statistics: one of which is Ghana.
A Game-changer in Malaria Prevention
In 2019, The World Health Organization (WHO) recommended use of the malaria RTS,S vaccine for children in high-endemic regions. The vaccine was first piloted in three countries, including Ghana. Within Ghana, the pilot was scaled up in four regions, with highest malaria infection rates. With Zipline operating in two of the prioritized regions, Ghana’s Health Service turned to Zipline to support distribution of the novel vaccine.
The WHO pilot proved several important factors in global scalability: the vaccine reduced more severe and fatal strains of malaria, it increased equity in access to malaria prevention (not everyone had access to a net, prophylaxis, etc. and some combination has a much more favorable safety profile), and the vaccine proved to be cost-effective in higher risk locations. The WHO approved the malaria vaccine for rollout in the highest-incidence locations in October 2021.2
Supply Chain Solutions Lead to Better Access to Lifesaving Products
Zipline launched in Ghana also in 2019. Our end-to-end supply chain solution, which began operating in Rwanda in 2016, expanded with investment from Ghana’s Health Service into the country offering medicine, vaccines and blood products on-demand. We quickly grew from two to stock six supply distribution centers serving 23,000 sq km diameter from each. Zipline covers the on-demand medical product and supply needs of over half of the country’s health facilities. Our more remote distribution centers are our most instrumental: facilities without cold storage, and those farther from the regional medical stores rely on Zipline to deliver the medical products they need when they need them.
As our partnership with Ghana’s Ministry of Health grew, our reach expanded and so did our product list. Zipline warehouses, fulfills, manages inventories and delivers over 260 unique medical products, including malaria prophylaxis, treatment and vaccine products to the piloted districts. In January 2022, Zipline began adding the malaria vaccine into our supply chain distribution for certain eligible, or “high malaria risk” districts including Nkwanta North, Kadjebi, Krachi West, Krachi Nchumuru, and Biakoye. We procured malaria vaccines from national stores, warehoused the stock in refrigerators at one of our own six distribution centers (where we also stock malaria prophylaxis, nets, and treatment commodities).
Stock requests are sent from health workers at sites via whats-app, SMS or email. Zipline team members track all requests, package, and fly out what is needed, the products are delivered between 10 and 50 minutes from request.
Since we began operations in Ghana, we’ve delivered 70,000 malaria test kits and nearly 1.3 million courses of malaria treatment, on behalf of Ghana’s Health Service. In the last 5 months of supporting the piloted districts, we’ve been able to deliver about 5,000 malaria vaccines.
Many realize that though the vaccine isn’t the sole contributor, it’s boosted protection immensely to the disease.“There used to be a lot of malaria cases but now the [case loads] have gone down. We cannot outright ascribe it all to the RTS,S vaccines since there are other interventions at play here such as seasonal malaria chemoprophylaxis (SMC) and mosquito nets distribution.” says Emmanuel, a health facility manager at Oti EPI, discussing the pilot program and its outcomes.
While others working in these districts see a stark correlation between RTS,S and childhood malaria illness. Bismarck Waja of RTS,S pilot site Poase Cement Health Clinic elaborates “The most obvious impact of RTS,S vaccine for malaria has so far been reduction of incidence of severe malaria cases among children under five. Also, the vaccine played a significant role in malaria prevention as evidenced by the steady declining trend in reported and confirmed malaria cases among children under five since the introduction of the vaccine.”
Waja continues “ Before Zipline, we would go for [community-based] outreach programs and run out of vaccine supply. When that happens, we are unable to continue and some of the children end up missing their subsequent doses or having their follow-up doses shifted back. Clearly, that affects the effectiveness of the vaccine in those children. We had these incidents early in the pilot and we don’t anymore, because we are now able to rely on Zipline delivery to replenish even while at the outreach centers in the communities. We are now able to serve all the children to see the true effect of this immunization effort in this district.”
What’s next?
This targeted vaccine distribution inevitably reached the children in the highest-risk settings that it needed to reach to realize the impact and potential widespread use of a game-changing healthcare innovation. Globally, nearly 2.5 million doses of the malaria vaccine have been distributed to children. At Zipline, we’re committed to expanding reach of these vaccines to the children most at risk across the world.