On the platform of the Kinkolé port, an hour’s drive from the center of Kinshasa, a chain of handlers are busy, in the April heat, transferring hundreds of insulated containers from refrigerated trucks to cold rooms. They will soon unload precious doses of the R21/Matrix-M vaccine, developed by the Oxford University laboratory, intended for the first ever malaria vaccination campaign that the Ministry of Health of the Democratic Republic of Congo ( DRC) announced for early July.
While two vaccines have been developed in recent years after more than thirty years of research, all of Africa is now engaged in a decisive battle by welcoming this new weapon into its arsenal to fight the disease. Transmitted by the Anopheles mosquito, the Plasmodium falciparum parasite killed 608,000 people worldwide in 2022, almost all of them on the continent, according to the latest figures from the World Health Organization (WHO). In the DRC, it is the leading cause of death.
After a pilot phase of the first RTS serum, S (Mosquirix) from the British laboratory GSK, which benefited Ghana, Malawi and Kenya between 2019 and 2021, as well as Senegal, Burkina Faso, Liberia, Niger, Sierra Leone and Cameroon, in particular, which launched their vaccination campaign in 2023 and in January.
“Response Calibration”
The DRC, where the number of malaria deaths is the highest after Nigeria with nearly 75,000 deaths in 2022 – more than three-quarters of which are children under 5 years old – was also the beneficiary of an allocation of 1.2 million doses out of the 18 million ordered by the GAVI Vaccine Alliance fund. But, faced with the observation that the cold chain was still undersized, Kinshasa had given up. “It would have been like putting a big pump in a small pipe because the change in scale that is coming is so important,” illustrates Doctor Hamed Idrissa Traore, head of the cold chain for Unicef.
“It’s also a question of the caliber of the response,” explains Matthew Grek of GAVI. The vaccine, to be at its maximum effectiveness, must be administered in four doses from the age of 5 months. For a country the size of Congo, this requires very significant planning and stocks with large capacities on the part of the manufacturer, which is the case of the Serum Institute of India (SII), which produces the R21/Matrix-M while Mosquirix is made in small quantities. Finally, it was not relevant to start with one vaccine and continue with another. »
“It’s a delay for the better,” explains Doctor Aimé Cikomola, director of the Expanded Vaccination Plan (EPI) of the Ministry of Health, “because the second vaccine has also demonstrated better effectiveness and will be less expensive. This is far from being a detail for us. » The country, which pays 20% of the order, must receive 630,000 doses of R21/Matrix-M manufactured by the SII by June, which began deliveries in May. “This will not cover the entire territory,” continues the doctor. But in 2025, we will ramp up. »
“The solution lies in the plane”
To decentralize the delivery and increase the storage of tons of vaccines that the country needs in order to ensure its routine childhood vaccination to which is added that against malaria, the health authorities have launched, with the financial support of the World Bank, WHO, Unicef and GAVI, in the construction of several storage sites: two hubs in cities that have an international airport that can directly receive deliveries without passing through that of Kinkolé , and three secondary warehouses. After the opening in 2021 of the platform in Kisangani, the large city in the north center located 2,300 km from Kinshasa by road, another is about to be completed in Lubumbashi for commissioning at the end of June.
“For the moment, it is still the Kinkolé hub, which supplies the 26 provinces by road,” reports Doctor Hamed Idrissa Traore of Unicef. But the network, very poorly developed, is regularly damaged by rain and floods. We therefore had a real logistical problem so that the vaccines maintained their maximum quality until the last mile. » National road 1, for example, which crosses the country from the south, linking the capital, in the west, to the large cities of Mbuji-Mayi (center) and Lubumbashi (east), is currently being repaired. “The solution therefore involves the plane, and perhaps one day also the river,” explains Doctor Idrissa Traore. Not exploiting this track in a country crossed by the enormous Congo River and its tributaries would be absurd! »
The doctor has just returned from Goma, in the east, where he visited the construction site of a secondary warehouse which should complete the territorial coverage of this country four times the size of France. The site, which is ultimately intended to also become a hub thanks to its international airport, is in addition to those of Bukavu (South Kivu) and Bunia (Ituri) delivered at the end of June which will reduce costs by 30%. , estimates Doctor Hamed Idrissa Traore.
Solar refrigerators
“Since the inauguration of the Kinkolé hub in 2018 until today, we have multiplied our net storage volume more than tenfold,” explains Jelly Cola, the logistician who manages the site on behalf of the PEV. And solar energy will allow us to improve the quality of electricity on which the quality of conservation depends. » The batteries of the Kinkolé platform must be renewed in the coming months to take advantage of the 600 m2 of solar panels installed on the large hangars. The stocks will then be dispatched to nearly 120 cold room branches, some of which can store the most fragile serums such as those against the Ebola virus, at -80°C, from where the vaccines will be sent by road to the 9,217 health centers. health, almost all of which are now equipped with solar refrigerators.
From the refrigerated truck to the pick-up to the motorcycle with coolers, the entire land fleet has therefore been reinforced to reach a population that is still overwhelmingly rural, living both in the tropical forest and the desert valleys. of Haut-Katanga or the Rift Mountains tempered by altitude – Mount Stanley, located in the Rwenzori massif, peaking at 5,109 m.
“This little revolution began in 2016, recalls Doctor Idrissa Traore, with a reinforced global agenda to ensure global immunization of populations whose interdependence has no longer been demonstrated since Covid-19. The fight against malaria benefits fully from this. »