MCD Inc.

Malaria Control and Elimination

Bioko Island Malaria Elimination Program (BIMEP)

Country: Equatorial Guinea

Funders: The Government of Equatorial Guinea, Marathon Oil, Noble Energy, Sonagas, GEPetrol and Atlantic Methanol (AMPCO)

Implementing partners: Ministry of Health and Social Welfare, Republic of Equatorial Guinea; Ministry of Mines and Hydrocarbons, Republic of Equatorial Guinea; Sanaria Inc.; Swiss TPH; London School of Hygiene and Tropical Medicine; Liverpool School of Tropical Medicine; Texas A&M University; George Mason University Department of Global and Community Health; University of Washington School of Medicine; University of Washington Institute for Health Metrics and Evaluation; Ifakara Health Institute; University of Southern Maine Department of Computer Science

Duration: 2019-2025 (2020-2025 funding currently pending)

The Bioko Island Malaria Elimination Project (BIMEP) is a natural fusion of two long-standing anti-malaria programs in Equatorial Guinea, with MCDI as the lead implementing partner:

  • The Bioko Island Malaria Control Program (BIMCP) was established in 2004 to use mostly mosquito control approaches to control malaria on Bioko Island. The BIMCP began with high coverage of Indoor Residual Spraying (IRS) of insecticides to kill malaria-transmitting mosquitoes, and later supplemented with distribution of long-lasting insecticide treated nets (LLINs), entomological monitoring, malaria diagnosis and treatment, and a robust monitoring and evaluation system that includes GIS mapping of all households on Bioko Island to track interventions and cases. With these interventions, the BIMCP has been responsible for driving down malaria prevalence on Bioko from over 45% prevalence in 2003 to the current 12.5%, as measured in 2-14 year old children, the group with the highest prevalence rates on the island, and reducing infant mortality by 85%. This impressive success has plateaued over the last few years, and the need for an additional malaria control tool has long been recognized.
  • The Equatoguinean Malaria Vaccine Initiative (EGMVI) was established in 2013 to test the safety and protective efficacy of whole sporozoite (SPZ) malaria vaccines in Equatorial Guinea (EG) aimed at controlling Plasmodium falciparum (Pf), the deadliest of the five malaria parasites infecting humans and by far the most prevalent malaria parasite on Bioko Island. These live, attenuated, whole SPZ vaccines were strategically identified as the key additional malaria control tool needed to completely eliminate malaria from Bioko Island. Manufactured by the US biotechnology company Sanaria Inc., PfSPZ-based vaccines are the most promising of all candidate malaria vaccines under development, and are the only such vaccines with the safety record and the technical profile appropriate to the need. To develop Sanaria’s leading vaccine candidate, PfSPZ Vaccine (radiation-attenuated PfSPZ), the project needed to establish from scratch all facets of a research program required to conduct clinical studies up to Phase 3 compliance. The EGMVI therefore has established clinical research capacity in Equatorial Guinea by developing personnel, infrastructure, regulatory processes, ethical review, a clinical laboratory and a national research institute, all of which form critical building blocks for the next clinical studies.

These two important components – malaria control and PfSPZ Vaccine development have now come together as the Bioko Island Malaria Elimination Program (BIMEP), building upon years of impressive progress and with the ambitious aim of elimination malaria from Bioko, a region that was once ranked amongst the highest locations in Africa for malaria transmission.

The BIMEP is charged with a very ambitious, two step long-term objective that is unique for a sub-Saharan African country in the malaria heartland in the modern era: to develop and implement a realistic, evidence-based program for malaria elimination from the capital city Malabo and for all of Bioko Island. This first step leads to the much more ambitious and challenging second objective of controlling and eliminating malaria from the Equatorial Guinea mainland, where the grip of malaria has been worsening since 2015, according to the WHO World Malaria Report.

The main activities of the BIMEP include:

  • Continuation of the highly effective vector control, surveillance, case management, and social behavior change communication activities of the BIMCP
  • Implementation of a Phase 3 trial to support licensure of the PfSPZ vaccine (beginning January 2020)
  • Implementation of a Phase 4 trial aimed at measuring public health impact of mass vaccination in combination with optimized malaria control program, measured by a cluster randomized trial of the island
  • Island-wide immunization, using a step-wedge approach that will evolve into a full implementation and control program
  • Vaccination program established to protect travelers from the mainland of Equatorial Guinea who travel to Bioko Island, reducing malaria importation
  • Establishing an ongoing surveillance program to flag imported malaria cases

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