Malaria Control and Elimination

Bioko Island Malaria Elimination Project (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: 2019-2023

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 Project (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 Project (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

Recent accomplishments:

  • The Bioko Island Malaria Elimination Project (BIMEP) is a unique Public-Private Partnership between the Government of Equatorial Guinea (EG) and Noble Energy EG Ltd (a Chevron Company), Marathon Oil, and Atlantic Methanol Production Company (AMPCO) with the aim of eliminating malaria from Bioko Island (with a population of about 335,000). The project's major approach combines a series of integrated malaria control measures centered on indoor residual spraying, distributing long-lasting insecticide nets (LLIN), intermittent preventive therapy for pregnant women, malaria case management, epidemiological surveillance, vector monitoring, and social and behavior change communication. BIMEP is also supported in-country to research and develop through clinical trials a malaria candidate vaccine (PfSPZ Vaccine).
  • All the BIMEP malaria control interventions are provided free of charge to all residents on Bioko Island. Since 2004, the BIMEP has improved the socio-economic standards of the people in the communities, including:
    • 55% reduction in the malaria parasite prevalence in children between 2-14 years (from 45% in 2004 to 20.2% in 2020)
    • 63% reduction of all-cause mortality among children under 5 years old (attributed mainly to malaria interventions)
    • 92% reduction in severe anemia under five years old (from 15% in 2004 to 1.2% in 2020).
    • 97% reduction in the rate of transmission of malaria by mosquitoes on Bioko Island
    • 77% reduction in anemia and 68% reduction in parasite prevalence in pregnant women
    • To further reduce the burden of malaria from Bioko Island, BIMEP and its partners have received funding supports for research and development of a highly promising vaccine product to block malaria transmission in humans and mosquitos. The major innovation emerging from this project is the plan to complete the licensure of the PfSPZ Vaccine and integrate it into standard malaria control efforts, demonstrating that malaria elimination is possible for a large Sub-Saharan African population with extremely intense malaria exposure. The vaccine initiative has also completed four clinical studies, the establishment of a state-of-the-art reference laboratory to facilitate clinical research, and the recruitment and training of local capacity.
    • More than US$ 207 million has been invested from 2004 through 2023. There is an increasingly well-trained staff implementing malaria control, producing disease maps of Bioko, working at all clinical levels, and providing state of the art laboratory support and research. This is being done in the context of building and equipping a new laboratory and hospital to serve the program, plus extension into the community of the work, raising malaria awareness, and clinical research and protection of individuals by vaccination. The BIMEP has also registered 27 national staff pursuing programs in post-graduate work and technical specialization levels.
    • With the decline in malaria prevalence and decrease in all causes of childhood mortality, there has been a tangible social impact. These gains reflect the involvement and participation of the communities in the interventions being implemented. The establishment of the reference laboratory supports Equatoguinean laboratory and clinical professionals to carry out diagnostics and biological analytics at internationally recognized standards. The laboratory, with the support of the various stakeholders, has been transformed as the first WHO-certified laboratory for COVID-19 in Central Africa and the only laboratory for testing COVID-19 in the country.
    • The BIMEP integrated malaria interventions approach are flexible and can be adopted in different epidemiological settings. The PfSPZ Vaccines are replicated by other clinical study partners, including those in Mali, Burkina Faso, Gabon, Tanzania, and Kenya.
    • The BIMEP serves as a model of an integrated malaria control in sub-Saharan Africa. The project has successfully demonstrated the impact of the interventions in reducing the health and socio-economic burden of the disease in Equatorial Guinea.
  • The project's long-term results include a reduction in fatalities, improved standard of living, capacity development and transfer of skills to national entities, and the strengthening of the health system in the country.

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Implementing partners

Creciendo Sin Paludismo en Guinea Ecuatorial

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

Texas A&M University

Atlantic Methanol


Ifkara Health Institute

Marathon Oil Corporation

Sociedad Nacional de Gas

Yale University

UW School of Medicine