A day before the historic October 6, WHO ground-breaking decision on next steps for malaria vaccine, a group of community, opinion leaders, elders and parents in Ndhiwa sub-county, Homa Bay, Kenya, sat together to reflect and review the previous two years.
One after the other, the members spoke of their experiences at home, in the community and amongst family members, most of who have had testimonies of relief, hope and appreciation of a rare season. They told of spared lives, eased severity of what many know to be a deadly disease and some relief from an ever threatening enemy that most families have great dread for.
An emphatic YES seemed an answer across the five of the eight counties we visited to the question: Have the RTSS doses of the (malaria) vaccine made any difference?
“We have definitely seen the difference in the last couple of years since we seem not to have witnessed death of children as we did before, elder Peter Okoth, said.   
“You know malaria has always been a constant problem here -  it kills and threatens lives,” he added.
“For years, it has stalked us and we lost people – even adults- to the killer disease. But now we see the difference after they initiated this vaccine. We are very hopeful.”
Homa Bay is one of the eight counties selected for the pilots based on the burden of malaria, with Ndhiwa as one of the 26 sub-counties participating. The sub-county is also where the vaccine was launched on September 13, 2019.  Overall, more than 200,000 children in Kenya have received at least one dose of the vaccine.
While the decline may also be attributed to some other factors, the community notes, the vaccine has been the most significant. Members also said that even where malaria cases among the vaccinated children had been reported, these were mostly mild. 
“Even for whose children got malaria while in between the doses, the attack seemed to have been mild and they turned to the local ‘village doctor, the community health volunteer, for support, added Lilian Odhiambo, an opinion leader in the community.
The mothers in the meeting agreed, and talked of their relief since September 2019 saying that unlike other times, the children had not gotten as sick, despite Ndhiwa being plagued a heavy malaria burden.
Rebecca Apondi, a mother of five aged 16 and 2 years said her experience in the last two years with little Valery had been different from any other she could remember. She said all her other children had suffered malaria several times in that age and still get infected. But Valery had only been sick once - sometime after the third dose of RTSS -  but she says it was mild and she did not have to go to hospital.
Another mother, Nancy Achieng, 22, said her child had not gotten malaria since starting the vaccine doses in 2019.
“We only experienced a high fever on the first night after the first dose, but I had been cautioned about it at the hospital, and he soon felt better by the second day”, she said.
He started off at six months and took again at seven months, nine and at 24 months, as per the pilot guidelines. The child did not experience any fever in the follow-up doses, she says. 
Not too far from the Old Pharmacy building situated in the Ndhiwa Sub-county hospital where the community members met, hundreds of people had gathered under a large tent and beyond in the centre of the town two years before. Their mission had been to officially launch the Malaria vaccine pilot in Kenya, one of the three in the continent, with others in Ghana and Malawi. With national and international dignitaries, the community had witnessed a rare show of international and national attention – one that would expose their Homa Bay County into global limelight through the RTSS vaccine pilot.
Among them were the Cabinet Secretary for health, Ms Sicily Kariuki, County representatives, the WHO Representative, Path officials and a horde of technical health experts from as far as Geneva and the United States, who had worked for years in preparation for the momentous launch of the vaccine pilots.
Looking back, the community expressed gratitude as they reported the notable positive results and impact of the vaccine on children under two years in their community. 
“We are very hopeful from this relief experienced in the community we are hoping that such a vaccine can also be extended to children of all ages and even adults, Joseph Abichi, an elder who pastors a local church, said.
He was speaking for himself and others who agreed with him adding that regular community meetings had reported a notable reduction of the malaria infection on children under five. The community meets quarterly to discuss health issues and concerns and what they can do to prevent and control transmission of diseases. Mothers who attend the Maternal and Child Health Clinic at all health facilities also have a ‘health talk’ to help parents understand the essence of ensuring the child receives all vaccinations.
They attributed the infection reduction to the vaccine but also paid tribute to the constant support of community health volunteers, so called ‘village doctors’, who ensured families had nets and used them well. CHVs, who were community appointed and trained by health staff, were also within reach to use malaria kits that would determine if a child had the disease and the immediate cause of action. This could be referral to the hospital or where mild, use of prescribed medicine to treat the fever or any mild related condition.
“The overall relief comes from the fact that less and less children got sick in the past two years but also from knowing that the whole health system is well structured to support families who were taking the vaccine and from severe illness from malaria or death,” Beatrice Akoth Onyango, a community health extension worker, CHEW, explained.  
Beatrice works constantly with 12 Community Health Volunteers, CHVs, who report to her as they serve a community of about 2000 (1,931 households) in a larger population of 9,338.
“We visit families assigned to us to ensure they maintain their health status and where need be, advice on what they need to do.” Said Julia Atieno, a CHV.
In supporting the malaria pilot alongside other needs, the CHVs are on hand to use their malaria kit to determine status when a case is brought to their attention. They then determine if the child is to be referred to hospital due to high fever and other health complication or be treated with the prescribed drug based on the condition.
The Ndhiwa sub-county hospital also reported reduced numbers in admission and even deaths of under-five from malaria, due to the killer disease that had forever plagued the community.  
“We have had fewer admissions and those who get admitted have no complications that often accompany malaria cases,” hospital in-charge Doreen Kadu, said.
In 2018 and before, the hospital had been struggling with various complications due to the infection, including need for blood transfusion for the infected under five children, jaundice and other related issues. “Not any more, we rarely have these emergency situations and we attribute it to the vaccine,” she added.
We need the vaccination to go on, she emphasized.
Well it will. The WHO recommendation on October 6, 2021 following a convincing evidence of safety, feasibility and efficacy now allows the vaccine to be used broadly and cover other areas that were not in the pilot. The decision marks a historic moment for a disease that has stalked the continent and been the source of loss for thousands of children across Africa and parts of the world. The vaccine prevents severe malaria by more than 30 percent and used alongside other interventions like bed nets, makes a huge difference in the overall management of malaria.