In a crowded paediatric ward at Zomba Central Hospital, the sound of laboured breathing is all too familiar. Sitting beside her three-year-old son, 32-year-old Clara Nyoloka watches anxiously as his small chest rises and falls unevenly. This is not the first time she has been here.
“At first, I thought it was just a normal cough but within days, he could not breathe properly. He became very weak, that is when we rushed to the hospital,” Nyoloka narrates.
Doctors later diagnosed her son with pneumonia, a disease that continues to place a heavy burden on Malawi’s healthcare system, despite being both preventable and treatable. Although he was prescribed antibiotics, his condition showed little improvement, raising concerns that the infection was not responding as expected.
Pneumonia is among the leading causes of death among children under the age of five in Malawi, accounting for an estimated 12 to 14 percent of all under-five deaths, according to Ministry of Health data.
Globally, the disease kills more than 1.3 million people every year, according to UNICEF. Children under five and older adults are among the most vulnerable groups. The burden is particularly severe in low-income countries, where access to healthcare is often limited. Children with weakened immune systems, including those affected by malnutrition and HIV, face an even greater risk.
The scale of the challenge was highlighted during the Global Forum on Childhood Pneumonia held in Barcelona in 2020, where experts warned that without stronger interventions, Malawi could lose as many as 49,000 children to pneumonia by 2030.
The disease is caused by various pathogens, including pneumococcal bacteria, respiratory syncytial virus (RSV), and certain fungi. These infections fill the lungs with fluid and pus, making breathing difficult and potentially life-threatening.
Grace Banda, a paediatric nurse at Zomba Central Hospital, says many children arrive at health facilities when the disease has already progressed.
“In severe cases, children literally fight for every breath. What makes it worse is that many arrive late, when complications have already set in,” she says.
Although pneumonia can often be treated successfully with affordable antibiotics when diagnosed early, several systemic challenges continue to hinder progress. These include shortages of healthcare workers at community level, delays in seeking treatment, weak referral systems and limited diagnostic capacity.
Against this backdrop, researchers at Malawi Liverpool Wellcome Programme (MLW are pursuing a promising new approach through vaccine innovation.
The programme is currently testing a new pneumococcal vaccine known as PBV, developed through advanced laboratory systems under the Malawi Accelerated Research in Vaccine and Experimental Laboratory Systems (MARVELS) initiative.
Steve Mbewe, a laboratory scientist at MLW, says the research builds on encouraging findings from studies conducted in the United Kingdom.
“The PBV vaccine was previously tested at the University of Liverpool and showed higher effectiveness than the current PCV-13 vaccine. It reduced pneumonia cases by about 35 percent, and we are now applying a similar model here in Malawi. We are optimistic that it will offer strong protection,” says Mbewe.
He explains that while the Pneumococcal Conjugate Vaccine (PCV-13) has played a crucial role in reducing disease, it is becoming less effective against certain bacterial strains, particularly the SPN3 strain that is prevalent in Malawi and continues to drive pneumonia infections despite existing vaccination efforts.
The clinical study will involve approximately 416 participants and seeks to determine whether the PBV vaccine can provide stronger and broader protection against pneumonia than the current vaccine.
Health expert Maziko Matemba believes the research has the potential to transform pneumonia prevention in Malawi.
“If this vaccine proves effective in our setting, it could significantly reduce the number of severe pneumonia cases we see every year. This would be a major step forward for child survival in Malawi,” he says.
As Malawi continues to battle a disease that remains both preventable and deadly, healthcare workers and researchers are hopeful that advances in science, coupled with stronger health systems, can help turn the tide against pneumonia and save thousands of young lives in the years ahead.
