by Utsa Chaturvedi
Photo byDiana Polekhina on Unsplash
Usually caused as a result of being bitten by an infective female Anopheles mosquito, malaria is a vicious disease common among young children in the developing world, especially Africa and South Asia. According to estimates by the World Health Organization (W.H.O.), of the 229 million clinical cases of malaria and 409,000 deaths caused by malaria in 2019, two-thirds were children in Africa under the age of 5. Since most of the countries where malaria is prevalent are poor, the disease maintains a vicious cycle of disease and poverty in these nations.
In Africa, one of the few widespread preventive measures for malaria is insecticide-treated bed nets. When babies are born in western Kenya, where malaria runs rampant, it is common for mothers to be sent home from the hospital with such bed nets, which, unfortunately, are not very effective - they cut malaria deaths in children under 5 by only about 20 percent.
With so many deaths attributed to it, it comes as a surprise to many that until recently, there had been no vaccine to successfully treat and consequently attempt to eradicate this disease. However, in October 2021, the W.H.O. announced that it had approved the world’s first malaria vaccine, based on the results of administering over 2.3 million doses to around 800,000 children in Kenya, Malawi, and Ghana since 2019.
The vaccine, RTS,S, also known as Mosquirix, was developed by the British pharmaceutical company GlaxoSmithKline (GSK), and funded by the Bill & Melinda Gates Foundation in Seattle, Washington, at a cost of over US$750 million. It targets the deadliest malaria parasite and the most common in Africa - Plasmodium falciparum. Additionally, it is not only the first vaccine for malaria, but also the first developed for any parasitic disease, which are much more complex than viruses or bacteria. “It’s a huge jump from the science perspective to have a first-generation vaccine against a human parasite,” said Dr. Pedro Alonso, director of the W.H.O’S global malaria program.
While this is a pivotal moment for global healthcare, the vaccine - called Mosquirix - has limited efficacy, and prevents about 39 percent of malaria cases and 29 percent of severe malaria cases among small children in Africa over four years of trials. The trials did not directly measure the vaccine’s impact on deaths, which has led some experts to question whether it is a worthwhile investment in countries with countless other demanding problems. Furthermore, while the vaccines are a “huge addition to the fight” against malaria, health officials will have to employ “a Swiss cheese strategy”, including insecticide-treated bed nets and indoor spraying, says Dr. Githinji Gitahi, the chief executive officer for Amref Health Africa, a nongovernmental organization. Moreover, some places have seen skepticism about the vaccine, partly as a result of mistrust of the W.H.O. “I wonder why they want to help Africa,” said Mamadou Tounkara, a 40-year-old teacher in Dakar, the capital of Senegal, questioning why the W.H.O. did not fund better hygiene and sanitation instead. “If W.H.O. wants to help eradicate this disease, they can do it without the vaccine,” he said.
Despite the voicing of such doubts, the vaccine seems beneficial for healthcare systems. A study led by the London School of Hygiene & Tropical Medicine (LSHTM) found that when young children were given both the RTS,S and antimalarial drugs, there was a 70 percent reduction in hospitalisation or death. Moreover, GSK said it was committed to supplying up to 15 million doses a year at a maximum of 5 percent above the cost of production, and would work with partners, sponsors, and governments to support additional supply of the vaccine. Professor Sir Brian Greenwood from the LSHTM said, “The RTS,S vaccine does not provide complete protection but this decision is testament to the global health community’s drive and vision to find a way forward. As part of a tailored approach it has great potential to reduce death and illness in high burden areas, especially when combined with other interventions such as seasonal malaria chemoprevention and bed nets, and be a huge boost to malaria control efforts.”
In essence, while a decades-long effort against malaria is finally seeing results, it will be a long while before the production, cost, and overall practicality of the distribution of this vaccine will be able to match up to the problems that many developing countries face, and at last be able to see a truly zero-malaria world. Said Professor Sir Brian Greenwood, “We still have a very long road to travel. But this is a long stride down that road.”
References
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Davies, L. (2021, October 6). WHO endorses use of world’s first malaria vaccine in Africa. The Guardian. https://www.theguardian.com/global-development/2021/oct/06/who-endorses-use-of-worlds-first-malaria-vaccine-in-africa
Djibo, Y. (2021, October 10). Opinion | What the Malaria Vaccine Means for Africa. The New York Times. https://www.nytimes.com/2021/10/10/opinion/international-world/malaria-vaccine-africa.html?searchResultPosition=1
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Maxmen, A. (2021, October 8). Scientists Hail Historic Malaria Vaccine Approval—But Point to Challenges Ahead. Scientific American. https://www.scientificamerican.com/article/scientists-hail-historic-malaria-vaccine-approval-but-point-to-challenges-ahead1/
Pandey, M., & Waterhouse, J. (2021, October 11). Malaria vaccine “will change African lives forever.” BBC News. https://www.bbc.com/news/newsbeat-58848721
Press, T. A. (2021, October 6). Video: A “Historic Day”: W.H.O. Approves First Malaria Vaccine. The New York Times. https://www.nytimes.com/video/health/100000008011749/first-malaria-vaccine-who-approval.html?searchResultPosition=3World Health Organization. (2021, October 6). WHO recommends groundbreaking malaria vaccine for children at risk. Www.who.int. https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk
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