It took scientists 30 years to create the first malaria vaccine, approved by the World Health Organization in 2021. A second, even better one is now almost ready to be deployed against the disease. Governments and philanthropies should be stepping up their funding to global health partners so they can build on that momentum in the battle against malaria, where progress has been stalled for years.
Malaria kills more than 600,000 people a year, the vast majority young children in sub-Saharan Africa. That makes it the third-leading cause of death each year among children under the age of 5, just after pneumonia and diarrhoea. Developed by scientists at the University of Oxford, a new vaccine appeared remarkably effective at preventing malaria in a study of children in Burkina Faso, where the malaria season is short and intense -- in 2019, nearly 8 million cases were reported in a population of roughly 20.3 million people, according to the WHO. In a trial of more than 400 children there, the vaccine was 80% effective. If those results hold up in a larger, longer study, they would exceed the WHO's goal of achieving 75% or greater efficacy.
The Oxford vaccine is a close cousin of the world's first malaria vaccine, developed by GlaxoSmithKline. Called Mosquirix, it was recommended by the WHO in October 2021. Both vaccines train the immune system against the same protein from the malaria parasite, but they use different adjuvants (used to boost the immune response). Mosquirix was recommended based on a large study that showed four doses of the vaccine were 30% effective against serious infections and reduced infections overall by 40%. Although the Oxford vaccine's more robust protection still needs confirmation in a larger study, it so far also looks potentially safer than Mosquirix.
If larger studies pan out, the Oxford vaccine also offers a practical advantage over Mosquirix: It is cheaper and easier to make. Serum Institute of India is prepared to make 200 million doses of the vaccine should it be recommended by the WHO next year. By contrast, GlaxoSmithKline committed to making just 15 million doses of Mosquirix per year -- far short of what is needed to vaccinate every child in countries where malaria is endemic. Recent media reports suggest even that target won't be met due to lack of funding.
And there are still questions about the role these vaccines will play in reducing transmission of the infection. Researchers have yet to show how well the new vaccine works in a place where, instead of a short malaria season, transmission is relentless throughout the entire year. Malaria experts also suspect that after an initial multi-dose regimen, children will need annual boosters of this vaccine, and probably Mosquirix, too, for them to remain effective. That presents financial and logistical challenges in resource-poor countries.
In the end, those limitations mean these shots are a critical advance but aren't a quick fix to the heavy burden of malaria. Rather, they will be just one layer of a complex response.
"There need to be more vaccine options," says Miriam Laufer, director of the Malaria Research Program at the University of Maryland's Center for Vaccine Development and Global Health. Even with these two vaccines, she says, it will be years before the world is able to make enough.
To be clear, any new tool for malaria is worth celebrating. After a period of rapid decline in infections and deaths thanks to a global push to address the disease, progress has stalled. More worrisome, progress began to reverse in the early part of the pandemic. Malaria experts say they've squeezed all they can out of the current tools -- interventions like mosquito nets, insecticides, diagnostics and treatments. Without more funding, they'll be left to make tough decisions about where to divert resources.
"No kid should die from malaria," says Thomas Eisele, director of Tulane University's Center for Applied Malaria Research and Evaluation. "It's a matter of will."
And will is a matter of funding. A WHO recommendation next year for the Oxford vaccine could mean significantly more children in Africa have access to immunisation.
But that's only the beginning of what is needed to move the field in the right direction. The world has fallen behind on the WHO's goal of reducing malaria deaths from 2016 levels by 90% by 2030. In addition to supporting next-generation vaccines, more money is needed to ensure existing tools are being deployed in even the hardest-to-reach parts of Africa, and that efforts to develop new insecticides, preventative medicines and therapies are fully supported. To get there, the agency says funding for malaria prevention will need to be tripled to US$10.3 billion (378.9 billion baht). Consider the many billions in government funding that drove the speedy development of Covid vaccines. A fraction of that money and urgency could be transformative in malaria.
The parasite that causes this disease has vexed researchers for decades. Finally, scientific breakthroughs in malaria are arriving -- but those only translate into breakthroughs in global health if they reach the people who need them. ©2022 Bloomberg
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.
