After almost six decades of painstaking research, scientists have done what at times seemed almost impossible: the world now has not one but two malaria vaccines. The need is unquestionable. Malaria remains one of the world’s most deadly infectious diseases, claiming around half a million lives a year, mostly of children under five.
Although research for a vaccine began in the 1960s, the complexity of the challenge meant that the World Health Organization did not recommend a vaccine – RTS,S – until two years ago. That is being rolled out across multiple countries in Africa. Now the WHO has backed another. Critically, R21 is easier and cheaper to produce, vastly increasing the supply. Used in combination with other measures – such as insecticide-treated bednets – it will save countless lives.
But it still requires four doses to give protection: no small ask when the same factors that tend towards malaria prevalence, such as poverty, poor infrastructure, poor health services and insecurity, are likely to make vaccine delivery difficult. It reduces cases by 75% in trial conditions in areas with seasonal malaria: in real life, that will be lower.
Malaria had vanished from western Europe by the 1930s, and 21 countries have eliminated it since 2000. But 2015’s ambitious target of reducing malaria cases and fatalities by 90% by 2030 now looks unachievable. Malaria cases have actually risen in recent years, from 232m in 2019 to 247m in 2021. The rise has many likely causes: disruptions to prevention and treatment services during the pandemic, insecurity, global heating, mosquitoes’ ability to become resistant to insecticides, and the parasites they carry growing resistant to drugs.
Another cause has been a shortfall in funding – only half of the $7.3bn needed last year was achieved, says the WHO. Successes and failures in the fight against malaria have usually tracked investment. Had malaria still been blighting richer countries, a vaccine might have been found sooner; pharmaceutical firms tend to concentrate research where they foresee sizable profits. But investment also follows successful interventions. When donors see that measures work, they are more likely to pay for them.
As experts have stressed, the new vaccine is not a magic bullet. It will not replace other measures, but must be employed alongside them. None of that takes away from its importance and its promise. To dismiss it would be to misunderstand how progress will best be made: through a multitude of complementary measures. At a point where the battle against malaria has looked dismaying, it offers hope. Scientists continue to work on a wide variety of interventions, including genetically engineering mosquitoes. And research will need to continue to develop vaccines providing better or longer protection, and against another form of malaria parasite. Both the existing vaccines target Plasmodium falciparum, which accounts for about 90% of deaths, but Plasmodium vivax also poses a significant threat.
This week’s awarding of the Nobel prize in physiology or medicine to Katalin Karikó and Drew Weissman, whose work enabled the mRNA Covid vaccine, has highlighted again the extraordinary potential offered by this technology. BioNTech and others are already working on mRNA malaria vaccines. There will be more setbacks on the path to tackling malaria. But there will also be more moments of triumph – and they should be recognised and celebrated as they arrive.
