Why first malaria vaccine is a dose of hope for Africa

RTS,S Mosquirix malaria vaccine dose. It won the approval of WHO in October 6, 2021. In 2019, malaria infected 229 million people, claiming the lives of 409, 000. The larger percentage is African children below 5 years of age. PHOTO/Courtesy.

Malaria cases have been on the rise for decades.

Though the disease is preventable and curable, the burden has been made heavier by the absence of a vaccine against it.

In many Sub-Saharan countries in Africa, a malaria infection over the years meant a knock of death, loss and despair.

This has been instigated by the rising cases of antimalarial drug resistance.

Latest data from World Malaria Report indicates a caseload of 229 million infections of malaria in 2019 compared to the 228 million cases witnessed in 2018.

The estimated number of malaria deaths stood at a staggering 409, 000 in 2019, compared to the 411, 000 deaths in 2018.

Children under 5 years of age are the most vulnerable group affected by malaria.

For instance, in 2019 they accounted for 67% (274 000) of all malaria deaths globally.

Of more worry is that in 2019, Africa was the home to 94% of these cases.

Scientists blame infected female Anopheles mosquitoes, which spread the Plasmodium parasites to humans through bites.

According to the World Health Organization (WHO), there are 5 parasite species that cause malaria in humans, and 2 of these species, falciparum and P. vivax, pose the greatest threat.

P. falciparum is the deadliest malaria parasite and the most prevalent in Africa.

P. vivax is the dominant malaria parasite in most countries outside Sub-Saharan Africa.

Undoubtedly, the need to develop a vaccine to curb such losses has been vital for many decades.

A myriad of scientists, researchers and organizations, including WHO, have constantly dirtied their fingers in search for a vaccine.

In October 6 2021, the world rejoiced when WHO made a landmark endorsement of the RTS, S/AS01 malaria vaccine, whose trade name is Mosquirix.

The vaccine doubles as the world’s first licensed malaria vaccine and also the first vaccine licensed for use against a human parasitic disease of any kind.

It aims at battling the deadly P. falciparum plasmodium parasite.

“The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at a press conference in Geneva.

This move was a green-light for the long awaited roll-out of this vaccine, which medical experts say could be the saviour to millions of young children at risk.

It’s journey hasn’t been any rosy, however.

Tracing its conception back in the late 1980s by scientists working for the current GlaxoSmithKline laboratories in Belgium, the vaccine has undergone hundreds of trials and advancements.

The recent WHO approval of the vaccine leaned on positive results from pilot trials being done in Malawi, Ghana and Kenya, and evidence generated by a collaboration of partners.

This vaccination pilot project was launched in April 2019 in Malawi and Ghana and in September 2019 in Kenya.

Since it’s 2019 launch in the three countries, the pilot study programme has seen a remarkable 800,000 children get vaccinated with the RTS, S/AS01 malaria vaccine.

So far, the WHO backed program has reported a 30-percent decrease in severe malaria cases among vaccinated children, coupled with the use of other interventions like use of bed mosquito nets.

Years of clinical trials have proved the vaccine to be safe and able to protect children against malaria, especially when used alongside the other toolkit of malaria prevention.

“We have a number of things in our toolkit to fight malaria, and they are all used together: bed nets, spraying, chemoprevention,” notes Sean Murphy, a University of Washington malaria vaccine scientist.

He points out that the current vaccine cannot replace all these tools.

As at now, its efficacy ranges from 26 to 50% of severe malaria cases in infants and young children.

Previous research shows that delayed fractional dosing (administering portions of the whole dose until full dose is taken within a certain period) may boost the vaccine’s efficacy up to 86%.

According to Human Vaccines and Immunotherapeutics website, four doses are currently indicated for children, with the first dose injected at 5 months of age.

The first 3 doses are administered monthly, and the third should be completed by 9 months of age.

A mosquito biting a human skin. The female anopheles mosquito passes the malaria-causing plasmodium parasite through a bite. PHOTO/Getty Images.

In Africa, for instance, as studies agree, efficient administration of 30 million doses of the malaria vaccine each year across sub-regions of 21 African countries could avert between 2.8 million and 6.8 million malaria cases annually.

This would save the lives of between 11,000 and 35,000 children under the age of five.

But with the process requiring millions of dollars and numerous verification processes, Africa will have to hopefully wait a little longer.

In a statement to media and investors only,  on October 6 this year, GlaxoSmithKline committed to donate up to 10 million RTS,S/AS01 doses for use in the pilots, and to supply up to 15 million doses annually.

This would be possible if their recommendation and funding for wider use would be effected.

Despite the approval by WHO, individual countries are supposed to make their own endorsements and policies regarding its use and circulation within the countries.

This vaccine won the formal endorsement of WHO from a pool of over 140 malaria vaccines which are under trial.

Scientists say that developing a vaccine for an organism like Plasmodium, which quickly adapts to it’s environment, is challenging.

“Plasmodium goes through multiple life stages as infections spread from the bloodstream into the liver and then back into the bloodstream, when the parasite infects red blood cells themselves,” writes Michael Greshko.

The other reason for the delayed production of malaria vaccine is safety.

Though the target group of the vaccine is children aged five to eighteen months, clinical trials by researchers had to start with adults as volunteers, trickling down to the children.

This would effectively gauge and prove its efficacy and safety.

An improved version of the RTS, S/AS01 vaccine, called R21, is in the waiting list.

A phase two trial of the R21 vaccine in Burkina Faso, involving 450 people, has placed it’s efficacy at 77%.

The funding of this Mosquirix vaccine has been done by the non-profit PATH Malaria Vaccine Initiative (MVI) and GlaxoSmithKline with funding from the Bill and Melinda Gates Foundation.

In October 14, through her Twitter handle, Melinda Gates tweeted that “WHO’s recommendation of the first malaria vaccine for children in Africa brings us one step closer to a malaria-free world.

I’m inspired by the scientists and partners who have dedicated their lives to end malaria starting in 1965 with immunologist Ruth Nussenzweig.”

Despite the many steps and challenges associated with roll-out of vaccines, we all remain hopeful that the RTS, S/AS01 vaccine and other advanced ones will save the hundreds of millions of lives at risk of getting lost every year.

Related: HOPE: Malaria vaccine may eliminate killer disease

Scientists: Mosquito repellent could help prevent malaria

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Mr. Makau holds a Bachelor of Arts degree in Linguistics, Media & Communication from Moi University, Kenya. He is a Columnist and Editor with Scholar Media Africa, with a keen interest in Education, Health, Climate Change, and Literature. His contact: b.makau@scholarmedia.africa.

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