Malaria kills more than 600,000 people each year, the vast majority of them young children in sub-Saharan Africa. It is the third leading cause of death in children under the age of 5 every year, right after pneumonia and diarrhea. A new vaccine developed by Oxford University scientists appeared to be 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 diagnosed in Burkina Faso a population of about 20.3 million people according to the WHO. In a study of more than 400 children there, the vaccine was 80% effective. If these results hold up in a larger, longer study, they would exceed the WHO target of achieving 75% efficacy or more.
The Oxford vaccine is a close relative of the world’s first malaria vaccine developed by GlaxoSmithKline. It’s called Mosquirix and was recommended by the World Health Organization in October 2021. Both vaccines train the immune system against the same protein found in the malaria parasite, but use different adjuvants (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 by 40% overall. Although the Oxford vaccine’s more robust protection has yet to be confirmed in a larger study, it also looks potentially safer than Mosquirix so far.
If larger studies are conducted, the Oxford vaccine also offers a practical advantage over Mosquirix: it’s cheaper and easier to manufacture. The Serum Institute of India is poised to produce 200 million doses of the vaccine should it be recommended by the WHO next year. In contrast, GlaxoSmithKline pledged to produce just 15 million doses of Mosquirix a year — far fewer than is needed to vaccinate every child in countries where malaria is endemic. Recent media reports even indicate that the goal cannot be achieved due to a 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 year-round. Malaria experts also suspect that after initial multi-dose therapy, children may need annual boosters of this vaccine, and likely Mosquirix, to remain effective. This poses financial and logistical challenges in resource-poor countries.
Ultimately, these limitations mean that these vaccines represent a crucial advance, but are not a quick fix to the severe burden of malaria. Rather, they are just one layer of a complex reaction.
“There must 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 those two vaccines, she says, it will be years before the world is able to produce enough.
To put it bluntly, any new antimalarial drug is worth celebrating. After a period of rapid declines in infections and deaths thanks to global efforts to tackle the disease, progress has stalled. Even more worryingly, progress reversed early in the pandemic. Malaria experts say they’ve squeezed everything they can out of current tools – interventions like bed nets, insecticides, diagnostics and treatments. Without more funding, they must make difficult decisions about where to redirect resources.
“No child 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 question of funding. A WHO recommendation for the Oxford vaccine next year could mean significantly more children in Africa have access to vaccination.
But that’s just the beginning of what it takes to move the field in the right direction. The world has fallen behind the WHO target of reducing malaria deaths by 90% by 2030 compared to 2016 levels. In addition to supporting next-generation vaccines, more money is needed to ensure that existing tools are deployed in the hardest-to-reach parts of Africa, and that efforts to develop new insecticides, preventative medicines and therapies are fully supported. To get there, funding for malaria prevention will need to triple to $10.3 billion, according to the agency. Think of the many billions of government funds that fueled the rapid development of Covid vaccines. A fraction of that money and urgency could be transformative in malaria.
The parasite that causes this disease has occupied researchers for decades. There are finally scientific breakthroughs in malaria – but these will only lead to breakthroughs in global health if they reach the people who need them.
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Lisa Jarvis is a columnist for Bloomberg Opinion, covering biotechnology, healthcare and the pharmaceutical industry. Previously, she was Editor-in-Chief of Chemical & Engineering News.
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