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Malaria vaccine brings hope, but the fight is not over yet

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NSHistorical but incomplete. That’s how I think about the recent approval by the World Health Organization. The long-awaited malaria vaccine, Formally known as RTS, S / AS01, or simply RTS, S.

This recommendation follows the careful decisions of WHO’s two high-level advisory boards. Immunity And another malaria, RTS, S provide important protection against illness and death, demonstrating that they are safe and cost effective.

This is a major step forward for the disease, which will have 230 million cases in 2019, and last year there were competitive statistics, one of which was Killed 409,000 people.. Malaria is most common in sub-Saharan Africa, but it is also endemic in Southeast Asia, the Eastern Mediterranean, the Western Pacific, and Latin America.

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The final WHO recommendations are: Ongoing pilot program In Ghana, Malawi and Kenya, more than 800,000 children have already been given 2.3 million doses.this Demonstration of the program RTS, S can be given with other pediatric vaccines and their introduction does not interfere with other malaria intervention programs.

In countries where malaria is endemic, vaccines can be included as one of the interventions for children starting at 5 months of age. To boost immunity to recurrent infections, the first 3 doses are set monthly and the last 3 doses are set to 4 doses 2 years later. Children in endemic areas usually suffer from multiple infections, Therefore, this booster dose is especially important..

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Its approval is historic because RTS and S are the first malaria vaccines in history and the first vaccines against parasitic diseases.Widely accepted Vaccine development roadmap Currently, we have set goals of 75% protection for malaria cases and 50% protection for deadly forms of malaria. However, both of these targets far exceed the protection provided by RTS, S— Almost never exceed 40% for malaria cases or 30% for fatal severe malaria — RTS, S will also be incomplete.

It has become a hot topic in recent years Eradicate malaria, The actual progress is slow. Since 2000, larger investments in the fight against malaria have avoided estimates. 1.5 billion malaria cases and 7.6 million deathsStill, the total burden of malaria has not changed due to population growth and countless other challenges in sub-Saharan Africa.In fact, since 2015, many of the countries with the highest malaria burden have recorded. Will increase in some cases..

In this situation, a transformative approach is needed to significantly reduce the global burden of malaria and maintain benefits for the following concerns: Insecticide resistance When Drug resistance..

WHO should consider this vaccine as one component of the arsenal against malaria, Consider in a broader context Ongoing malaria control efforts. Since RTS and S are not silver bullets, countries should continue to use existing malaria interventions such as artemisinin combination treatments, pesticide-treated bed nets, and preventative treatments for pregnant women and children.

This is how the adoption of RTS, S will change the outlook for malaria control, whether vaccines will be affordable, whether there are sufficient doses to avoid them, and who will fund the vaccine program. It raises the question of what to do. Therefore, countries adopting RTS, S may want to prioritize the areas with the highest burden of vaccines. Expected to have the greatest impact..

No matter what malaria prophylaxis strategy the country chooses, the benefits of RTS and S are the government. Strengthen the basic infrastructure Of their health system to enable effective vaccine delivery. Taking 4 times per child can increase complexity and reduce overall effectiveness. Fortunately, ongoing pilot studies suggest that the RTSS vaccine can be easily integrated into a pediatric immunization (EPI) expansion program without adversely affecting other malaria interventions. These EPI programs are already widespread in Africa Most cost effective..

With the exception of governments in countries where malaria is endemic, the major donors for malaria control today are: World Fund, Created in 2002, US President’s Malaria Initiative, Created in 2005. Most of the funding may already be allocated to existing tools, so the introduction of RTS, S will initiate detailed negotiations on either additional funding or reprogramming of available budgets. It’s a schedule.

NS Global Vaccine Alliance (GAVI)Pediatric vaccination in low-income countries, and more recently the extraordinary champion of Covid-19 vaccination, could also play an important role in negotiations on RTS, S funding, funding, and provision. ..

Beyond RTS and S, other candidate antimalarial vaccines are currently undergoing advanced testing. These include Sporozoite vaccineAfter injecting live malaria parasites, preventive doses of chloroquine should be given to ensure that they do not develop the actual disease but are well protected from future infections.There is also R21 vaccineRecently, a small study of 450 children in West Africa showed up to 77% protection and a larger study is planned.Probably the most exciting Recent announcement by BioNTech To construct the mRNA technology behind the successful Covid-19 vaccine to target Plasmodium.

These options have various strengths and weaknesses and are an important next step in the currently activated malaria vaccine era. Accelerating all promising options is essential to make up for all the years when malaria innovation was very slow.

Malaria endemic countries need to resist the temptation to see RTS, S as a one-off solution, instead consider multiple options and develop context-specific packages of interventions for maximum impact. .. They need to continue to build a more comprehensive strategy of stronger health care systems and multi-sectoral initiatives needed to sustain profits. As well as the pursuit of potentially transformative tools to accelerate malaria control efforts.

As the first vaccine against parasitic diseases Widely appreciated by African scientists, RTS, S could stimulate new interest in public health and signal greater commitment to malaria control. In the future, African countries should gather more energy to drive innovation on priority health issues.

The road to zero should not end here, and WHO approval of the RTS, S vaccine should not promote complacency. Instead, a greater focus should be placed on achieving malaria eradication as quickly as possible and with as few deaths as possible, using all available strategies.

Fredros Okumu is a mosquito biologist, public health expert, director of science at the Ifakara Institute of Health in Tanzania, and New Voices Fellow at the Aspen Institute. He is a member of the WHO Malaria Policy Advisory Group, which evaluated RTS and S, and reports that he has received research funding from the Bill & Melinda Gates Foundation and the Wellcome Trust. The views expressed here are his own and should not be considered representative of the organization to which he belongs.

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