The world’s first malaria vaccine has been approved, so this cannot be the last

Currently, it seems likely that the number of malaria cases has increased significantly for the first time in decades. This may turn out to be a temporary blip caused by Covid disrupting the malaria program, but in the long run it may be a taste of what’s to come.

Even with conservative estimates, climate change can make malaria an increasingly common illness for more and more people, including the United Kingdom.

Rising global temperatures and changing weather patterns will expand the range of this ancient disease, reaching Europe and northern America by the end of this century, doubling 2000’s risk to 8.4 billion people. There is sex.

Given that efforts to eradicate malaria began to stagnate six years ago after 20 years of tremendous progress. GSK malaria vaccine, RTS, S are game changers and may be additional tools needed to avoid this scenario. Approximately 35 years after its development, more than a century has passed since the search for malaria vaccines began, and it is the first time in several years that a new important vaccine has been added to the malaria prophylaxis toolbox.

But rather than marking the end of a very long journey, we need to see Arrival of this vaccine As the beginning of a significant new one, alongside existing interventions, a series of vaccines, rather than one, will be needed to ultimately eliminate malaria. Therefore, RTS, S is the first malaria vaccine approved, but not the last.

One of the reasons we need more vaccines is that RTS, S are not as effective as we want. Phase 3 trials found a 39% reduction in clinical malaria cases and a 30% reduction in severe malaria. This was only in addition to other measures such as pesticide-treated mosquito nets after 4 doses. If the Covid-19 vaccine yields similar results, it will not be approved by the World Health Organization (WHO) for emergency use.

However, given the prevalence of malaria, there are more than 238 million cases and more than 400,000 deaths annually, and even with such modest efficacy, the potential impact is enormous. .. In fact, one life can be saved for every 200 vaccinated children. Therefore, if included in a regular pediatric immune program, it will be the third most influential vaccine in terms of life saved.

Gavi will fund the vaccine yesterday as 260,000 African children under the age of five die of malaria each year and six Gavi-backed countries account for 50% of global mortality. Made a historic decision. This means that in sub-Saharan Africa, there is another tool in the arsenal to combat this deadly disease.

The other weapons we have against malaria are also not perfect. Mosquito nets treated with antimalarials and pesticides can save lives, but they are only partially effective. For example, not everyone has access to the bed net, and sleeping under the bed net is not always realistic. In addition, these nets will eventually need to be reprocessed, and mosquitoes that spread malaria may increase resistance to the pesticides and drugs used.

However, when used in combination with existing measures, the vaccine provides a separate string for the malaria prophylaxis bow, adding a layer of protection. Based on the results of a pilot survey involving 800,000 children from Gavi, Kenya and Malawi, with the help of three global health agencies, Gavi, the World Fund and Unitaid, RTS, S will be part of the standard routine. If included, it can protect more children. Immunity.

That’s because childhood vaccination programs are already very widespread. In fact, pilots have found that vaccination can reach two-thirds of children who normally do not sleep under bed nets. And, decisively for children who used mosquito nets, this did not discourage people from continuing to use mosquito nets.

What this means is that vaccination expands our scope and 90% of children when combined with existing measures to supplement large investments over the past few decades from organizations such as the World Fund. Is to allow some form of protection against malaria. But with more effective vaccines and vaccines that protect against other forms of malaria, we can go even further. And in the face of the increasing threat posed by climate change, it will become increasingly important.

Perhaps one of the reasons why it took so long to reach so far is lack of investment. It is no coincidence that the countries most affected still tend to be poor. Mostly in Africa, the vast majority of people who need to sleep under the net are often poor and unable to sleep in bed. From a vaccine development perspective, this creates great uncertainty regarding market potential. The fact that GSK has embraced the risk, invested US $ 700 million in this vaccine and donated 10 million doses to the four-year pilot program should be commended.

But now we need other malaria vaccines. Fortunately, you don’t have to wait for the next 35 years with another promising malaria vaccine in the advanced stages of development or another vaccine in preclinical development. In addition, the successful development of the Covid-19 vaccine has given us the key to unlocking new technologies that could lead to even better vaccines, and BioNTech is currently working on mRNA-based malaria vaccines.

• Dr. Seth Berkley is the CEO of Gavi, the Vaccine Alliance, co-founder of the Covax scheme.

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