Are we finally getting vaccines for malaria?

The wait for malaria vaccines has been excruciatingly slow.

Despite intensive research to rid the world of the Plasmodium parasite transported through the bites of the Anopheles mosquitoes, the search for a malaria vaccine continued for over 30 years. It was only last year that the first malaria vaccine was approved for use by the World Health Organisation (WHO).

This vaccine – Mosquirix or the more scientific RTS,S/A S01 – has been created by GlaxoSmithKline, and has been endorsed by the WHO for ‘broad use’ in children in sub-Saharan Africa.

Malaria is a particular problem in Africa. The continent was home to 95% of malaria cases and 96% of malaria deaths in 2020. Even worse, 80% of all malaria deaths in Africa were in children under 5.

“In a major step towards the equitable roll-out of Mosquirix, the WHO awarded the vaccine prequalification status in September 2022,” Dr Jaishree Raman from the South African National Institute for Communicable Diseases writes in a Conversation piece.

“The prequalification step follows approval. It ensures that only good quality products are procured and distributed by United Nations agencies and other major donors.”

The results from large scale pilot studies were promising. The WHO found that for kids who were given Mosquirix there was a 30% reduction in cases of severe malaria. This significant reduction remained even in areas where there is good access to diagnosis and treatment, and insecticide bed nets are already being used.

It’s also cheap enough that it can be cost effective in areas with lots of malaria transmission. This isn’t always the case with treatments, and can be a huge barrier to stopping the spread.

But it’s not the only vaccine that’s looking promising. Earlier this year, a team of researchers from the University of Oxford created a vaccine they described as “world-changing”.

Results from this vaccine – R21/Matrix-M – were published in the journal The Lancet in September.  The team took 409 children who had already had one dose of vaccine and gave them a booster dose, and then monitored them for another 12 months.

The team found that for those that got the three original doses of the Matrix-M vaccine and then a booster 12 months later, the vaccine showed up to 80% protection against the disease. The team also noted no serious adverse effects relating to the vaccine.

The Oxford team is now undertaking a phase III trial in a larger group of children.

The researchers have also signed a manufacturing agreement to try and supply a larger number of vaccines. The Serum Institute of India has agreed to supply 200 million doses a year minimum. GlaxoSmithKline on the other hand is only contracted to produce 15 million to 18 million doses of Mosquirix each year.

The hope is that this will prevent bottlenecks which could cause an unequitable distribution of vaccines – similar to the COVID-19 vaccine distribution. The WHO says that the number of Mosquirix vaccines are not enough to supply all those who need it.

“Demand over the next five to 10 years will probably outstrip the current forecasts on supply,” Thomas Breuer, GlaxoSmithKline’s chief global health officer told Reuters.

This means that other solutions will likely still need to be in place until supply issues are sorted.

In tomorrow’s issue of Cosmos Weekly we look at malaria eradication in Timor-Leste and discover how – if given enough support – a country can effectively eradicate malaria without requiring vaccines.

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