As the world’s very first malaria vaccine is approved, we can’t let it be the last

It now seems highly likely that, for the first time in decades, malaria cases are on the rise. While this may turn out to be just a temporary incident caused by Covid disrupting malaria programs, in the long term it could be a taste of things to come.

Even by conservative estimates, climate change threatens to make malaria an increasingly common disease for growing numbers of people, including in the UK.

Rising global temperatures and changing weather patterns are expanding the scope of this ancient disease, so that by the end of this century it could reach parts of northern Europe and America, endangering up to 8.4 billion people, double the number of 2,000.

Since efforts to eliminate malaria, after two decades of incredible progress, began to stagnate six years ago, GSK’s malaria vaccine, RTS, S, could be a game-changer and be the extra tool we need to avoid this scenario. Almost 35 years of development and more than a century since the search for a malaria vaccine began, this is the first significant addition to the malaria prevention toolkit in years.

But rather than mark the end of a very long journey, we must see the arrival of this vaccine as the start of important news, because alongside existing interventions, it will take not one but a range of vaccines to ultimately eliminate malaria. So although RTS, S is the very first malaria vaccine to be approved, we cannot let this vaccine be the last.

One of the reasons we need more vaccines is that RTS, S is not as effective as we would like. In phase 3 trials, it was found to reduce clinical malaria cases by 39% and severe malaria cases by 30%, and that only after four doses and in addition to other measures like mosquito nets. impregnated with insecticide. If a Covid-19 vaccine produced similar results, it would not gain World Health Organization (WHO) approval for emergency use.

However, given the prevalence of malaria, with over 238 million cases and over 400,000 deaths per year, even with such modest efficacy, the potential impact is enormous. In fact, for every 200 children vaccinated, one life could be saved. Therefore, if included in routine childhood immunization programs, it would be the third most effective vaccine in terms of lives saved.

With 260,000 African children under five dying each year from malaria and six Gavi-supported countries accounting for 50% of global mortality, that’s why Gavi yesterday made the historic decision to fund this vaccine; this means that in sub-Saharan Africa we will have another tool in their arsenal to fight this deadly disease.

The other weapons we have against malaria are not perfect either. While antimalarial drugs and insecticide-treated bednets save lives, they are also only partially effective. Not everyone has access to a mosquito net, for example, and it is not always practical to sleep under a mosquito net. In addition, over time, these nets must be removed and mosquitoes that spread malaria can develop resistance to the insecticides and drugs used.

Using a vaccine in conjunction with existing measures, however, provides another bowstring of malaria prevention and an additional layer of protection. Based on the results of pilot projects involving 800,000 children in Ghana, Kenya and Malawi supported by a collaboration between three global health agencies – Gavi, the Global Fund and Unitaid – RTS, S helps protect more children when ‘it is included as part of the standard immunization routine.

This is because childhood immunization programs already have a huge reach. Indeed, the pilots found that thanks to the vaccination, two thirds of the children who do not normally sleep under a mosquito net could be reached, and especially for those who used mosquito nets, this did not discourage people from continuing to use them. .

This means that when used with existing countermeasures and as a complement to the significant investments made over the past decades by organizations like the Global Fund, immunization extends our reach so that 90% of children benefit from it. ‘a form of protection. against malaria. However, with more effective vaccines and those that protect against other forms of malaria, we could go much further. And in the face of the growing threat posed by climate change, it will become increasingly important to do so.

Arguably one of the reasons it took so long to get to this is the lack of investment. It is no coincidence that the countries that are still most affected tend to be poor countries, mainly in Africa, countries where the majority of people who need to sleep under a mosquito net are often too poor to sleep in. a bed. From a vaccine development perspective, this creates huge uncertainties in terms of market potential. The fact that GSK took the risks and invested US $ 700 million in this vaccine, and donated 10 million doses for this four-year pilot program is to be applauded.

But now we need more malaria vaccines. Fortunately, we shouldn’t have to wait another 35 years for the next one, with another promising vaccine against malaria in late development, and more in preclinical development. Additionally, the successes in developing the Covid-19 vaccine have given us keys to unlock new technologies that could potentially lead to even better vaccines, with BioNTech now working on mRNA-based malaria vaccines.

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

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