Moa Jamir
Rollout of Malaria Vaccine offers hope
The initiation of the world's inaugural routine vaccine program against malaria on January 22 in Cameroon marks a significant stride in the battle against this life-threatening disease, transmitted to humans by certain types of female mosquitoes, as outlined by the World Health Organization (WHO).
According to the WHO's 'World Malaria Report 2023,' in 2022, there were approximately 249 million malaria cases globally, surpassing the pre-pandemic level of 233 million in 2019 by 16 million cases. The WHO estimated that malaria was responsible for 608,000 deaths in 85 countries in 2022. Although malaria is generally considered preventable and curable, various factors contribute to it remaining one of the most common diseases, particularly in tropical countries. The WHO emphasises that the African Region bears a disproportionately high share of the global malaria burden, constituting a primary cause of childhood illness and death in sub-Saharan Africa.
Amid such grim statistics, the administration of the first dose of the RTS,S/AS01 (RTS,S) malaria vaccine to a baby girl named Daniella in Yaoundé, Cameroon could revitalises the fight against malaria. The country is reportedly offering the vaccine, totaling four doses, free of charge to all infants up to the age of six months.
It is noteworthy that in October 2021, the WHO first recommended the widespread use of the RTS,S malaria vaccine among children in sub-Saharan Africa and other regions with moderate to high P falciparum malaria transmission. This recommendation was based on the results of a pilot programme in Ghana, Kenya, and Malawi and resulting in a substantial drop in mortality (13%) among children age-eligible for the vaccine, and reduction in severe malaria hospitalisations, according to the WHO.
Dr Tedros Adhanom Ghebreyesus, the Director-General of WHO, then hailed the long-awaited malaria vaccine for children as a "breakthrough for science, child health, and malaria control” and expressed hope that the use of the vaccine, coupled with other tools to prevent malaria, could save tens of thousands of young lives annually.
The WHO's recommendation stipulates that the RTS,S malaria vaccine should be administered in a schedule of four doses in children from 5 months of age for the reduction of malaria disease and burden.
However, two critical questions linger. Why did it take so long to develop a vaccine for malaria, a perennial disease, compared to the swift approval and rollout of COVID-19 vaccines? Additionally, can it be deemed a "silver bullet" against malaria, and is a large-scale rollout feasible? Besides, despite assurances from health officials that the vaccine is "safe, effective, and free," challenges of fears and doubts on drug efficacy contribute to vaccine hesitancy.
Two key factors appear to hinder such progress. A scrutiny of existing literature indicates that the inherent nature of the disease stands out as one of the major obstacles. According to the United States' Centers for Disease Control and Prevention (CDC), the complex life cycle of malaria parasites and the intricate immune response to infection pose significant challenges. The parasites are genetically complex, producing numerous potential antigens, the CDC noted, complicating vaccine development.
Beyond scientific challenges, the political economy plays a role. While COVID-19 impacted the world universally, malaria burden is mostly confined to the Global South, increasingly in Africa, leading to less urgency in funding and research efforts. Incidententally, the development of the RTS,S vaccine took 30 years of research by the British drug-maker GSK (formerly GlaxoSmithKline plc), and was undertaken as part of its social responsibility.
The anticipated rollout of a second jab, R21, developed by Oxford University and to be manufactured by the Serum Institute of India, could enhance supply. However, along with the complex nature, if the same political economy persists, the sting from the Anopheles mosquito will remain persistently lethal.
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