After 30 years in the making, the WHO approved the first ever malaria vaccine on 6 October, recommending its administration to children across sub-Saharan Africa.
This backing of the RTS,S vaccine, otherwise known by the brand name Mosquirix, marks an important step forward in tackling Malaria, a disease which killed 411,000 people globally in 2018. One modelling study found that complete vaccine administration could prevent the deaths of 23,000 children per year, which is not an insignificant dent in the disease’s annual death toll.
However, issues do still exist with this vaccine. Four doses must be administered to each child under the age of five for full protection. At $5 per dose, this adds up to an estimated cost of $325 million per year to distribute and administer the vaccine across ten African countries with the highest malaria incidence.
In efforts to combat the financial hurdle to vaccine rollout, the vaccine manufacturer GSK is pledging to make 15 million doses available annually at just above production cost. Although this is a noble effort, the reality is that roughly 100 million doses are needed annually if children in high incidence countries are to each receive all 4 required doses for full protection.
Furthermore, the vaccine itself has only modest efficacy, preventing severe disease and hospitalisation in 30% of malaria cases in children under the age of five.
Badara Cisse, a malaria researcher at the Institute for Health Research, Epidemiological Surveillance and Training in Dakar, said: “The reality is that so much money has been poured into this vaccine, even when the results from studies are disappointing
“I don’t think a 30% effective vaccine would be acceptable for Americans.”
Promisingly, further clinical trials have concluded that the vaccine could reduce childhood malaria deaths by up to 73% when children receive three doses in the run up to the rainy season, when malaria incidence peaks, and a further dose before the rainy season in the following two years, making up a total of 5 doses. However, it is worth noting that this efficacy rate was found in children who were also undergoing seasonal malaria chemoprevention, where healthy children take monthly doses of antimalarial drugs during the rainy season to help prevent disease.
Despite the modest efficacy of the current vaccine, there is agreement among epidemiologists that RTS,S could have a notable positive impact in some regions. However, for this to be achieved, better communication is needed to improve the trust and relationships between scientists and local communities.
James Tibenderana, a Ugandan epidemiologist at the Malaria Consortium in London, said: “People will wonder what a 30-year-old, partially effective vaccine is suddenly being introduced during a pandemic – and targeted only at Africans.”
The trust that communities and the public have in scientists cannot be taken for granted, as was witnessed globally during the Covid-19 outbreak. However, long term trust over many years is vital if children are to receive the full four doses of this vaccine required for full protection. In order to help build this trust, clear communication and transparency about the vaccine will be more important than ever.
Despite these challenges ahead, James and Badara are also grateful for the WHO’s decision to approve the vaccine for use. After the devastation brought by Covid-19 and increasing resistance to antimalarial drugs emerging, James says “it’s uplifting to hear some positive news.”
