Malaria: Is the End in Sight?

The world’s first malaria vaccine has been approved for use in sub-Saharan Africa.

Writer: Priya Ord
Editor: Keerat Singh
Artist: Lia Bote

In a historic breakthrough, the World Health Organization (WHO) has approved the world’s first malaria vaccine (RTS,S or Mosquirix) for use in children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission. In 2019, nearly half of the world’s population was at risk of contracting malaria, with some groups facing a much higher risk of developing severe symptoms. These groups include: children under 5 years of age; pregnant women; patients with HIV/AIDS; and people with low immunity who move to areas with high malaria transmission.

The vaccine approval follows an ongoing pilot implementation of the RTS,S vaccine in Africa. Launched in April 2019 in Malawi, Ghana and Kenya, the project has seen more than 800,000 children receiving at least one dose. Financing for the WHO Malaria Vaccine Implementation Programme (MVIP) has come about through the collaboration of Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, said “The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control…[It] could save tens of thousands of young lives each year.” African children under the age of five are most at risk and more than 260,000 die from malaria annually.

RTS,S, which is given in four doses between 5-18 months of age, prevents approximately 40% of all malaria cases and 30% of severe cases. The vaccine also reduces the need for blood transfusions–which are required to treat life-threatening malaria anaemia–by approximately 30%. It will be used alongside other measures to control malaria transmission such as insecticide-treated bed nets, as well as more public education and training of health workers.

Malaria parasites infect female Anopheles mosquitoes and are transmitted via their bite. When infected mosquitoes bite humans, they inject their saliva into the bloodstream which inhibits blood coagulation and allows the parasite to enter the body. The parasite then travels via the bloodstream to the liver, where it reproduces asexually and the infection develops. Then, the parasites re-enter the bloodstream and invade healthy red blood cells, causing them to burst. Malaria symptoms include a high temperature, feeling hot and shivery, headaches, vomiting, muscle pains, diarrhoea and death in severe cases.

This vaccine contains part of a parasite protein bound to part of another protein from the hepatitis B virus, which helps immune cells recognise the parasite protein and stop the parasite from maturing and multiplying in the liver. Because of this, RTS,S also helps protect against infection of the liver with the hepatitis B virus, but should not be used only for this purpose.

The vaccine has been developed by GlaxoSmithKline (GSK) over three decades, beginning in 1987. GSK has pledged to supply the doses at manufacturing cost plus 5%, has donated 10 million doses for the pilot and has committed to providing 15 million doses annually. With sufficient funding, doses could become available for wider use from the end of 2022 or early 2023, according to GSK’s Chief Global Health Officer Thomas Breur.

In January 2021, PATH, GSK, and Bharat Biotech (BBIL) announced that BBIL will take over the production of RTS,S, and will become the only company to supply the vaccine by 2029. This product transfer agreement will help to ensure the long-term, widespread supply of the vaccine.

The next steps for this vaccine will include the acquisition of further funding in order to enable a broader rollout. Individual countries also have to decide whether to use the vaccine alongside other malaria control measures. Vaccination is one of humanity’s main weapons against infectious disease and recent successes pave the way for the future of the fight against malaria.

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