The New Malaria Vaccine: An Editorial
Living in a tropical country, it’s almost impossible to not hear the word malaria. Mothers and pregnant women fear it, adults miss work because of it, and doctors are, quite frankly, pretty tired of writing prescriptions to treat it. And if you know about malaria, you know something about mosquitoes, those pesky insects that carry the microscopic organisms responsible for malaria.
It seems we know a lot about malaria. We know if we suddenly come down with a fever, headache and tiredness it’s likely we got bitten by some cursed mosquito about two weeks before (even though it could be one of any number of causes and you should always take a test to confirm, especially in children). We know Coartem is the most common of the drug combinations used to treat malaria, even though there are several others, which is helpful since Plasmodium spp. seem to have a knack for developing resistance to drugs every few years. We know that sleeping in mosquito treated nets, regular outdoor spraying with pesticides and wearing protective clothing at night protects us from malaria.
But same as basically everything else, there’s a lot we might not know. Almost half the world’s population is at risk of being infected with malaria. There are also over 200 million cases of malaria worldwide every year, with Africa having the majority of cases. 93% of all malaria deaths (435,000 in 2017) also occur in Africa, with 61% of all deaths occurring in children under five.
With these morbid statistics, you should be happy to hear that there are a lot of people working almost every conceivable angle to try and eliminate this disease. From gene drives to environmental measures to vaccines, the world is on course to rid us all of this potentially fatal disease, and initial results are very promising.
Among all these emerging methods the one in the local news recently is the malaria vaccine, which is currently being piloted in three African countries, including Ghana, as of May 2019. This isn’t the first time the vaccine has been used in Ghana, which was a site for the Phase 3 trial. Let’s go a little bit into what that means.
Clinical trials generally involve four stages. Every new drug has to go through a clinical trial before it can be approved for the public. This trial is approved and monitored by an independent board to make sure it is both ethical and safe for those participating and to make sure data or results aren’t falsified.
The first two phases are generally to test the safety of the drug. These two use relatively fewer volunteers. The third phase is used primarily to assess how useful or potent a drug is in the target population. It is this phase that was done in Ghana and six other countries in Sub-Saharan Africa from 2009 to 2014 after the safety phases were done and the drug was deemed safe enough to be given to children. Phase 4 studies are done after the drug has been approved to investigate the long term effects of a drug in the population, currently being done in some of the pilot areas.
If you’ve been following the media reports you know there is some public mistrust about the vaccine, which isn’t misplaced. I’d be wary if strangers showed up and wanted to inject my child with a relatively new drug which they promised worked fine. So let’s clear up the misunderstandings.
To start off, what exactly is the new malaria vaccine?
Like all vaccines, the malaria vaccine, RTS,S, contains components of the causative organism, in this case, Plasmodium falciparum, which is the cause of the most severe forms of malaria, and most common in sub-Saharan Africa. These components stimulate the body’s immune cells to produce antibodies against the organism, which protect the body against future infection. The malaria vaccine has been in the works for almost 30 years and is to date the only vaccine that has been proven to actually work.
Who is the malaria vaccine for?
As of now, the vaccine is targeted at those who need it most; children in countries with high malaria prevalence and mortality. According to the current schedule, the four doses start at five months and end just before the child turns two.
Next, how well does this vaccine work?
Well, it works! The vaccine has been proven to prevent some 4 in 10 cases of malaria in children under five, and in those who still do get malaria, it prevents severe life-threatening illness. The fact that it doesn’t entirely prevent disease makes it a harder sell to communities and families, which might make it difficult to convince families to take all doses for all their children.
What are the side effects of the vaccine?
The side effects noted have largely been the same as for other vaccines; fever, pain and swelling at the injection site and the vaccine is pretty well-tolerated.
So in the end, what am I saying?
The vaccine certainly isn’t perfect by any means, but it’s a great start, and I’m looking forward to a generation that relates to malaria as we relate to smallpox. And if you’re asking yourself what that is, well that’s my point.