Malawi will begin immunising young children against malaria this week, in a landmark large-scale pilot programme of the first vaccine to give partial protection against the disease, the World Health Organisation said.
Although the vaccine protects only a third of children aged under two years from life-threatening or severe malaria, clinical trials have found those who are immunised are likely to have less severe cases of the disease. Earlier, smaller trials also showed the vaccine prevented four in 10 cases of malaria overall, in babies aged between five and 17 months.
Malaria remains one of the world’s leading killers, claiming the life of one child every two minutes, and there are signs the battle against the disease has slowed. The report says children under five are most at risk, particularly in Africa, where 250,000 die from malaria every year. “We have seen tremendous gains from bed nets and other measures to control malaria in the last 15 years, but progress has stalled and even reversed in some areas” said WHO’s director-general, Dr Tedros Adhanom Ghebreyesus. “We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there. The malaria vaccine has the potential to save tens of thousands of children’s lives.”
The “RTS,S” vaccine was 30 years in the making. The report says the nearly 40% efficacy rate is not as high as vaccines for other diseases, but the WHO said RTS,S will add to the preventative measures already being used, such as bed nets and insecticides.
“Nobody is suggesting that this is a magic bullet,” said Dr David Schellenberg, scientific adviser to the WHO’s Global Malaria Programme. “It may not sound like much but we’re talking about 40% reduction in severe malaria, which unfortunately still has high mortality even when you have good access to good treatment.”
The report says Malawi is one of three countries in Africa where the vaccine is being introduced into routine immunisation programmes. The pilot scheme, aimed at gathering evidence to inform WHO policy on broader use of the vaccine, will be introduced in Ghana and Kenya in coming weeks. They will look at reductions in child deaths, safety and vaccine uptake – including whether parents bring their children in time for the required four doses. Concerns have previously been expressed over the practicality of the number and the timing of doses required – once a month for three months and then again at 18 months – which is out of sync with typical immunisation schedules in poorer countries.
“Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death,” said Dr Matshidiso Moeti, WHO regional director for Africa. “We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes. This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination.”
The report says the countries were picked because they already run large programmes to tackle malaria, including the use of bed nets, yet still have high numbers of cases.
The vaccine schemes, co-ordinated by WHO, are a collaborative effort involving the ministries of health in Malawi, Kenya and Ghana and international partners including PATH, a non-profit organisation, as well as GSK, the vaccine developer and manufacturer, which is donating up to 10m vaccine doses. The campaign aims to reach 360,000 children in three countries annually.
The report says Gavi – the Vaccine Alliance, the Global Fund to Fight Aids, Tuberculosis and Malaria, and UNITAID are providing just under $50m to fund the first phase of the schemes in Malawi, Kenya and Ghana.
The RTS,S vaccine, the first to give partial protection to children, trains the immune system to attack the malaria parasite, which is spread by mosquito bites. According to a Daily Maverick report, children between 5 months and 2-years-old will be inoculated, and according to the WHO, the vaccine will reach some 360,000 children per year until the end of 2022 across the three countries.
“There are over 250,000 deaths of children in Africa every year because of malaria,” Mary Hamel, the coordinator for the Malaria Vaccine Implementation Programme at the WHO is quoted in the report as saying. “It’s intolerable, the devastating effect for the families, societies. It’s the potential to save so many children’s lives that makes this vaccine so exciting.”
The protein-based RTS,S vaccine went through five years of clinical trials on 15,000 people in seven countries. The report says in one clinical trial, children who received doses of the vaccine had a lower chance of developing malaria, the WHO says, as well as of developing severe malaria. A study showed that the innovative vaccine prevented about four in 10 malaria cases among children and “overall, there were 29% fewer cases of severe malaria in children who received the vaccine.”
Hamel said that while the vaccine wasn’t a perfect solution, the “WHO expects this vaccine could have considerable impact”. “It is the world’s first malaria vaccine that has been shown to provide partial protection against malaria in young children”.
The report says these sentiments were echoed by Pedro Alonso, director of WHO’s Global Malaria Programme, who said: “The fight against malaria is one where we use imperfect tools; only when we combine them can we achieve great impact. This malaria vaccine adds a tool to our toolkit,” he said.
“This vaccine will be rolled out at a time when progress in the global malaria response has stalled,” he added, noting that a resurgence of the disease has been seen in some countries that had once achieved great progress.