Almost inseparable from the notion of Africa is the histories of human suffering that plague the West Africa and Sub-Saharan region. Malaria is one of the leading causes of death in developing countries. In 2019, there were 229 million malaria cases globally that led to 409,000 deaths, 67 percent of which were children under the age of five. That is a daily death toll of 750 children: one child every two minutes. Half of these deaths come from only six sub-Saharan African countries.
The social and economic repercussions of these statistics speak for themselves. For centuries, this disease has ravaged the lives of hundreds of communities and thousands of families, leaving pain and suffering in its wake. It has been the cause of economic hardships as well as lost labour potential, wages, household income, and massive government spending in healthcare and preventative measures. In addition to other direct consequences, it is estimated that malaria costs the economies of developing countries at least $12 billion annually.
These staggering realities make the first malaria vaccine approved for widespread use by the World Health Organization (WHO) all the more admirable. As of October 6, 2021, three decades of labour paid off when the first malaria vaccine, RTS,S, also known as Mosquirix, developed by GlaxoSmithKline (GSK), a London-based pharmaceutical firm, received the greenlight after a pilot project was carried out in collaboration with the WHO in affected countries such as Malawi, Kenya, and Ghana.
Medical researchers and health workers have lavished praise for the vaccine, for the approval marks a beacon of hope for the hundreds of millions who contract the disease annually. This vaccine comes at a time when the WHO and other major organizations have been reporting a stagnation in the fight against the disease. Prior to the vaccine, as parasitic resistance to the most widely used treatment mounted and the Anopheles mosquito, the malaria vector, grew increasingly resistant to insecticides, malaria recovery efforts grew bleak. The emergence of this vaccine thus proves especially timely.
The development of RST,S is the product of new mRNA technology similar to those in many COVID-19 vaccines. Mosquirix targets Plasmodium falciparum—the most common and lethal of four malaria parasite species when the pathogen enters the body—before the parasite reaches the liver, its primary target.
Like all things, however, this vaccine is imperfect. Some experts are concerned about the actual impact this vaccine can make, given its middling long-term efficacy. The vaccine requires that a child receive four doses before the age of five, and immunity lasts a mere four years. A working system of distribution would be difficult to implement in any country; the poor health infrastructure, information systems, and high rates of poverty that plague many malaria-ridden countries exacerbate this implementation. As such, many experts are concerned about the accessibility of this vaccine and whether the price is worth it.
“But nobody really expected to get very high efficacy because malaria is such a complicated disease,” says Peter Smith, epidemiologist at the London School of Hygiene & Tropical Medicine (LSHTM), a scientific adviser to the project. Smith believes that despite this, the vaccine “could make a huge difference.” According to molecular biologist Joe Cohen, who led the vaccine effort until he retired from GSK in 2012, “The real period during which children are at risk of severe disease and death is under five years old.”
It is because of this fact that many leaders have decided to pursue distributing RST,S despite the challenges it poses. On its own, the malaria vaccine cannot reduce the number of infections currently being experienced. Only when implemented alongside existing prevention and treatment measures do the vaccines stand a chance at turning the tide. This means that in addition to maintaining their current measures, countries will have to find the funds to administer this vaccine at $5 per shot. While the vaccine was developed with the support of the Bill and Melinda Gates Foundation, it is unclear who will subsidize the cost of vaccinating the millions of at-risk children.
It seems safe to assume that once again this burden shall fall upon African governments whose healthcare systems are already taxed by COVID-19 and other illnesses. While malaria prevention and treatment is already underfunded, researchers estimate that it will take an additional $325 million to vaccinate vulnerable kids, leaving many to wonder: is this really worth it?
Yes. In a time when options are dwindling, it may be just what we need to push forward in our battle against this disease. In Ghana, where the vaccine was administered to over 2.3 children, health officials recorded that hospitalisations for severe malaria reduced by 30 percent. While it may not be the Malaria vaccine we’ve always dreamed of, it is still the one we need.
By: Dominique Williams