Yes, you read it right. We might have malaria vaccine available very soon; if luckier, may be as soon as this monsoon. RTS,S/AS01, which has been in the making for many years now, once approved, would be the first of its kind against malaria and it could turn out to be the most important tool for potential prevention of malaria and reduction of its transmission.
Why is it in dire need? Apparently, half of the world’s population is at risk of malaria, threatening a devastating impact on people’s health and livelihoods around the globe, poorest and marginalized communities being victimized majorly. If WHO’s estimates (December 2014) are to be believed, there were about 198 million cases of malaria in the year 2013 resulting in an estimated 5,84,000 deaths (three-quarters of them being children under 5). Though most malarial cases and deaths are focussed in Africa where it kills almost half a million children under 5 each year, some parts of Asia, Latin America, the Middle East (to a lesser extent), and of Europe are also affected. India isn’t far behind: with around 128 million suspected cases of malaria and about 280 million Indians at high risk of getting infected with malaria.
On the World Malaria Day (25th April 2015), the WHO called for high-level commitment towards vision of a malaria-free world with the theme, in the future: Defeat malaria. However ambitious it may sound, driving on the pride of eliminating malaria from four countries in the past decade, the new strategy aimed to eliminate it from further 35 countries by 2030 and to reduce cases and deaths by 90% from current levels require meticulous planning and implementation strategy. There is tremendous stress on the global health community to address on priority basis. There are many significant gaps in the diagnosis, treatment and prevention of malaria and the scenario demands an urgent need to expand prevention measures and happy wheels demo quality-assured diagnostic testing and treatment to reduce the burden caused by malaria.
For the past many decades of struggle to control malaria epidemic through using insecticide-treated nets, indoor residual spraying and treatment with artemisinin-based combination therapies, the very idea of malaria prevention through vaccines seemed a far cry despite intense efforts in research. This is proving to be challenging due to several reasons like the complexity and diversity of the parasite, consideration of which stage and effect (anti-parasitic/anti-toxic) of parasite should be targeted and other factors.
However, RTS,S/AS01 (commercial name: Mosquirix), the most advanced (recombinant) vaccine candidate so far to combat the most deadly form of human malaria (Plasmodium falciparum) is in the process of getting evaluated and licensed. This being developed by the non-profit PATH Malaria Vaccine Initiative (MVI) and GlaxoSmithKline (GSK) with support from the Bill and Melinda Gates Foundation, had its Phase 3 trial started in May 2009 and has completed enrolment in 2011 with 15,460 children in seven countries of sub-Saharan Africa where malaria still kills around 1300 children every day. In November 2012, after 18-month long trial (Phase 3) of RTS,S, they observed that it provided prudent protection against both clinical and severe malaria in young children (by 46 percent) and infants (by 27 percent) for up to 4 years after vaccination (prolonged by the booster dose). The results were published in The Lancet in April 2015 issue. GSK has been developing the malaria vaccine for three decades, and now has the credible support of the WHO, is ready to recommend the use of RTS,S once it is assessed by the European Medicines Agency (EMA) for its efficacy, safety and quality.
If all goes well, this would be a milestone in combating malaria and bringing down the burden of epidemics and we could soon use vaccines to protest ourselves from the deadly disease. Fingers crossed!
– Sharmila Shanmugasundaram