There was no vaccine for 35 years: why the "killer infection" malaria cannot be defeated

Vaccines against COVID-19 managed to be made in almost a year, but as many as 35 people were waiting for the WHO-approved vaccination against malaria


World Health Organization (WHO)first approved a malaria vaccine in October 2021. “This is a historic moment,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

The vaccine was named RTS,S.Its developers promised that fully vaccinated children would have a 30% reduction in the incidence of severe disease. In 2020, a research team estimated that a vaccine could prevent between 3 and 10 million cases of illness each year and save between 14,000 and 51,000 lives of young children.

But during the general celebration they missed onean important detail - the main ingredient of the malaria vaccine was actually almost 35 years old. Researchers have known since the late 1990s that this formula was effective in protecting against infection.

Why did the vaccine take so long?

The question arises why the vaccine from the mainthe killer infection - malaria - took so long to create? According to the researchers involved in the development of the RTS, S, the complex biology of the parasite played a role. There was also insufficient funding during its production. This hampered the logistics of research testing at every stage.

People who suffer from malaria, "they don'tEuropeans, they are not Australians, they are poor African children,” said Ashley Birkett, director of the malaria vaccination initiative at PATH, a non-profit global health organization. “Unfortunately, I think we have to admit that this is one of the reasons for the lack of urgency,” she said.

Researchers have been looking for a malaria vaccine since the end1960s. In 1980, they identified a protein with which the parasite is almost completely covered - it is a circumsporozoite protein. Researchers realized that a vaccine directed against this protein could provide immunity.

After the 1984 governmentUS researchers sequenced the gene for this protein, the military asked them to develop a malaria vaccine to protect military personnel abroad. Government officials then turned to Smith, Kline & French, the predecessor company of pharmaceutical giant GlaxoSmithKline, for help.

What were the difficulties with the malaria vaccine?

Experts note that this work was verydifficult. The malaria parasite has a complex life cycle with at least three distinct stages. When it enters the human body, it literally evolves completely, said Lod Schuerman, spokesman for GSK's global vaccination program.

If a vaccine is developed for a specific stage,then it will stop the parasite only for a while. What's more, the basic tools researchers use today to accelerate vaccine development didn't exist in the 1990s.

Scientists have vaccinated people dozens of timesvaccine based on circumsporozoite protein, but all attempts have failed. The exception was RTS,S. In the late 1980s and early 1990s, a team of scientists moved forward, and a 1998 study in the Gambia of 250 men showed that the vaccine prevented 34% of infections.

If RTS,S has existed for a long time, then why has it not been used for so long?

Nevertheless, attention to the vaccine was caused more by intellectual interest than by the desire to help the sick as soon as possible. Malaria was not seen as a public health problem.

As the people involved in the development of the vaccine said, the only difficulties that lay ahead were the testing of the vaccine, which does not have a commercial market.

When vaccine manufacturers startedtrials in African countries, they realized that this is a very difficult task. For example, there were many logistical problems and there were no suitable conditions for laboratory research.

Phase I and II trials that evaluatethe safety and efficacy of the vaccine were tested first in adults, then in older children, and finally in very young children. It was also necessary to optimize the dosage for each age group, taking into account side effects. This whole process took about 10 years.

Phase II trial results were successful,infants began to become infected less frequently by 65.9% compared with the control group. This led to phase III trials, which only began in 2009.

Phase III trials took place from 2009 to 2014 inseven countries in sub-Saharan Africa. More than 15,000 children took part in them. And the results were promising, so much so that GSK began preparing the plant for production.

Everything had to be started over. Why?

But in October 2015, the WHO reviewed data onphase III results. It turned out that vaccinated children were more likely to have meningitis than in the control group. There was also an increase in mortality among vaccinated girls, although it was not entirely clear whether this was due to the vaccine. To address these concerns and test the vaccine in more advanced settings, the WHO has asked for an even larger trial.

Today, most researchers agree onthat additional research was warranted. It was important to rule out any potential safety concerns, said Wongani Nyangulu, a physician who heads the Phase IV research center in southern Malawi.

The vaccine was eventually tested for 900000 children in Ghana, Malawi and Kenya. In October 2021, WHO reviewed the results and recommended a vaccine for widespread use in areas with moderate or high levels of malaria transmission. More than 20 years after the first successes in vaccine development, RTS,S was ready for mass use.

Doctors around the world have noticed a major difference in how they treat COVID-19 and malaria.

“If the development of a vaccine against malariaIf the same resources were sent as in the case of COVID-19, then malaria could be eradicated,” wrote Damaris Matoke-Muhia, a scientist at the Kenya Medical Research Institute. She noted that malaria has killed more people in Africa than COVID-19.

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