A different vaccine in the works

The most life-saving new vaccines may not be the bevy of COVID-19 shots going into arms around the world. It may, instead, be one tested on 450 toddlers in Burkina Faso.

Preliminary reports published in Lancet April 20 from a small vaccine test indicate researchers have found a formula that can reliably prevent malaria. If the early results are born out in larger trials, the malaria vaccine developed by University of Oxford scientists could open the door to ending one of the world’s deadliest diseases.

Previous attempts to develop a malaria vaccine haven’t managed to reach the World Health Organization’s goal of 75 percent. For 50 years, scientists have labored to develop a shot that meets that benchmark. GlaxoSmithKline’s Mosquirix vaccine—which earned approval for pilot programs in Ghana, Malawi, and Kenya in 2019—provided only 30 percent protection after four doses.

To test the Oxford-developed R21, researchers partnered with scientists in malaria-ravaged Burkina Faso in West Africa. A year after children aged 5-17 months received R21 shots, researchers reported 77 percent effectiveness. That makes R21 the first malaria vaccine ever to meet the WHO goal in a phase 2 trial.

According to Adrian Hill, the director of Oxford’s Jenner Institute, phase 3 trials involving 4,800 participants could begin this year, with results ready in 2022. If those tests mirror earlier results, the malaria vaccine could see approval as early as 2023. For epidemiologists in sub-Saharan Africa, that’s welcome news. “Now we all wait patiently to see what will come out,” University of Ghana epidemiologist Kwadwo Koram told Nature. “If that shows 75 percent efficacy, then we would be very happy and jumping around.”

Unlike most diseases, which spread through viral or bacterial infection, malaria transmits via single-cell parasites called Plasmodium. Once mosquito bites spread the parasites into humans, Plasmodium attack liver and blood cells, causing flu-like symptoms or even death. The World Health Organization estimated there were 229 million cases of malaria in 2019 with 409,000 worldwide deaths. Children under 5, who are considered the most vulnerable to the disease, accounted for two-thirds of malaria deaths that year.

National governments and public health officials have relied on mosquito control programs like insecticides and bed nets to control spread of the disease. Using these methods alongside anti-malarial medicines, wealthy, developed nations have largely eradicated malaria. But bed nets and bug spray have only afforded a partial solution, and in sub-Saharan Africa, the disease rages on, claiming lives and soaking up foreign aid. The United States alone has directed more than $13.2 billion toward solving the global malaria problem since 2001, according to the Kaiser Family Foundation.

Hill said that, after proving efficacy, the next challenge for the R21 vaccine will be to build up reliable production lines. “Really importantly, it can be manufactured at large scale,” he told Al Jazeera. “And we’re hearing from the Serum Institute of India that they’ll be able to produce 200 million doses or more.”