The World Health Organisation (WHO) has come out to endorse the world’s first malaria vaccine and recommended it to be used on children across Africa. On 6 October, WHO director-general Tedros Adhanom Ghebreyesus announced the recommendation and called it “a historic moment” after its expert advisory groups endorsed using the malaria vaccine. The RTS,S or Mosquirix, was developed by British drugmaker GlaxoSmithKline (GSK) in 1987. It has been in the making for over 30 years and is the only known jab that has shown the capability to reduce the chances of contracting malaria.
“Today’s recommendation offers a glimmer of hope for the continent, which shoulders the heaviest burden of the disease. And we expect many more African children to be protected from malaria and grow into healthy adults,” said Dr Matshidiso Moeti, WHO’s Africa director.
WHO has been coordinating the research for Mosquirix in Ghana, Kenya and Malawai since 2019 in which over 8 lakh children were administered the malaria vaccine. So far, 2.3 million doses of Mosquirix have been administered to the children.
WHO said its decision was largely based on the results from the ongoing research in Ghana, Kenya and Malawi where more than 800,000 children have been administered the malaria vaccine since 2019.
“This is a vaccine developed in Africa by African scientists and we’re very proud,” said WHO chief Tedros Adhanom Ghebreyesus.
While Mosquirix is the first vaccine to be authorised, it does have challenges: the vaccine is only about 30% effective, requires up to four doses and its protection fades after several months.
Still, given the extremely high burden of malaria in Africa where the majority of the world’s more than 200 million cases a year and 400,000 deaths a year occur scientists say the vaccine could still have a major impact.
“This is a huge step forward,” said Julian Rayner, director of the Cambridge Institute for Medical Research, who was not part of the WHO decision.
“It’s an imperfect vaccine, but it will still stop hundreds of thousands of children from dying.”
Rayner said the vaccine’s impact on the spread of the mosquito-borne disease was still unclear, but pointed to coronavirus vaccines as an encouraging example.
“The last two years have given us a very nuanced understanding of how important vaccines are in saving lives and reducing hospitalizations, even if they don’t directly reduce transmission,” he said.
Dr Alejandro Cravioto, chair of the WHO vaccine group that made the recommendation, said designing a shot against malaria was particularly difficult because it is a parasitic disease spread by mosquitoes.
“We’re confronted with extraordinarily complex organisms,” he said. “We are not yet in reach of a highly efficacious vaccine, but what we have now is a vaccine that can be deployed and that is safe.”
WHO said side effects were rare, but sometimes included a fever that could result in temporary convulsions.
Sian Clarke, co-director of the Malaria Centre at the London School of Hygiene and Tropical Medicine, said the vaccine would be a useful addition to other tools against the disease that might have exhausted their utility after decades of use, like bed nets and insecticides.
“In some countries where it gets really hot, children just sleep outside. A bed net cannot protect them,” Clarke explained. “So obviously if they have been vaccinated, they will still be protected.”
Clarke said that in the last few years little significant progress has been made against malaria.
“If we’re going to decrease the disease burden now, we need something else,” she explained.
Azra Ghani, chair of infectious diseases at Imperial College London, said she and colleagues estimate that the introduction of the malaria vaccine in African children might result in a 30% reduction overall: up to 8 million fewer cases and as many as 40,000 fewer deaths per year.
“For people not living in malaria countries, a 30% reduction might not sound like much. But for the people living in those areas, malaria is one of their top concerns,” Ghani said.
“A 30% reduction will save a lot of lives and will save mothers (from) bringing in their children to health centres and swamping the health system.” She said the WHO guidance would hopefully be a “first step” to making better malaria vaccines. Ghani said that the messenger RNA technology used to make two of the most successful Covid-19 vaccines, those from Pfizer-BioNTech and Moderna, may boost efforts to produce a second-generation malaria vaccine.
“We have seen much higher antibody levels from the mRNA vaccines, and they can be adapted very quickly,” Ghani said, noting that BioNTech recently said it would begin researching a possible malaria shot. “It’s impossible to say how that may affect a malaria vaccine, but we definitely need new options to fight it.”