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World's First Malaria Vaccine Launches In Sub-Saharan Africa

Apr 23, 2019
Originally published on April 23, 2019 9:05 pm

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Today health officials are making history. They're rolling out the first approved vaccine aimed at stopping a human parasite. It's for malaria — and the hopes are that one day the vaccine could save the lives of tens of thousands of children each year.

"This [rollout] is a massive success of the research community," says Dr. Pedro Alonso, who directs the Global Malaria Programme at the World Health Organization.

This vaccine — called RTS,S — is one of the few immunizations designed and launched specifically to help young children in Africa, says Deborah Atherly at PATH, a nonprofit that helped develop the immunization.

"It's a pro-poor vaccine, if you will," Atherly says. "I think that's also a really important milestone in vaccine development and introduction."

Malaria is still a top killer of children worldwide, but children in Africa are most affected. Every two minutes a child or baby there dies of the disease. Some children can have up to six bouts of malaria in just one year, says Dr. Mary Hamel of WHO.

The vaccine took more than 30 years — and more than $500 million — to develop. It was an international collaboration among WHO, PATH, the pharmaceutical company GlaxoSmithKline and a network of African countries. The Bill & Melinda Gates Foundation — which is a sponsor of NPR and this blog — is also a funder of the vaccine.

On Tuesday, toddlers in Malawi started receiving the immunization. Then children in Ghana and Kenya will follow shortly. The goal is to vaccinate about 360,000 children in this large-scale pilot project. And then WHO will determine the best way to roll out the vaccine elsewhere, Atherly says.

The big question is: Will this vaccine work as well in the real world as it has in clinical trials, says epidemiologist William Moss, who directs the International Vaccine Access Center.

"The launch of the malaria vaccine is really a landmark," Moss says, "but the vaccine's efficacy is much lower than that for many of our other childhood vaccines."

In a large trial, the vaccine reduced the number of clinical malaria cases by about 40 percent and severe malaria cases by about 30 percent, Moss says. By comparison, some childhood vaccines offer more than 90 percent protection.

Parasites, such as malaria, are more complex than viruses and bacteria, Moss says. They can have more sophisticated machinery for evading our immune systems. So creating effective vaccines against them is quite challenging, he says.

Still, Moss thinks the vaccine could have a significant impact on children's health because malaria is so common in parts of sub-Saharan Africa. "There are estimates that one life would be saved for every 200 children who are vaccinated," he says.

Another issue with the vaccine is that children need four doses. That means four trips to a clinic — which could be tough for some families in rural areas, Moss says.

But PATH's Atherly thinks many families will want to make the extra trips.

"Just from a human perspective, I think if a mom can provide something for her child that will help control this disease, she will," Atherly says. "We believe there will be a lot of demand from the mothers and other caregivers."

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ARI SHAPIRO, HOST:

Today global health officials are making history. They're rolling out the first vaccine aimed at stopping malaria. Malaria infects more than 200 million people a year, and it's one of the biggest killers of children worldwide. In Africa, more than a quarter-million kids die each year from the disease. The vaccine has taken 30 years to develop. And as NPR's Michaeleen Doucleff reports, toddlers in Malawi will be the first to get it.

MICHAELEEN DOUCLEFF, BYLINE: Back in the mid-1980s, scientists at Walter Reed Army Institute here in the U.S. started developing an experimental malaria vaccine. The first versions failed, so they teamed up with the company now known as GlaxoSmithKline and tried again. Then they started seeing promising results in the petri dish. Thirty years later, that vaccine is finally ready to be given to kids in the countries that need it the most - those in sub-Saharan Africa.

DEBORAH ATHERLY: We're extremely excited that we're at the point of being able to do pilot introductions in the areas where malaria is actually causing the death and disease.

DOUCLEFF: That's Deborah Atherly, who leads vaccine deployment at PATH, a nonprofit which has helped develop the vaccine. Every two minutes, a child or baby in sub-Saharan Africa dies of malaria. In some places, a baby can have six bouts of it in just one year. Atherly points out that this vaccine is one of the few to be designed and launched specifically for children across Africa.

ATHERLY: I think that's also a really, really important milestone in sort of vaccine development and introduction.

DOUCLEFF: Most vaccines are targeted for people in rich countries because they are expensive to make. But this vaccine has been heavily subsidized by GSK, foundations and governments. Starting today, toddlers in Malawi will receive the vaccine, then kids in Kenya and Ghana. The initial goal is to immunize about 360,000 children over the next few years. But the vaccine isn't a silver bullet for malaria. For starters, kids need four doses of the vaccine for it to be effective. For families in rural areas, four trips to a clinic could be hard. The second problem is the vaccine isn't super effective.

WILLIAM MOSS: The vaccine efficacy is much lower than many of our other childhood vaccines.

DOUCLEFF: That's William Moss. He directs the International Vaccine Access Center and is an epidemiologist at Johns Hopkins University. He says the vaccine protects kids only about 30 percent of the time. By comparison, many childhood vaccines offer 80 or 90 percent protection. The buzz around the vaccine is warranted. So many children get malaria in Africa that even a weak vaccine can have a big impact on a community's health.

MOSS: There are estimates that one life would be saved for every 200 children who are vaccinated, so that's where the impact is.

DOUCLEFF: And that could save the lives of tens of thousands of kids every year.

Michaeleen Doucleff, NPR News. Transcript provided by NPR, Copyright NPR.