I reported a while ago on the development of a vaccine against malaria, and the fact that the search for such a life-saving solution to one of the world’s greatest killers had taken years. Recently, that success story has been upgraded in a significant way. A cheap malaria vaccine that can be produced on a massive scale has been recommended for use by the World Health Organization (WHO). The vaccine has been developed by the University of Oxford: It is only the second malaria vaccine ever to be developed. Malaria kills mostly babies and infants, and has been one of the biggest scourges on humanity, forever.

     There are already agreements in place to manufacture more than 100 million doses a year of this new vaccine.

     It has taken more than a century of scientific effort to develop effective vaccines against malaria. The disease is caused by a complex parasite, which is spread by the bite of blood-sucking mosquitoes. It is far more sophisticated than a normal virus, as it hides from our immune system by constantly shape-shifting inside the human body. That makes it hard to build up immunity naturally through catching malaria, and difficult to develop a vaccine to combat it.

     It is almost two years to the day since the first vaccine – called “RTS,S” and developed by GSK – was backed by the WHO. On learning about the new vaccine, Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO, said it was a moment of “great pleasure”. “I used to dream of the day we would have a safe and effective vaccine against malaria, now we have two,” he said.

     The WHO said the effectiveness of the two vaccines was “very similar” and there was no evidence one was better than the other. However, the key difference is the ability to manufacture the University of Oxford vaccine – called R21 – at scale.

     The world’s largest vaccine manufacturer – the Serum Institute of India – is already lined up to make more than 100 million doses a year, and plans to scale up to 200 million doses a year:

So far there are only 18 million doses of “RTS,S” available.

     The WHO said the new R21 vaccine would be a “vital additional tool”. Each dose costs $2-4 (£1.65 to £3.30), and four doses are needed per person. That is about half the price of the “RTS,S”. vaccine.

     The two vaccines use similar technologies, and target the same stage of the malaria parasite’s lifecycle. However, the newer vaccine is easier to manufacture as it requires a smaller dose and uses a simpler adjuvant (a chemical given in the vaccine that jolts the immune system into action).

     In 2021, there were 247 million cases of malaria worldwide, and 619,000 people died, most of them children under the age of five. More than 95% of malaria is found in Africa. Dr. Matshidiso Moeti, the WHO regional director for Africa, said: “This second vaccine holds real potential to close the huge demand-and-supply gap. Delivered at scale, and rolled out widely, the two vaccines can help bolster malaria prevention, and save hundreds of thousands of young lives.”

     Data that has been published online, but that has not yet been through the usual process of scientific review, shows the R21 vaccine is 75% effective at preventing the disease in areas where malaria is a seasonal problem.

     The WHO’s strategic advisory group of experts said that figure was comparable to the first vaccine (RTS,S) in seasonal areas: The effectiveness of both malaria vaccines is lower in areas where the parasite is present all year round.

     Professor Sir Adrian Hill, director of the Jenner Institute in Oxford, where R21 was developed, said: “The vaccine is easily deployable, cost effective and affordable, ready for distribution in areas where it is needed most, with the potential to save hundreds of thousands of lives a year.”

     Gareth Jenkins, from “Malaria No More UK”, said: “The reality is that financing to combat malaria globally is far from where it needs to be, and annual deaths from malaria rose during the pandemic and are still above pre-pandemic levels, so we cannot afford to be complacent as new tools are developed.”

     Although this is great news and should be celebrated worldwide, I would add a word of caution. That caution does not, in any way, detract from the achievement of this new vaccine, and its life-saving potential. It concerns what happens in countries where successful use of this vaccines becomes a reality. It concerns the necessary accompaniment of family planning programs.

     As an example, when women traditionally have, say, ten children, based on the reality that seven to eight of them will die in childhood from malaria, that birthrate will have severe economic consequences when only one or two of them die of malaria.

     This concept applies to all aid programs that result in better health, and the world’s aid donors have been very slow in recognizing this unfortunate economic reality. All the efforts aimed at health and survival betterment are wasted if the end result is a massive, and unsustainable, increase in the population. Children will just die of malnutrition, or starvation, instead of malaria.

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