I reported some time ago on the development of a vaccine for malaria. Malaria has been one of the major killers of children in the developing world for centuries; it currently kills hundreds of thousands of children each year.

     Malaria also stays with you as an adult even if you survive the initial case. I am told I still cannot give blood for transfusions because I caught a mild case of malaria in Sierra Leone fifty-seven years ago.

     This month it was announced that Ghana has become the first country in the world to approve the new vaccine for malaria that has been developed by Oxford University. The approval is unusual as it comes before the publication of final-stage trial data. However, the excitement in the international medical community over something that has been sought for so long, has probably modified the caution with which new vaccines are normally treated. Hopefully, this excitement will also eliminate the influence of the usual cranks and conspiracy theorists who are anti-vaxxers.

     It is unclear when the vaccine for malaria may be rolled out in Ghana since other regulatory bodies, including the World Health Organization (WHO), are still assessing its safety and effectiveness. “The WHO can provide support, but it is not an approving institution. The FDA has the mandate as a regulator, and that is what we have done,” said Delese Darko, CEO of Ghana’s Food and Drugs Authority (FDA). Darko did not comment on the timeline for the vaccine rollout as that will be organized by the Ghana health service, the Ghana Malaria Programme, and the country’s immunization body, the EPI.

     It is impossible to over-state the importance of this development. The mosquito-borne disease kills more than 600,000 people each year, most of them children in Africa.

     Oxford scientist Adrian Hill said Ghana’s drug regulator has approved the vaccine for malaria domestically for the age group at highest risk – children aged 5 months to 36 months. Oxford has a deal with Serum Institute of India to produce up to 200 million doses of the vaccine – known as R21 – annually.

     However, this is not the first vaccine for malaria that the pharmaceutical industry has produced. Glaxo, SmithKline (GSK) produced the first malaria vaccine, Mosquirix, which was endorsed by the WHO last year after decades of work. But a lack of funding, and commercial potential, is thwarting GSK’s capacity to produce as many doses as needed, demonstrating the need for another candidate.

     GSK has committed to produce up to 15 million doses of Mosquirix every year through 2028, well under the roughly 100 million doses a year of the four-dose vaccine the WHO says is needed long-term to cover around 25 million children. The Oxford vaccine for malaria can now help fill this gap.

     Ghana, Kenya and Malawi were all involved in the pilot program for the roll-out of Mosquirix, and have begun introducing it more widely in recent months; since the roll-out began in 2019, 1.2 million children across the three countries have received at least one dose. The WHO said last month that in the areas where the vaccine has been given, child mortality has dropped by 10%.

     A vaccine for malaria has taken decades to develop given the complicated structure and lifecycle of the malaria parasite.

     Mid-stage data from the Oxford vaccine trial involving more than 400 young children was published in September, showing vaccine efficacy of between 70-80% at 12 months following the fourth dose. Data from an ongoing phase III clinical trial with 4,800 children in Burkina Faso, Kenya, Mali and Tanzania is due to be published in the coming months.

     No-one with any sense, or compassion, could possibly argue against this wonderful development, except the lunatic anti-vaxxers of course, but it should send a warning signal of required planning to the governments of those countries that stand to benefit most. If the vaccines can be distributed effectively, and that is always a question, then infant mortality rates will drop dramatically.

     It is, perhaps, not politically correct to mention this, but many poor African families have multiple children on the assumption that many will not survive to adulthood. When many more survive because of better health conditions, including vaccines, it creates a completely new set of economic hardships; populations can boom rapidly.

     Education and family planning have to go hand-in-hand with the vaccine programs so that one tragedy is not replaced with another. Kenya has already gone through that cycle once, when a boom in health services resulted, unintentionally, in a boom in population that the government was not prepared for.

     The news from Ghana is excellent but reality says it should be accompanied by realistic planning and investment so that the gains can be sustained.

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