Recently, the World Health Organisation allowed the widespread use of the world’s first vaccine against malaria, a common mosquito-borne disease that claims more than four lakh lives every year.
WHAT IS MOSQUIRIX?
According to the European Medicines Agency (EMA), Mosquirix is a vaccine that is given to children aged 6 weeks to 17 months to help protect against malaria. Developed by British drugmaker GlaxoSmithKline, the mosquirix vaccine also known as RTS,S/AS01, has already been administered to nearly 8 lakh children in Ghana, Kenya and Malawi as part of a pilot programme since 2019.
The WHO endorsement paves the way for the use of this vaccine outside the pilot programme, in all areas where malaria is known to be widely prevalent.
The RTS.S/AS01 vaccine, known by its brand name of Mosquirix, is considered only the first step towards effective immunization of the global population against malaria.
This vaccine is able to prevent severe cases of malaria in only 30% of the cases, and the quest for more effective vaccines is still underway.
HOW IS MOSQUIRIX USED?
Mosquirix is given as a 0.5 ml injection into a muscle of the thigh or in the muscle around the shoulder (the deltoid). The child is given three injections with one month between each injection.
A fourth injection is recommended 18 months after the third. Mosquirix can only be obtained with a prescription.
HOW CAN THE VACCINE HELP?
WHO’s recommendation is based on the advice of its two global advisory bodies, one for immunization and the other for malaria.
WHO has recommended that in the context of comprehensive malaria control, the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by it.
The malaria vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.
P. FALCIPARUM
The vaccine acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa.
Among children who received 4 doses in large scale clinical trials, the vaccine was able to prevent approximately 4 in 10 cases of malaria over a 4-year period.
This is the first malaria vaccine that has completed the clinical development process, and received a positive scientific opinion from the European Medicines Agency (EMA).
WAY FORWARD
The next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout in endemic countries, and Country decision-making on whether to adopt the vaccine as part of national malaria control strategies.
A vaccine is a breakthrough addition to the malaria toolkit and can help get malaria control back on track.
THE TRAIL
The trials of this malaria vaccine started in 2019. When trialled in 450 children in Burkina Faso, the vaccine was found to be safe & showed “high-level efficacy” over 12 months of follow-up.
A malaria vaccine has taken much longer to come to fruition because there are thousands of genes in malaria compared to around a dozen in coronavirus, and a very high immune response is needed to fight.
The vast majority of vaccines haven’t worked because it’s very difficult.
WHICH COUNTRIES IT HAS BEEN ADMINISTERED?
It is also the first malaria vaccine to be introduced by three national ministries of health through their childhood immunization programmes. More than 800,000 children in Ghana, Kenya, and Malawi have been vaccinated, and are benefiting from the added protection provided by the vaccine as part of a pilot programme.
Other recent clinical evidence shows that strategic delivery of the vaccine just prior to the high malaria transmission season in areas where malaria is highly seasonal, can optimize impact and markedly reduce mortality, especially when combined with other recommended malaria control interventions.
GLOBAL BURDEN OF MALARIA
Malaria is known to be one of the deadliest diseases in human history, having claimed millions of lives. Even now, the disease kills over four lakh every year, according to WHO figures.
This is still a huge improvement from twenty years ago, when close to double the number of people were succumbing to the disease.
Malaria is most endemic in Africa, with Nigeria, Congo, Tanzania, Mozambique, Niger and Burkina Faso together accounting for over half the yearly deaths.
In 2019, there were an estimated 229 million cases of malaria worldwide, and the estimated number of malaria deaths that year stood at 409,000.
Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274,000) of all malaria deaths worldwide.
India is one of the countries badly affected by the disease. Deaths due to malaria have come down sharply in the last few years – officially these are only in hundreds now – but infections continue to be in millions.
COUNTRIES THAT HAVE ELIMINATED MALARIA
Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria.
In 2019, 27 countries reported fewer than 100 indigenous cases of the disease, up from 6 countries in 2000.
Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination.
Over the last two decades, 11 countries have been certified by the WHO Director-General as malaria-free:
United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019), and El Salvador (2021).
With this we come to the end of this blog. We covered all the major details about the first ever vaccine against malaria.
