A malaria vaccine has proven to be very effective in trials in Africa, offering a real possibility of reducing the death toll from a disease that kills 400,000 mostly young children each year.
The vaccine, developed by scientists at the Jenner Institute at Oxford University, showed up to 77% effectiveness in a 12-month trial on 450 children in Burkina Faso.
The hunt for malaria vaccine has been going on for almost a century. One, the Mosquirix vaccine developed by GlaxoSmithKline, has been the subject of long clinical trials but is only partially effective, preventing 39% of malaria cases and 29% of severe malaria cases in young children in Africa over four years. It is piloted by the World Health Organization in parts of Kenya, Ghana and Malawi.
The Oxford vaccine is the first to reach the WHO goal of 75% efficacy against parasitic disease transmitted by mosquitoes. Larger trials are now starting, involving 4,800 children in four countries.
Professor Adrian Hill, director of the Jenner Institute, where the Oxford / AstraZeneca Covid vaccine was invented, said he believed the vaccine had the potential to significantly reduce the death toll. “What we’re hoping to do is bring those 400,000 down to tens of thousands over the next five years, which would be absolutely fantastic.”
Other interventions, such as insecticide-treated mosquito nets and antimalarial drugs, have reduced the death toll by one million a year, he said, and these must continue. But, if the vaccine could reduce the death toll to tens of thousands, perhaps they could turn to “a bigger goal – eventually eradicating malaria.”
Hill said the institute could seek emergency approval for the malaria vaccine, just as it did for the Covid vaccine. “I make as strong an argument as possible, that because malaria kills many more people than Covid in Africa, you should think about authorizing emergency use of a malaria vaccine for use in Africa. And this has never been done before.
The institute would likely seek scientific advice from regulators in Europe or the UK on the vaccine and then ask the World Health Organization to approve its use in Africa. “They did Covid in a matter of months – why shouldn’t they have malaria for a similar length of time as the health problem on an even larger scale in Africa?” Hill said.
The vaccine will be manufactured on a large scale and at low cost, say the researchers, who have reached an agreement with the Serum Institute of India, which is involved in making the Oxford / AstraZeneca Covid-19 vaccine.
The Serum Institute has had to delay delivery of the Covid vaccine to the rest of the world due to the huge increase in cases in India, but has promised to deliver 200 million doses per year of the malaria vaccine if authorized.
Hill said the best-case scenario was approval by the end of 2022, when the Serum Institute would have sufficient capacity.
Dr Cyrus Poonawalla and Adar Poonawalla, president and CEO of the Serum Institute respectively, said in a statement that they were “very pleased to see these results on a safe and highly effective malaria vaccine that will be available worldwide.” The project was carried out in collaboration with Oxford and Novavax, which provide adjuvant, a substance that enhances the response of the immune system.
“We are confident that we will be able to deliver over 200 million doses per year as per strategy, as soon as regulatory approvals are available,” they said.
The children participating in the trial, which is published in the Lancet journal, were between the ages of five and 17 months and lived in Nanoro, an area encompassing 24 villages with a population of around 65,000 people. They were divided into three groups; two had the vaccine, but with a low or high adjuvant dose, while the third group received a rabies vaccine, thus acting as a control.
The children received three doses and have since received another booster. Mosquirix vaccine is also given in four doses.
Hill said mothers were keen to bring their children back for other vaccines because of their experience with malaria. Efficacy was 77% in the high dose adjuvant group and 74% in the low dose group.
Gareth Jenkins, Malaria No More UK, said: “We can end malaria in our generation, but only if governments invest in the research needed to deliver the new drugs and products that can hasten the end of this terrible disease.
“The Jenner Institute’s groundbreaking work on new Covid-19 and malaria vaccines is a prime example of this and demonstrates how much the safety of humanity depends on new science.
“An effective and safe malaria vaccine would be an extremely important additional weapon in the arsenal needed to defeat malaria, which still kills more than 270,000 children each year. For decades, British scientists have been at the forefront of developing new ways to detect, diagnose, test and treat malaria, and we must continue to support them.
“A world without malaria is a safer world both for the children who would otherwise be killed by this disease, and for us here at home. Countries freed from the burden of malaria will be much better equipped to tackle new disease threats when they inevitably emerge in the future. “