Eradicating the ague in africa: two cheers for gsk’s new malaria vaccine  | thearticle

Last week, the World Health Organization’s (WHO) approval of the roll-out of a vaccine against malaria made the news. GlaxoSmithKline (GSK) had been working on finding an effective malaria

vaccine for 30 years. Stage Three trials, the final stage, took five years and were completed in 2015. Pilot implementation in Africa began in 2019. Before the Covid pandemic, such a WHO

approval would scarcely have merited a paragraph. That’s some measure of how vaccines are on everyone’s minds. It also says something about the response to any killer or debilitating disease

which is confined to the tropics. This is not a swipe at GSK particularly, nor at their perseverance, but comparison with the incredibly speedy design and production of anti-Covid vaccines

does inadvertently highlight pharmaceutical companies’ research – and commercial — priorities.  By the end of the 20th century, malaria still caused over 800,000 deaths worldwide every year,

most of them children under five and pregnant women, mostly living in sub-Saharan Africa. The Millennium Development Goals (MDGs) set a reduction target to reverse the incidence of the

parasite and to halve deaths from malaria by 2015. The roll-out of a new malaria vaccine, the first against any parasite, represents a collaborative response by GSK, the Bill and Melinda

Gates Foundation, and the Seattle-based health not-for-profit _Program for Appropriate Technology in Health _known as PATH, an impressive outfit with some 1,600 staff. It is another step

towards the goal of eradicating disease that emphasises the importance of partnerships.  Vaccines trigger our immune system to attack invading viruses. You might think that immune systems

prompted by a vaccine would be easily aroused against the two malaria parasites, _Plasmodium falciparum_ and _Plasmodium vivax_, large bodies when compared to Covid viruses. But you’d be

wrong. _Plasmodium_ is like some Alien life form, transforming itself several times in its life-cycle: merozoites bursting out of red blood cells causing fever and turning into gametocytes,

oocysts taking up residence in the salivary glands of certain types of female mosquitos, merozoites finding such a home-from-home in our livers that our immune system ignores them. _Homo

Sapiens_ and _Plasmodium_ have known each other for a very long time and the parasite has adapted and flourished. Finding the right stage of the parasite’s development to intervene, zapping

the parasite before it gets into the liver, or into the red blood cells, was only the beginning of the long haul to find an effective vaccine. The danger of the vaccine being mistakenly

taken for a magic bullet represents a problem for GSK. Their present vaccine alone is, at most, 40 per cent effective. Yet combined with seasonal treatments, two anti-malarial drugs

administered during each of the year’s most dangerous four months — after West Africa’s short rainy season – it does create a high level of protection from the disease. But scaling up such

combined treatments will make heavy demands on Africa’s fragile health systems. And for malaria to be eradicated, established preventative measures must continue alongside vaccination. 

Bed-nets, impregnated with insecticides harmless to people, contributed to the halving of malaria deaths around the world from an estimated 839,000 in 2000 to 438,000 in 2015 — though there

was only an 18 per cent drop in infections. American financier, Ray Chambers, appointed UN malaria envoy in February 2008, marshalled funding that contributed towards a global campaign that

delivered a billion bed-nets and prevented 6.2 million deaths. Even this simple solution was not as straightforward as it appeared. It required explaining the causes of malaria so that

people understood what bed-nets were for and how to use them –- and ensured they persisted keeping their young children tucked in, despite the nets reducing any cooling airflow.  The World

Bank bed-net programme in Sierra Leone and Nigeria was a case in point. Nets were delivered efficiently, but too often they got used as bridal veils, or fishing nets, or sold, or not hung

properly. Health education was necessary. And it will be just as essential to persuade people that besides getting vaccinated, the other protections against malaria remain vital: correct use

of bed-nets, cleaning up standing water where mosquitoes breed, access to rapid diagnostic kits – because misdiagnosis can be fatal.  Changing parents’ understanding and behaviour, as I

learned in Sierra Leone, needs a nationally-planned malaria control programme, involving everything from radio jingles to engaging chiefs, local elders, imams, sheikhs, pastors and priests

as health educators within their communities. I watched religious leaders preaching sermons and _khutba_ on parents’ moral duty to protect the under-fives, as well as training others in

their communities to undertake house-to-house visits, introducing malaria prevention messages.  Malaria is _now_ a tropical disease. But that is because in the last century countries with

substantial budgets for health and well-developed health systems succeeded in producing effective anti-malarial drugs and eliminating mosquitoes and thus the disease. Eight US Presidents

caught malaria. George Washington was infected in Virginia aged 17, Abraham Lincoln while growing up in Illinois. Deaths from malaria in Britain’s marshy coastal areas only began to decline

in the 19th century. In 1861, Britain was reading Charles Dickens’ _Great Expectations _in serial form. The story opens with Pip, the book’s protagonist, staring at his parents’ gravestone

and describing those of his dead brothers as, “little stone lozenges each about a foot long . . . arranged in a neat row”. It is in that graveyard that Pip and the escaped convict Magwitch

first meet. The setting for this encounter, St James, Cooling, in “the marsh country down by the river” in Kent, was on one of Dickens’ favourite walks, and the “stone lozenges” referred to

can still be seen today. They marked the graves of a large family whose children had died of “the ague” — malaria.  Malaria could be eradicated in Africa, too, but it would require better

co-ordinated national malaria campaigns, strengthening of health systems, and reversing our cuts in international development aid. Success to date has involved supportive governments and

complex international partnerships. In Sierra Leone, religious leaders, key influencers, reached five million people with national malaria programme messages. Ebola and the pandemic have

slowed the momentum created by the Millennium Development Goals. When less than one per cent of people in Africa have received Covid jabs, GSK’s announcement may seem almost irrelevant. But

the new vaccine has the capacity to further reduce malaria deaths from the present over 400,000 a year. It is a significant further step towards the goal of eradication. So perhaps not a

herogram for GSK, but at least two cheers. A MESSAGE FROM THEARTICLE _We are the only publication that’s committed to covering every angle. We have an important contribution to make, one

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