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fter nearly 60 years of rigorous research, scientists have achieved the seemingly impossible: the global community now has not one, but two effective malaria vaccines. This development is crucial considering the devastating impact of malaria, which remains one of the most fatal infectious diseases worldwide, claiming the lives of approximately half a million individuals annually, with young children being the most vulnerable.
Although research on a vaccine began in the 1960s, the complexity of the challenge hindered the World Health Organization (WHO) from endorsing the RTS,S vaccine until only two years ago. This vaccine, now being implemented across several African countries, is being supplemented by another WHO-backed vaccine called R21. Significantly, R21 is easier and less expensive to produce, leading to a significant boost in the vaccine’s availability. When used in conjunction with other preventive measures such as insecticide-treated bednets, R21 has the potential to save numerous lives.
However, it is important to note that R21 requires four doses for effective protection, which presents a considerable challenge in regions facing malaria prevalence due to factors like poverty, inadequate infrastructure, limited healthcare services, and insecurity. Furthermore, the vaccine’s efficacy may be lower in real-life settings compared to controlled trial conditions, where it has shown a 75% reduction in cases in areas with seasonal malaria.
Malaria was eradicated from western Europe by the 1930s, and since 2000, 21 countries have successfully eliminated the disease. However, the ambitious target set in 2015 to reduce malaria cases and fatalities by 90% by 2030 now appears unattainable. In fact, malaria cases have increased in recent years, rising from 232 million in 2019 to 247 million in 2021. This rise can be attributed to various factors, including disruptions in prevention and treatment services during the COVID-19 pandemic, global warming, the development of insecticide resistance in mosquitoes, and drug resistance in the malaria parasites they transmit.
Insufficient funding has also contributed to the surge in malaria cases, as only half of the required $7.3 billion was secured last year, as reported by the WHO. Historically, investment has played a significant role in the success or failure of malaria control measures. Recognition of effective interventions leads to increased funding from donors. Had malaria been a problem in wealthier nations, a vaccine may have been developed sooner, as pharmaceutical companies tend to focus research where substantial profits are anticipated.
It is essential to understand that the new malaria vaccine does not provide an all-encompassing solution. It must be implemented alongside existing measures, and its importance and potential should not be dismissed. Progress in malaria control requires the deployment of a range of complementary strategies. At a time when efforts against malaria may seem disheartening, this vaccine offers hope. Scientists continue to explore various interventions, such as genetically modifying mosquitoes, and research must persist to develop vaccines offering improved and longer-lasting protection against different forms of the malaria parasite. While current vaccines target the Plasmodium falciparum parasite responsible for approximately 90% of malaria deaths, the threat posed by the Plasmodium vivax parasite should not be overlooked.
The recent Nobel Prize in Physiology or Medicine awarded to Katalin Karikó and Drew Weissman, pioneers of mRNA technology, has once again emphasized the remarkable potential offered by this innovative approach. Companies like BioNTech and others are already working on mRNA-based malaria vaccines. Overcoming setbacks on the path to malaria control is inevitable, but there will also be moments of triumph that deserve recognition and celebration as they emerge.
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