On October 6, the World Health Organisation (WHO) recommended the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine, commonly known as Mosquirix, manufactured by GlaxoSmithKline (GSK). After years of trial in Ghana, Kenya and Malawi, this four-dose vaccine is the first safe and cost-effective vaccine proven to have helped prevent the disease.
Malaria affects about half a million people a year. While it is also endemic in southeast Asia, the eastern Mediterranean, the western Pacific, and Central and South America, most of these cases are native to sub-Saharan Africa, including a staggering 260,000 children under the age of five. In fact, it is one of the primary causes of childhood illness and death in the region.
The development of the RTS,S is thus being hailed as historic not only because it is the first-ever malaria vaccine but also because it is the first vaccine against any parasitic disease. Crucially, it has proven to stimulate a child’s immune system to thwart Plasmodium falciparum, which is considered to be the deadliest of five malaria pathogens and the most prevalent one in Africa.
However, as historic as the vaccine’s development is, RTS,S has an efficacy rate of only around 40% against regular malaria cases and just 30% in severe cases. Nevertheless, if it is put to use in the hardest-hit countries, the vaccine is strong enough to prevent 5.4 million cases and deaths of 23,000 children per year.
Aside from the public health impact, the new vaccine is also expected to be a game-changer for African economies, given that malaria is both a cause and consequence of poverty. Those affected by the disease incur substantial medical costs and lost income. Simultaneously, rural and poor populations are the highest at risk because they are the least likely to have the means to prevent or treat malaria. Taking this into consideration, the World Bank estimates that malaria slows economic growth in some African nations by up to 1.3% a year.
According to Voices for a Malaria-Free Future, African households lose up to 25% of their income to the disease. With respect to national economies, the disease can negatively impact some nations’ gross domestic product by as much as an estimated 5–6%. Meanwhile, the annual direct and indirect costs of malaria to the African continent as a whole are estimated to exceed $12 billion. This includes costs of health care, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.
The widespread negative health and economic impacts of the disease raise questions around why it even took so long in the first place to develop a vaccine for it. In fact, researchers have been trying to create a viable solution for over a century!
The scientific reason for this lies in the nature of the transmission of malaria. The malaria parasite, which is carried by mosquitoes, is much more complex than viruses or bacteria. It is also extremely dangerous, as it is capable of infecting the same person multiple times. According to a paper written by Rogier et. al, children in many parts of sub-Saharan Africa, even those sleeping under insecticide-treated bed nets, have on average six malaria episodes a year.
However, there are also capitalist motives, or the lack thereof, at play. The absence of financial incentives for companies to make making vaccines for non-Western countries is arguably another one of the driving forces behind why it has taken so long to develop a malaria vaccine. According to an Oxfam and Médecins Sans Frontières report cited by The Guardian, research and development (R&D) of drugs is “based on a model in which multinational pharmaceutical companies charge high prices for products tailored to wealthy markets.”
Consequently, there is little incentive for pharmaceutical companies to invest in R&D for diseases that affect populations with limited purchasing power. As a result, several diseases that do not affect wealthy Western nations continue to be ignored by pharmaceutical companies altogether or the vaccines available “are not well-adapted for people in developing countries.”
For example, about 240 vaccines for diseases that predominantly affect people in non-western countries are currently in the early stages of their development. However, as optimistic as that number sounds, progress on these products often is often slow due to the lack of a financial incentive. In recent years, only a handful of them have made it to market.
Similarly, even companies who do spend the time, money, end effort on developing vaccines that do not yield as much revenue have openly stated their reluctance to do so. For example, GSK, which spent more than 30 years and over $700 million developing the malaria vaccine, has said that while it is “incredibly proud” of its achievement, it is a “kind of endeavour [that] can’t be repeated” due the lack of a payoff.
The effect of delays in access to vaccines has been on show during the ongoing pandemic, during which several rich countries bought more vaccines than they had people to account for by offering vaccine manufacturers high prices that developing countries could not compete with. This hoarding in turn helped Western economies restart their economies and approach pre-pandemic levels of growth much faster. On the flip side, the economic woes of already vulnerable poor countries are only growing, and they are yet to offer even a first dose to the majority of their population, almost a year after the first vaccine was made available.
Having said all this, the malaria vaccine is still a breakthrough development. However, it is important to remember that it does not substitute other forms of preemption and prevention of the disease.
Two centuries ago, malaria was ravaging parts of Europe at the same rate as in Africa right now. Europe succeeded in eliminating the disease mostly through policies and practices driven by economic development. This consisted of building improved houses, minimising environmental risks by draining swamps where mosquitoes breed, separating humans and domestic animals, and more generally strengthening health systems.
However, while Europe had the means to afford such a massive overhaul of its systems, this is easier said than done for most African countries, who can ill-afford such a massive financial undertaking, particularly now, given the adverse economic impact of the pandemic.
Instead, the route taken there is more commodity-based, which includes sourcing insecticide-treated bed nets, drugs, diagnostic tools, insecticides, mosquito repellents and attractants, and drones that deliver insecticides against mosquitoes. Currently, almost all of these commodities are sourced through international aid. These stop-gap measures do little to tackle malaria at its source, which requires more large-scale reform that could take most African countries decades to implement.
Nevertheless, the vaccine for malaria is still worthy of hope and must be made accessible to those highest at risk. While it is not an end solution to the epidemic, it has most definitely paved a crucial step on the path to eradicating malaria.
What Does the Malaria Vaccine Mean for Sub-Saharan Africa?
After years of trials in Ghana, Kenya and Malawi, the four-dose RTS,S vaccine is the first safe and cost-effective vaccine proven to have helped prevent malaria.
October 22, 2021
SOURCE: FRANCE24