Malaria Vaccine Will Be an Expensive Failure

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May 16, 2017 | 19,822 views

Story at-a-glance

  • Starting in 2018, GlaxoSmithKline’s (GSK) RTS,S (Mosquirix) malaria vaccine will be given to some children living in Ghana, Kenya and Malawi
  • Research suggests the malaria parasite has wide genetic diversity and the vaccine would need to be 100 percent effective against all the different strains in order to eradicate the disease
  • Separate research found three doses of Mosquirix didn’t prevent malaria infection but rather delayed it until the children were older; the solution was to add a fourth shot to the schedule, but even this may not be enough

By Dr. Mercola

Malaria is a mosquito-borne disease caused by plasmodium parasites. When an infected Anopheles mosquito bites a person, it can spread the disease, leading to flu-like illness that can progress to life-threatening complications if left untreated.

It's estimated that close to half of the global population is at risk of malaria, with 91 countries experiencing ongoing transmission. According to the latest data from the World Health Organization (WHO), in 2015 there were 212 million cases of malaria along with 429,000 deaths, occurring primarily in children living in sub-Saharan Africa.1

WHO set a goal to eliminate malaria by 2040, with the primary mode of prevention currently being mosquito control. They recently announced, however, that a malaria vaccine will be tested on African children beginning in 2018. While being hyped as a potential breakthrough in the fight against this deadly disease, there's reason to believe the pilot program may end up being nothing more than an expensive failure.

World's First Malaria Vaccine to Be Given to Infants in 2018

Starting in 2018, GlaxoSmithKline's (GSK) RTS,S (brand name Mosquirix) malaria vaccine will be given to some children living in Ghana, Kenya and Malawi. The vaccine has completed a Phase III clinical trial via a partnership between GSK, several African research sites and the PATH Malaria Vaccine Initiative (with support from the Bill & Melinda Gates Foundation).2

The vaccine is not the only malaria vaccine in the pipeline, but it's the one that's furthest along in development and, reportedly, the only one to show a protective effect against malaria in Phase III clinical trials.3 After testing the vaccine in the real world, further reports on the vaccine's efficacy and safety profile are expected to be provided by 2020.

According to GSK, during the Phase III trial, malaria cases were reduced by almost half in children aged 5 to 17 months after three doses of the vaccine, and by 27 percent in those aged 6 to 12 weeks, when used alongside other malaria prevention measures, like the use of insecticide-treated mosquito netting.

After four doses of the vaccine, malaria cases were reduced by 39 percent over four years in children and by 27 percent over three years in infants. GSK, which has major incentive to get their vaccine to market, considering the global malaria vaccines market is expected to top nearly $592 million by 2024,4 further stated:5

"RTS,S aims to trigger the body's immune system to defend against the Plasmodium falciparum malaria parasite when it first enters the human host's bloodstream and/or when the parasite infects liver cells. It is designed to prevent the parasite from infecting, maturing and multiplying in the liver, after which time the parasite would re-enter the bloodstream and infect red blood cells, leading to disease symptoms."

Doubts about the vaccine surfaced in 2016, however, when a study found it didn't actually prevent malaria infection but rather delayed it until the children were older. When three doses of GSK's malaria vaccine were given, the protection waned within four years.6 Their solution was to add a fourth shot to the schedule, but even this may not be enough.

Research Casts Serious Doubt on Malaria Vaccine's Efficacy

Research published in Proceedings of the National Academy of Sciences paints a very different picture regarding RTS,S and other malaria vaccines in development.7 The study, which was funded by the National Institutes of Health, used DNA fingerprinting to show that the malaria parasite has wide genetic diversity. Among 600 children with malaria living in Gabon, each child's malaria was caused by a different strain of the parasite with upward of 60 varying genes. According to Bloomberg:8

"The group found that the malaria parasite swaps genes during sex to create new variants that can evade the immune system and reinfect the same people, much like influenza can.

The finding of distinctly different strains in infected children — as many as 10 at once — means that even small human populations in malaria-endemic areas are constantly being infected with the parasite, said [study author Karen] Day, a professor of population science and dean of science at the University of Melbourne."

She compared malaria to influenza (another disease against which vaccines have a dismal record of effectiveness), except "much more complicated," noting there could be thousands of different strains. According to Day, the vaccine would need to be 100 percent effective against all malaria strains in order to work; otherwise "it can persist and bounce back to pre-control levels."9

Day's work also revealed that malaria may not be transmitted as easily as once thought, causing perhaps only five or six secondary infections instead of dozens. "This suggests malaria isn't as difficult a foe to control as previously thought," Bloomberg noted, which suggests efforts to find effective ways to control mosquitoes may be all the more important.

Rates of Malaria Are on the Decline

While malaria still causes a tragic number of deaths among young children living in certain parts of the world, its incidence is on the decline. WHO reported that malaria incidence rates fell by 21 percent between 2010 and 2015, while malaria mortality rates fell by 29 percent globally and 31 percent in the African region.10

During the same time period, the rate of malaria mortality among children under 5 years also fell by 35 percent. The use of insecticide-treated mosquito nets has been touted as the "cornerstone of malaria prevention efforts" in sub-Saharan Africa, according to WHO, with 53 percent of those at risk sleeping under a treated net in 2015 (compared to 30 percent in 2010).

Indoor spraying of insecticides is also used in some areas, marking a sad trade-off of one set of health risks for another, as insecticides are toxic in their own right. Even the widely banned DDT is still used to control mosquitoes in some countries. Further, there is some concern that mosquitoes are developing resistance to at least one class of insecticides used in the nets and spraying. Malaria is treatable, but growing resistance to malaria drugs is a concern. WHO reported:11

"In many countries, progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. To date, parasite resistance to artemisinin — the core compound of the best available antimalarial medicines — has been detected in [five] countries of the Greater Mekong subregion."

In addition, the ability to resist diseases like malaria requires a strong immune system, and for that, you require good nutrition, clean drinking water and sanitation — three elements that are lacking for many children affected by this disease. If we want to help lower malaria rates, it would be wise to focus on these basics first. In order to eradicate infectious disease from a nation, you have to first address compromised immune systems.

Safer Solutions for Combating Malaria

The global fight against malaria is centered on insecticide application and distribution of insecticide-treated bed nets, along with anti-malaria drugs and new malaria vaccines. But both mosquitoes and parasites are developing drug resistance, and the spraying of toxic insecticides is not a safe or sustainable solution.

It's likely, too, that malaria vaccines will prove to be lacking in effectiveness. Pesticide Action Network (PAN) Germany has called for safer, non-chemical means of targeting this disease, with significant impacts seen during a pilot program in West Africa.

The program began by increasing residents' knowledge and awareness of the sources of malaria. This included sharing strategies for reducing mosquito breeding sites, as many of the villagers were unaware that potential breeding sites existed nearby in areas of food waste, refuse and standing water.

Villagers were educated about how to help prevent indoor mosquito infestations via cleaning and garbage removal, as well as how to cover outdoor wells and septic tanks with lids. Fish were introduced to certain areas to help with mosquito larval control. The local health center was also educated on how to better treat malaria, leading to a significant drop in school absenteeism due to the disease, from up to 30 percent from 2009 to 2011 down to 4.6 percent in 2012.12 As PAN International noted:13

"The only effective and sustainable way to control malaria in the long term is through integrated vector management, which deploys a range of methods and emphasizes non-chemical approaches with pesticides used as a last resort to minimize the buildup of pesticide resistance."

Indeed, a study published in the journal Pathogens and Global Health also found that maternal education had a significant effect on childhood malaria — even more so than a vaccine.14

In the Democratic Republic of Congo, the prevalence of malaria among children of mothers with no education was 30 percent, compared to 17 percent in in those with mothers who received primary education and 15 percent among those with mothers educated beyond the primary years. Senior author Michael Hawkes, assistant professor at the University of Alberta in Canada, told Hindustan Times:15

"The World Health Organization is rolling out a new vaccine in countries across Africa that has an efficacy of about 30 percent … But children whose mothers are educated beyond the primary level have a 53 percent reduction in their malaria rates."

While the pharmaceutical industry is certainly pinning their hopes on a malaria vaccine taking off, it's important to remember that malaria once occurred in the U.S. as well, but was eliminated without the use of vaccines. How? Karl Tupper of PAN North America said in a press release:16

"It was improved sanitation, environmental management and access to health care that beat malaria in the U.S. — not DDT … Rising standards of living were also key — bringing things like screened windows to rural areas in the southern states of the U.S. where the malaria problem was the worst."

[+]Sources and References [-]Sources and References

  • 1 World Health Organization, Malaria Fact Sheet
  • 2 World Health Organization April 24, 2017
  • 3 Malaria Vaccine Initiative, RTS,S
  • 4, 8, 9 Bloomberg May 3, 2017
  • 5 GSK July 24, 2015
  • 6 N Engl J Med 2016; 374:2519-2529
  • 7 Proceedings of the National Academy of Sciences May 3, 2017
  • 10, 11 World Health Organization December 13, 2016
  • 12 PAN Germany, Combating Malaria Without DDT
  • 13, 16 PAN International April 18, 2011
  • 14 Pathog Glob Health. 2017 Mar;111(2):98-106.
  • 15 Hindustan Times May 10, 2017