Kenya today added the world’s first malaria vaccine to the routine immunization schedule for children under two, becoming the third country in Africa (after Malawi and Ghana) to roll out the vaccine for the disease that kills one child globally every two minutes.

Soon malaria will fall in the ranks of diphtheria, whooping cough and measles- diseases we only know about from books and don’t have to suffer from.

Vaccines are among the safest, cheapest and most effective ways to protect children from diseases and complications.

Here are 10 things you should know about the newly released malaria vaccine

1. Countries it is available

The pilot countries chosen by the World Health Organisation for clinical trials are Malawi, Ghana and Kenya being the third country not include it in their immunization schedule. The pilot will take six years. After two years there will be a safety evaluation and a recommendation for the rest of sub Saharan Africa. But it’s very unclear if the data coming out will be reliable enough to build on.

2. Name of Vaccine

The injectable vaccine, called RTS,S or Mosquirix, was developed by British drugmaker GlaxoSmithKline and was developed over a period of 30 years at a cost of over $1billion.

3. Age group that can get the vaccine

Only children between the age of 6 months to 2 years. It is not yet available for adults.

4. Number of Doses

In clinical trials it proved only partially effective and it needs to be given in a four-dose schedule, but it is the first regulator-approved vaccine against the disease. The malaria vaccine, which will be delivered through the routine national immunization programmes, is given at 6 months, 7 months, 9 months and 24 months of age.

5. How effective is the malarial vaccine?

It does not give 100 percent protection, the vaccine prevented about four in 10 cases of malaria and three in 10 cases of the most severe, life-threatening form of the disease, within the trial group, WHO says.

6. Which specie of malarial parasite does the vaccine offer protection?

There are about 4 species of malarial parasite but the vaccine protects ONLY against Plsamodium falciparum which is the deadliest and the most prevalent in Africa.

7. Does it provide lifelong immunity?

No. Immunity is expected to wane within a couple of years. Hope is the vaccine pulls them through their first years, but the disease might relapse.

8. Concerns/Worries

There is the worry that parents will reduce other measures, like bed nets or quick diagnosis and treatment. But so far, I don’t get that impression: malaria prevention has always been a multi-task effort. Then there are some safety concerns. A small but significant increase in meningitis has been observed among the vaccinated during the trial. Some believe this is caused by systemic immune effects. Cerebral malaria might increase because of the age shift in severe malaria. And remarkably: no decrease in all cause mortality has been observed and according to some measures, it might even increase among girls specifically.

9. Justifiable Reasons the Nigerian Government opted out of the Pilot Scheme

I have done more research into the Mosquirix malaria vaccine and I think the Nigerian government had a justifiable reason to not participate in the vaccine development and pilot.

There is even some opposition to the vaccine where I am. Clinical trials found Mosquirix to be both safe and effective, providing 39% efficacy at preventing clinical cases of malaria over the course of a four-year trial. This is somewhat low for a vaccine

Mosquirix provides protection in just four out of 10 cases. While this is good, what happens during the controlled setting of a clinical trial does not necessarily translate into a real-world situation.
Mosquirix requires four doses – a lot for a vaccine. If the fourth dose is not administered, the efficacy goes down to about 28% protection against clinical malaria
If the 4th dose is also not given, the efficacy of the vaccine against severe cases of malaria is almost zero. The highest efficacy of Mosquirix occurs between 5 -18 months. This is not synchronous with routine immunization schedules. Mosquirix is not a magic bullet against malaria and at best is a complementary tool in reducing malaria burden. Mosquirix is not the only malaria vacine under development. There are others. I hope the Nigerian government would come around when a more efficacious vaccine is in the pilot.

10. Prospects of the vaccine

There is a glimmer of hope that “something good” will come out of the clinical trials for the malaria vaccine. Scientists are still working out modalities to improve on them. Is this the end to the deadly malaria? Time will tell in 6 years time.

Malaria vaccine
WHO annouces the launching of Malaria vaccine on their official twitter handle

Some Credits:

Jop de Vrieze (Science Journalism Gold Award 2016)

Young King (Physician and Epidemiologist)


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