Even in the midst of a pandemic, and in the context of the maelstrom of our fast-paced, modern life, we often forget that there are many other infectious diseases that cause an unacceptable burden of disease and death around the world each year. These diseases are usually invisible to us because they are only transmitted in remote areas, in low-income environments, and in tropical climates. Malaria is the paradigmatic example of the diseases of poverty, and although it may seem very distant, it is only 60 years ago that we managed to eliminate it from our country.
There are few diseases that cause – without respite – more than 200 million clinical episodes and about half a million deaths annually, most of which occur in young African children. There is a whole series of recommended control tools (mosquito nets, vector control tools, drugs, etc.) that have allowed commendable progress and a significant decline in deaths due to this disease. However, any progress in the fight against malaria is fragile, and vulnerable to temporary fluctuations and unforeseeable deterioration. The COVID-19 pandemic, of course, is posing yet another painful stone in the road.
The parasite responsible for malaria is infinitely more complex than any virus or bacteria
Unlike many other infectious diseases, to date we had not been able to count on a vaccine that would protect those who need it most against malaria. On October 6, in a landmark announcement, the World Health Organization (WHO) finally endorsed the use of the malaria vaccine RTS, S / AS01 in young children in highly endemic areas of malaria in Africa.
Mass vaccination of all newborns (4 doses in the first 2 years of life, starting at 5 months of age) will thus complement the use of other preventive measures, which should continue to be used. The news is especially welcome in the context of the impasse in progress that has been observed over the last 5-6 years, where the progress observed in the first 15 years of the century seemed dangerously stagnant.
The WHO has endorsed the use of the malaria vaccine in 4 doses starting at five months of life in children of sub-Saharan Africa
During the announcement, many of us who have been involved in one way or another with this vaccine seeing the light of day could barely contain the excitement. The road has not been easy, and is attested by the more than 30 years it has taken (compare it with the little more than 6 months it took to have vaccines against COVID-19!) To have a product ready, available and recommended.
The complexity of the parasite responsible for malaria, infinitely greater than that of any virus or bacteria, would partly explain the technical difficulties of the process. Likewise, the suboptimal effectiveness of the vaccine (estimated at 30-50% during the phase III trial conducted in Africa), together with some safety signals identified in that same study, justified that, in 2015, after its regulatory approval By the European Medicines Agency, a carefully monitored pilot implementation would have to be organized in three countries (Malawi, Ghana and Kenya) before its use could be more widely endorsed.
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The results obtained during this pilot period confirm the excellent safety of this first generation of antimalarial vaccine, and above all its potential to save tens of thousands of lives each year, and to make a robust contribution to the control of the disease.
In such a long-lived process, but with a happy ending, it is also fair to remember those who bet – without hesitation – on this vaccine. The Bill and Melinda Gates Foundation, with their philanthropy, made possible its clinical development, and the training of African research centers that could lead the necessary clinical trials throughout the process. And it has been African scientists, in an exemplary way, who have led the entire process, including the ministries of health of the three countries chosen for the pilot program, thus closing the virtuous circle of an African vaccine for Africa.
A separate applause deserves the WHO, and especially Dr. Pedro L. Alonso, current director of the Global malaria program in this organization. His deep understanding of malaria and the enormous challenges inherent in the continent, and his tenacity, scientific rigor, and uncompromising leadership have made this vaccine possible. In this rarefied climate covidiano, where the poorest countries have once again been relegated to oblivion, where here we fight for a third dose of COVID-19 vaccine without thinking that our southern neighbors have only received 2% of world doses, news As extraordinary as this, it restores my hope.
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