Today in The Lancet, GlaxoSmithKline announced that it has developed a vaccine that, when tested in field trials in Mozambique, cut the chance of a child’s getting malaria by 30 percent, and reduced the child’s chance of getting a severe form of malaria by 58 percent. This is big news. No vaccine tested in Africa has ever been so effective in field trials. Even if this vaccine is as effective in general use as it was in the field trials, however, it will not be available for general use until at least 2010. During that time, malaria will have killed six to twelve million children. As promising as this vaccine appears to be for the children of the future, we need to help the children who are dying from malaria now.
Upon Edward Jenner’s discovery that cowpox inoculations protected people against smallpox, vaccines became the philosopher’s stones of infectious disease: a single measure capable of transforming a deadly threat into a practical non-entity. Vaccines have rendered polio, yellow fever, measles, and many other formerly deadly diseases less potent. As a result, the quest for a vaccine to quell yet another disease has consumed many a researcher.
Such is the case with malaria. A deadly disease that kills a child every 30 seconds and cripples economies, sucking $12 billion a year out of Africa and slowing the continent’s growth by 1.3 percent a year, malaria clearly needs to be stopped, and the smart money is on a vaccine’s being the solution to the malaria problem.
Developed and developing countries have spent hundreds of millions of dollars on malaria-vaccine research for over 20 years. In the 2004 congressional appropriation, for example, Congress stipulated that the United States Agency for International Development (USAID) dedicate ten percent of its malarial budget of $85 million to vaccine research, including the donation of $3 million outright to the Malaria Vaccine Initiative, a private-public partnership started and heavily funded by the Bill and Melinda Gates Foundation. This generous funding has produced significant advances in understanding parasite and mosquito biology, but as of yet no vaccine exists, and in spite of GlaxoSmithKline’s news, the prospects remain dim for a protective, long-acting, and affordable vaccine in the near term.
Having a malaria vaccine that was protective over a prolonged period of time would be an amazing accomplishment. Unlike natural immunity to most viruses, natural immunity to malaria parasites does not last for prolonged periods of time. Thus, such a vaccine would be a first for human experimentation, achieving a level of protective immunity that does not occur in nature.
If scientists do eventually find malaria’s philosopher’s stone–producing an affordable, long-acting, protective vaccine–that experimental vaccine will then need to go through a multi-year testing and approval process. But as we wait for the vaccine, what hope can we offer to those whom malaria is killing now?
Until a vaccine is found, countries need to use a multitude of measures to control malaria–because, like the parasite that causes it, malaria is an incredibly complex disease. Fortunately such protective measures exist. A combination of preventive measures and prompt, effective treatment can lower the number of deaths from malaria. They already do in some countries. South Africa quelled a spreading malaria epidemic in 2000 with a combination of indoor residual spraying using DDT and artemisinin-based drugs, dropping rates by 78 percent in the first year and 74 percent in the next.
South Africa’s experience also shows that a malarial country cannot depend on only one or two methods of mosquito control: It needs to use them all. Unfortunately, current international malaria-control policy heavily skews mosquito control toward one method–the use of insecticide-treated bed nets–while ignoring indoor residual spraying. Remember USAID’s $85 million malaria budget? Out of that, only about $260,000 goes directly toward funding indoor residual spraying worldwide, even as many countries clamor to be able to use this method. That’s better, to be sure, than the amount USAID spends on the routine purchase of anti-malarial drugs (zero), but $260,000 is still a dismally small amount to spend on a vital and effective preventive measure.
In light of the desperate need for measures to combat malaria now, is it wise to continue spending vast amounts on vaccine research? Yes, it is. An effective malaria vaccine will be worth the money, providing an inestimable good to the people and economies of malarial countries, and hence to worldwide stability. But is it ethical for a great and wealthy country to support only narrowly focused research while denying support for methods proven to reduce death, disease, and suffering? No, it’s not. We should continue to support vaccine research, but as we work to minimize future deaths, we should work to minimize the present deaths as well.
–Jennifer Zambone works for the health advocacy group Africa Fighting Malaria.