Figure 1: Twins Dorcas and Deborah Bendak, 7, under a mosquito net at their home in Tanzania
The end of Xavier’s life began late one summer night when a mosquito flew through the opening of the net covering his bed. For the next two weeks, he continued to play make-believe and tease his younger siblings just like any other 4-year-old. Then, the fevers began. Chills, vomiting, and diarrhea soon followed. A few days later, he started to seize. His parents rushed him to the community hospital 10 hours away, and IV fluids and anti-malaria medications were started. He fought for a few more days, but by then it was too late. Less than a month after the mosquito bite, a parasite had overwhelmed his body and shut down his vital organs. Xavier was one of 480,000 children under 5 who died of malaria last year, a disease essentially eradicated in the United States.
Malaria infections date back thousands of years; the parasite responsible for the disease has coexisted with humans since the onset of written history. Despite advances in medical treatment, malaria caused 2-5% of all deaths in the 20th century. Today, malaria is primarily confined to the African continent, where it causes the death of a child every 75 seconds. The World Health Organization views travel to many African countries as dangerous enough to warrant intensive chemoprophylactic drugs to prevent incubation with the Plasmodium parasite. Malaria remains one of the world’s public health emergencies that has worsened since the beginning of the COVID-19 pandemic.
Malaria vaccine development was tainted by technical challenges and lack of funding. The economically poor countries in Africa were unable to support the significant sums of money needed for research and development in the private pharmaceutical sector. Unfortunately, this meant that funding for the vaccine fell on citizens of the developed world, countries that aren’t impacted by malaria. While significant funding has come from the United Kingdom and United States, malaria vaccine development remained woefully slow for over 50 years.
The story of malaria, however, appears to be entering a new chapter. This chapter began in 1987, when researchers at the pharmaceutical company GlaxoSmithKline developed a new vaccine targeting a surface protein of malaria. After roughly 30 years, this vaccine was finally approved and marketed under the brand name of Mosquirix. Last year, it became the first malaria vaccine endorsed by the World Health Organization for widespread use. Despite the requirement for multiple booster shots and the vaccine’s limited efficacy of 36% over a four-year span, widespread uptake of this vaccine will save countless lives throughout the African continent.
Yet, Mosquirix is not the reason for hope. The reason for hope is R21, a vaccine with a similar design to Mosquirix. A phase 1/2b clinical trial with 401 children published in December of 2022 indicates a vaccine efficacy of 80%, one previously thought unattainable due to the complex lifecycle of the Plasmodium parasite. R21 has officially entered phase 3 clinical trials with over 4500 participants, and is expected to enter into commercial production this year. R21’s efficacy is so promising that the largest nonprofit backer of Mosquirix, The Bill and Melinda Gates Foundation, has pulled out of funding for its rollout. The argument, one made in good faith, is that money spent on the inferior vaccine will be wasted. The end of the malaria endemic, as we know it, is in sight.
I’ll end this piece by linking to a 2001 article in the Journal of Public Health Policy, titled ‘Malaria Kills One Child Every 30 Seconds’. In his article, journalist Donovan Webster spoke about his experiences working with malaria researchers in the Indonesian jungle. He envisioned a world where a vaccine against malaria prevented the cruel and unjust deaths of millions of children, a hope that went unfulfilled by the time of his death in 2018. Five years later, R21 may finally make his vision a reality.
If you would like to donate to malaria research and eradication, many nonprofits accept individual donations. One accepting donations is https://www.malarianomore.org/donate/
