Researchers have been trying for more than 70 years to develop a vaccine against the elusive malaria parasite without notable success. Two studies conducted in East Africa suggest that they are finally closing in on their goal.
The Bill and Melinda Gates Foundation deserves huge credit for enabling this research to go forward when the drug manufacturer was unwilling, on its own, to take the financial risk to try to develop a vaccine.
The new studies showed that the most advanced candidate vaccine — made by GlaxoSmithKline — cut illnesses in infants and young children by more than half and could safely be given with other childhood vaccines that are already routinely administered throughout Africa. The results were published in The New England Journal of Medicine, along with an editorial that called the vaccine’s performance a “hopeful beginning” toward prevention of the disease.
There is no guarantee of success. The studies were carried out in areas with relatively low transmission of malaria; no one knows if the vaccine will work as well where malaria is more rampant. And the vaccine must still undergo much larger trials next year.
Even a vaccine that is partially effective could save hundreds of thousands of lives a year. It would bolster the gains already being made by insecticide-treated bed nets that prevent mosquitoes from spreading the parasite and by malaria pills to treat sick patients.
That the candidate vaccine has gotten this far is a tribute to the power of charitable contributions to generate and sustain industrial interest.
Glaxo had been funding development of a vaccine aimed at military personnel and travelers but was unwilling to undertake pediatric studies unless a financial partner could be found. That’s when the Gates Foundation came to the rescue. It has pumped in $107.6 million so far. Glaxo says it has spent about $300 million and expects to invest $50 million to $100 million more to complete the project. If all goes well, the vaccine could be submitted for regulatory approval in 2011.
EVEN FURTHER STILL:
(T)he evidence base for allocating resources for malaria control on a global scale is poor.
National reporting on malaria continues to be fanciful; Kenya, for example, reported only 135 malaria deaths in 2002 to the World Health Organization . In addition, less than half (22/49) of the malaria-endemic countries in Africa provided information for the most-recent reporting year, 2003; the rest were older . Information on the global burden of malaria remains the subject of best guesses rooted in national reporting systems , informed estimation based on epidemiological data linked to historical malaria distributions , or unvalidated models of malaria distribution in Africa [5–7]. As a corollary, resource allocations for malaria interventions remain driven by perceptions and politics, rather than an objective assessment of need. This status quo is untenable when global and national financial resources must be defined to meet needs for new, expensive antimalarial drugs and commodities to prevent infection, and to ensure that these interventions are optimally targeted.
It has been almost 40 years since the last global map of malaria endemicity was constructed , and a decade since the need for maps of malaria transmission in Africa was first advocated . Although substantial progress has been made [10–21], an evidence-based map of malaria transmission intensity for Africa remains illusive, and there have been no recent efforts to construct a credible evidence-based global malaria map.
A New Mapping Project
The primary goal of the recently launched Malaria Atlas Project (MAP) is to develop the science of malaria cartography. Our approach will be first to define the global limits of contemporary malaria transmission; we have initiated this process [12,13], but will substantially refine these layers with additional medical intelligence in future years.
Within these limits, we plan to then model endemicity using a global evidence base of malaria parasite prevalence. This Health in Action concentrates mostly on how we intend to achieve this important goal. Once we have created these global endemicity maps, these will then provide a baseline to facilitate estimation of populations at risk of malaria and more-credible predictions of disease burden. These maps will also provide a platform to help target intervention needs, and may provide a means to measure progress toward national and international malaria public health goals at a global scale.