WHO recommends first malaria vaccine

The World Health Organization (WHO) recommended this October the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine, the first and only malaria vaccine to have been shown in pivotal long-term clinical trials to significantly reduce malaria in children.

The vaccine, another major breakthrough in the global fight against malaria, is the result of over 30 years of research by science-led global healthcare company GlaxoSmithKline (GSK).

Malaria vaccine pilot programs in Ghana, Kenya and Malawi have shown high impact in real-life childhood vaccination settings, strong community demand and that RTS,S can be effectively delivered through routine child immunization platforms. More than 2.3 million vaccine doses have been administered to date, with over 800,000 children receiving at least 1 dose of the vaccine.

Based on the recommendation of its global advisory bodies for immunization and malaria, WHO has recently recommended the wider use of GSK’s RTS,S malaria vaccine in children living in sub-Saharan Africa and other regions with moderate to high malaria transmission.

“This long-awaited landmark decision can reinvigorate the fight against malaria in the region at a time when progress on malaria control has stalled. Both real world evidence and clinical trial data show that RTS,S, alongside other malaria prevention measures, has the potential to save hundreds of thousands of lives,” said Thomas Breuer, GSK Chief Global Health Officer.

The WHO recommendation comes on the heels of new data showing that RTS,S, in combination with seasonal administration of antimalarial medicines, lowers malaria cases, hospital admissions with severe malaria, and deaths by around 70%.

“These data indicate that the impact of RTS,S vaccination can be increased to further reduce mortality, especially when combined with other recommended malaria control interventions in a seasonal setting,” GSK said.

Beyond research and development, GSK announced a Product Transfer, including technology transfer for long-term antigen production, with Bharat Biotech of India to boost vaccine production.

As the coronavirus disease 2019 (COVID-19) pandemic continues to disrupt health services across the world, the WHO underscored the urgent need to aggressively tackle the novel coronavirus while ensuring that other killer diseases like malaria are not neglected.

WHO data showed that in 2019 there were an estimated 229 million cases of malaria worldwide. Around 409,000 people lost their lives due to malaria that same year. Children aged under 5 years are the most vulnerable, accounting for 67% of all malaria deaths worldwide in 2019.

Africa carries a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of malaria cases and deaths, according to the WHO.

The incidence of malaria in the Philippines has been significantly reduced by 87% from 48,569 in 2003 to 6,120 cases in 2020, according to the Department of Health (DoH).

The DoH also reported a 98% reduction in the number of deaths due to malaria, from 162 in 2003 to 3 in 2020. Along with the declining cases and deaths is the shrinking geographic extent of malaria in the country.

The DoH has officially declared 60 provinces across the archipelago as malaria-free. An additional 19 provinces have reached malaria elimination phase with zero local transmission, and are waiting to be assessed and declared malaria-free provinces.

While the fight against malaria in the country is yielding encouraging results, efforts must continue. At the end of 2020, around 126 barangays from 2 provinces in the country have still recorded local malaria transmission.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Five parasite species cause malaria, two of which pose the greatest threat — Plasmodium falciparum and Plasmodium vivax, according to the WHO.

In non-immune individuals, symptoms usually appear 10 to 15 days after the infective mosquito bite. In malaria-endemic areas, people may develop partial immunity, which explains the occurrence of asymptomatic infections.

The initial symptoms — fever, headache, and chills — may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Malaria is preventable and curable. Vector control through insecticide-treated mosquito nets and indoor residual spraying is the main way to prevent and reduce malaria transmission. Antimalarial medicines such as sulfadoxine-pyrimethamine can also be used to prevent malaria. The best available malaria treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT), according to the WHO.

Since 2000, the WHO estimates that ACT has resulted in the prevention of 1.5 billion malaria cases and the saving of 7.6 million lives. In 2001, Novartis signed an agreement with the WHO, committing to make ACT available without profit to the public sector of malaria-endemic countries.

The Swiss healthcare company continues to provide ACT on the same terms even after the agreement expired in 2011. Over the last 20 years, Novartis has delivered one billion antimalarial treatments without profit in more than 70 countries.

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP), which represents the biopharmaceutical medicines and vaccines industry in the country. Its members are at the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.