Malaria kills 1,000 children daily, now there’s a vaccine to fight it

The “world’s first malaria vaccine,” which is being rolled out in a large pilot program in Malawi, is rightly being lauded as a major milestone in the war between humans and the malaria parasite. If successful, the vaccine may be given to millions more children across Africa and save young lives that are needlessly lost every day. 

But in this war, which has been waged over millennia, we should be cautious not to vest too much hope in a single weapon.

{mosads}Malaria is a nasty bug, causing high fevers with shaking chills, crushing headaches and body aches and a slew of other debilitating symptoms. I know; I have had it four times. When diagnosed and treated quickly, it can be completely cured. Left unchecked, though, symptoms can progress within hours to severe anemia, seizures, coma and death.

But malaria’s real trick is to survive, evolving resistance to our drugs and evading our immune systems. Despite repeated efforts through history to eradicate it, malaria has always managed to escape our grip, only to come back stronger and harder to combat. And it is precisely where health systems and disease surveillance are weakest — where people are poor, migrating or fighting — that malaria thrives. 

This is why the promise of a vaccine is alluring. Vaccines are among the most cost-effective public health tools we have and an effective malaria vaccine could greatly ease stress on low- and middle-income countries that struggle to afford comprehensive surveillance and treatment programs.

The vaccine being launched this week in Malawi is no silver bullet. It reduces the risk of clinical illness in children by at most 40 percent in some places and populations. Nor is it, in fact, the world’s first malaria vaccine. As long ago as 1945 in New York City, an experimental vaccine effectively prevented malaria in ducks. But this one is a milestone: Developed at an estimated cost of $500 million over three decades, it is the first to survive the “valley of death” of rigorous safety and efficacy testing and be licensed for human use.

Still, there is good reason to hope that the “world’s first” will be followed by something better, perhaps soon. A completely different vaccine — one that, in a strange but satisfying biological twist, is actually manufactured in mosquitoes — will soon be rolled out in a large field test on Bioko Island off the coast of Equatorial Guinea, aiming to eliminate malaria there.

What these vaccines have in common, along with many of our best malaria drugs over the last century, is that they were developed with U.S. government funding, including long-term funding from the National Institutes of Health, the Centers for Disease Control and Prevention and especially the Department of Defense malaria research programs. The importance of this sustained public commitment to innovation cannot be overlooked. If we hope to read news about tomorrow’s more effective vaccines, we need to remain committed to funding the search for better tools today. 

Victories against malaria are most often the result of political will as much as scientific breakthrough. Once common in the United States, the disease was pushed out through sustained, consistent efforts, including raising living standards and improving access to malaria testing and treatment.

In recent decades, a similar story has been playing out in many parts of the world. When I first encountered malaria in Kenya in 1986, malaria killed more than 5,000 children every day. Today that number, while still shocking, is down to 1,000. It is no coincidence that this dramatic progress occurred at a time of renewed public commitment to controlling malaria, including the launch under President George W. Bush of the President’s Malaria Initiative and efforts by the Global Fund and World Bank.

So while I welcome news of even a partially effective vaccine, this modest cause for celebration should not convince anyone to consider the battle won. Malaria has shown us again and again that when we drop our defenses, it comes roaring back. We may have a new weapon to fight it today, but what will be in our arsenal tomorrow?   

Chris Plowe is a professor of medicine, molecular genetics and microbiology and global health at Duke University, where he directs the Duke Global Health Institute. As a past president of the American Society of Tropical Medicine and Hygiene, he worked for many years on studies of drug-resistant malaria and vaccine testing in Mali and Malawi and his current research aims to accelerate malaria elimination in Myanmar, China and Bangladesh.