The scourge of malaria can be tackled better now, given the first-ever vaccine
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Mosquirix - world's first malaria vaccine has arrived
- The story: The first malaria vaccine ever has completed its clinical development process, and received a positive scientific opinion from the European Medicines Agency (EMA). The RTS,S/ASO1 (RTS.S), trade name Mosquirix, which was endorsed by the World Health Organisation (WHO) on October 6, is the first and, to date only, vaccine shown to have the capability of significantly reducing malaria, and life-threatening severe malaria, in tests on young African children.
- Details: The vaccine acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Among children who received 4 doses in largescale clinical trials, the vaccine was able to prevent approximately 4 in 10 cases of malaria over a 4-year period.
- It is also the first malaria vaccine to be introduced by three national ministries of health through their childhood immunization programmes — more than 8,00,000 children in Ghana, Kenya, and Malawi have been vaccinated, and are benefiting from the added protection provided by the vaccine as part of a pilot programme.
- Other clinical evidence shows that strategic delivery of the vaccine just prior to the high malaria transmission season in areas where malaria is highly seasonal can optimize impact and markedly reduce mortality, especially when combined with other recommended malaria control interventions.
- Malaria: It is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. Still, in 2019, there were an estimated 229 million cases of malaria worldwide, and the estimated number of malaria deaths that year stood at 4,09,000. Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274,000) of all malaria deaths worldwide. In 2019, India had an estimated 5.6 million cases of malaria compared to about 20 million cases in 2000, according to WHO.
- How the vaccine will help: WHO’s recommendation is based on the advice of its two global advisory bodies, one for immunization and the other for malaria. It has recommended that in the context of comprehensive malaria control, the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by it. The malaria vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden. The next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout in endemic countries, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies. A vaccine is a breakthrough addition to the malaria toolkit and can help get malaria control back on track.
- Countries that eliminated malaria: Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2019, 27 countries reported fewer than 100 indigenous cases of the disease, up from 6 countries in 2000. Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last two decades, 11 countries have been certified by the WHO Director-General as malaria-free: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019), and El Salvador (2021).
- Indian situation: India carries 2% of the global malaria case burden and 2% of global malaria deaths (52% of all malaria deaths outside of sub-Saharan Africa). India also bears 85.2% of the malaria burden in South East Asia. Of importance is that India carries 47% of the global P. vivax malaria burden, making the country strategically important for global malaria elimination, particularly in the South-East Asian region. India made significant gains towards malaria control and eradication. In 2019, there were 6.8 million fewer cases than in 2016, and the number of cases per 1000 of the at risk population fell from 10 to 4.3. Over the same period, deaths also fell from 0.018 to 0.006 per 1000 of the population at risk. Just seven out of 36 states in the country accounted for 90% of the estimated cases in 2018. These states, together with other states in the north eastern part of India, have some parts of it being either forest-like, hilly, tribal or conflict-affected and have historically had a large burden of malaria. Even in states with low levels of malaria transmission, most of the malaria cases are confined to areas that have the above-mentioned geographical or socio-political profiles.
- EXAM QUESTIONS: (1) Explain the role that vaccines may play in diseases like malaria that can be handled otherwise also. (2) Summarise the malaria situation in India, and government efforts to control it.
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