Malaria milestone shows that inequality is the real enemy

It would be outrageous if coronavirus vaccines were funded because they affect the richer states and malaria vaccines were not because the disease is perceived as largely an African issue

  
A health agent prepares an anti-malaria injection at Marcory General Hospital in Abidjan, Ivory Coast October 7, 2021.

A health agent prepares an anti-malaria injection at Marcory General Hospital in Abidjan, Ivory Coast October 7, 2021.

Reuters/Luc Gnago
 

Are we about to say a long goodbye to one of history’s great killers? The breakthrough malaria vaccine announced last week is a major advance in tackling the parasite and one that could lead to its eradication.

The World Health Organization said that following successful pilot schemes in Ghana, Kenya and Malawi, the RTS,S, or Mosquirix, vaccine will be rolled out across Africa. Children, who make up so many of the victims of this terrible disease, will be vaccinated.

Dr. Tedros Adhanom Ghebreyesus, WHO director-general, described it as “a historic moment for science, child health and malaria control,” adding that tens of thousands of young lives could be saved each year.

This scientific milestone is worth celebrating not least because the world’s thoughts are focused on another killer disease that is also being pushed back with an innovative vaccination program. Scientists have been searching for a malaria vaccine for over a century.

The British pharmaceutical firm GlaxoSmithKline has spent 30 years developing Mosquirix, a long-term project that needed more than $1 billion in investment. No doubt the anti-vax conspiracy nuts will denounce it, but for those who value scientific fact-based medicine this is a major breakthrough.

Over 220 million people develop malaria every year, with the disease claiming more than 400,000 lives. In 2019, 260,000 of the victims were children, with 94 percent of the cases in Africa. In the 20th century alone, malaria claimed between 150 million and 300 million lives, accounting for 2-5 percent of all deaths. At least 40 percent of the world’s population still lives in areas where malaria is rife.

The disease has killed relentlessly throughout history. Cuneiform script on Mesopotamian clay tablets indicated a malaria-like fever. Chinese doctors also referred to malaria-like symptoms about 5,000 years ago. Herodotus tells us that the builders of the pyramids were given garlic to protect them from the disease. Homer cites malaria in the “Iliad,” while the “father of medicine,” Hippocrates, outlined the illness in the 5th or 4th century B.C.

Malaria spread along the trade routes of antiquity and may even have been a contributing factor to the fall of Rome. The name itself derives from the Italian, mal’aria, literally bad air, from a time when it was believed that the disease spread through foul air rising from swamps. In the Middle Ages, all sorts of useless remedies were deployed, from blood-letting to the use of toxic herbs such as belladonna. Malaria struck as far north as Britain, with Shakespeare citing it in eight of his plays.

The disease has wreaked its most deadly havoc in Africa. Early Portuguese traders encountered the illness and it struck at nearly every European colonial effort on the continent. German troops in East Africa during the First World War suffered such huge losses that a major effort was made after the war to find additional anti-malarial drugs.

It was not until 1880 that a French doctor, Alphonse Laveran, discovered that the female Anopheles mosquito carried the malaria parasite. Once mosquitoes were determined as the carrier, pesticides and other measures could be used. The invention of DDT was vital to reduce mosquito-infected areas. Swamps were often drained and insecticide-treated nets used.

In the 19th century, the use of quinine isolated from the bark of chincona tree was also a big step forward. However, malaria is a more sophisticated enemy than, say, the coronavirus since it has developed resistance to numerous drugs and can overpower the human immune system.

The struggle is far from over. Complacency, as ever, is dangerous. The new vaccine will target only the most common form of malaria in Africa, Plasmodium falciparum. Areas of the planet where other forms of the parasite are present will have to wait for a different vaccine. In all there are over 100 types of the disease. Yet one hopes that such an advance can lead to further vaccines for other variants.

As with the COVID-19 vaccines, many will be wondering if the rich industrialized world will be willing to share the science and help get the vaccines into the arms of those in need. GAVI, the Global Vaccine Alliance, is meeting in December to determine what funding it will provide. GSK has pledged to donate up to 10 million RTS,S doses for use in pilot projects, and to “supply up to 15 million doses annually following a recommendation and funding for wider use at no more than 5 percent above cost of production.”

The vaccine requires four doses to become effective. We shall have to wait to find out what the costs per dose will be and how rapidly mass production of the vaccine can be achieved. A study earlier this year found that 50-110 million doses will be required in Africa per year by 2030. An effective communications campaign is also essential to mitigate against vaccine hesitancy and ensure a high take-up of the treatment.

The great strides made in vaccination can make a huge difference not least in sub-Saharan African countries. An HIV vaccine in the pipeline could target a disease that has killed more than 36 million people since it was identified in the 1980s.

All of this requires the richer nations to play a positive role sharing the science in an effective and affordable fashion, and investing in the continent’s own capabilities, including vaccine production centers. It is already a stark indictment of the handling of the pandemic that sub-Saharan African countries have such low levels of vaccination against COVID-19 and barely any vaccination production facilities.

It would be outrageous if coronavirus vaccines were funded because they affect the richer states and malaria vaccines were not because the disease is perceived as largely an African issue. Africa has the lowest COVID-19 vaccination rate in the world, with just 4 percent of the continent’s 1.2 billion population fully inoculated. These huge inequalities are as dangerous as the pathogens. It is in the world’s interest that struggles against such diseases adopt a global approach that ensures nobody is left behind.

  • Chris Doyle is director of the London-based Council for Arab-British Understanding (CAABU). Twitter: @Doylech
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