The WHO authorized a malaria vaccine in October 2021. Tedros Adhanom Ghebreyesus, Director-General of the United Nations, called it “historic.” RTS, S reduces severe malaria by 30% in completely immunized youngsters. The vaccine might prevent 3 to 10 million malaria cases and save 14,000 to 51,000 children by 2020, depending on how it is delivered. Experts have known since the late 1990s that the vaccine’s fundamental component protects against malaria.

Why did a global killer vaccine take so long to develop, whereas COVID-19 dosages were approved in less than a year? A lack of urgency and finances, according to RTS, S specialists, hampered trial logistics at every point. According to Ashley Birkett, director of PATH’s malaria vaccination programme, the victims are impoverished African children. “Unfortunately, this contributes to the community’s lack of urgency.”

Vaccine research for malaria began in the 1960s. They identified a circumsporozoite protein on the surface of the parasite in 1980 and realized it could provide immunity. After finding the protein’s gene in 1984, the military pushed for a malaria vaccine. Smith, Kline & French, GlaxoSmithKline’s forerunner, assisted the government.

According to experts, the task was difficult. Once within people, the malaria parasite has a complex life cycle with at least three phases, and it “changes clothing” during its evolution. Any vaccination aimed at a specific stage of illness must be effective at that stage or it will fail. There was no basic vaccine development technology available.

Twelve circumsporozoite vaccines were unsuccessful. Only RTS. In a 1998 experiment in the Gambia, immunization prevented 34% of illnesses. “That’s where RTS and S come from,” stated LSHTM infectious disease expert Brian Greenwood.

Greenwood believes the vaccination was developed out of curiosity rather than necessity. No shoving. He believes it was done by intellectuals and immunologists. There are no health risks. Those involved in the vaccine’s development believe that evaluating a vaccine without a commercial market will be challenging.

In 1999, Walter Reed vaccinologist Ripley Ballou met with GSK officials. He was in the Belgian army. Ballou and his GSK colleagues revealed the findings of their Gambia trial. “This study gives us hope that something is happening,” he continued. The immunization will be particularly beneficial to children.

If Ballou and his colleagues can find a partner, they may be able to continue. If the project is successful, GSK may profit. The US military abandoned RTS-S because of concerns regarding personnel safety. PATH’s Malaria Vaccine Initiative, rather than the Gates Foundation, supported the effort.

When vaccine manufacturers experimented in Africa, they encountered difficulties. Ballou mentioned the onerous logistics. “We had to renovate an empty building,” he explained. Both time and money were required.

Before moving forward, phase I and II trials examining the safety and efficacy of the injection must be conducted in adults, then older children, and finally small children, optimizing the dosage versus side effects for each age group. “Ten years,” says Greenwood.

Following the third dose, phase II trials revealed a 65.9 per cent reduction in infection in infants, prompting a large-scale phase III study in 2009. No one, according to Ballou, had conducted a large-scale malaria immunization experiment.

From 2009 to 2014, seven Sub-Saharan African countries undertook phase III investigations. 15,000 children have been registered. According to Schuerman, GSK planned to build a factory after seeing promising results.

In October 2015, a WHO study of phase III trial data revealed that meningitis prevalence was higher in the vaccinated group than in the control group, and death was higher among vaccinated girls. However, the link was unclear. The WHO sought a broader study to test the vaccine in real-world settings. This statement surprised several scientists. “We halted production,” says Schuerman. The vaccine team was tasked with establishing clinical trials, which included gathering financing, selecting countries, and employing trial employees.

More research, experts agree, is required. Given the global anti-vaccine trend, Wongani Nyangulu, a phase IV trial site head in Southern Malawi, believes it is critical to rule out any safety concerns.

It took four years to launch the trial. 900,000 children were immunized in Ghana, Malawi, and Kenya. Following an evaluation of the findings, the WHO recommended making the vaccine widely available in October 2021. GAVI, an organization that supplies vaccines to impoverished countries, funded $155.7 million in RTS, S.

After 20 years of research, RTS, S was ready for general use. RTS, S was licensed less than two years after COVID-19 was released.

Sub-Saharan African researchers are irritated. In August, a Kenya Medical Research Institute scientist stated that if COVID-19 received the same attention and funding as malaria, it might be eradicated. Malaria killed more Africans before COVID-19.

Other African experts agreed with him. According to Deus Ishengoma of Tanzania’s National Institute for Medical Research, it would be “awful” if the world neglected malaria because of COVID. “There’s no reason not to create a malaria vaccine in the next ten years,” he stated.

Others cautioned against comparing vaccinations. Birkett believes that COVID is an easier immunization target. Malaria, he claims, is “harder.” According to analysts, RTS, S delayed the procedure. COVID-19 was not as important because antimalarial medicines and other treatments had long been used. According to experts, the disparity reflects how severe diseases are addressed. “No one wants to pay for a vaccine,” says Ballou.

Budgetary restraints, according to Birkett, stymied development. In that order, we required data, money, and a procedure. According to experts, economics may be a barrier to RTS and S adoption. This is Ballou’s primary immunization concern. According to Policy Cures Research, a global health think-tank, funding for malaria vaccine R & D has decreased since 2017.

Next-generation malaria vaccines are now possible thanks to RTS and S. In phase II trials, Oxford’s R21 vaccine demonstrated 77 per cent efficacy. Greenwood lauded the distribution system as well as the regulators. R21 is based on the same formula as RTS, S, and “all the evidence indicates it’ll be fairly equivalent,” according to Birkett.

BioNTech, which collaborated on the first mRNA COVID-19 vaccine, aspires to develop a malaria vaccine by 2022. Within 35 years, next-generation immunizations should be safe and effective. Birkett believes we’ll travel faster the next time.

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