At Last a Vaccine Therapy for Malaria? [editorial] (allAfrica.com)

The days of malaria, one of Africa’s main health challenges – and equally that of swathes of South and Central America and other tropical environments across the world – appears to be gradually coming to an end with the recent approval, for use, of the malaria vaccine, Mosquirix, which had undergone development and generally successful trials, in the past 28 years.

This is expected, hopefully, in the months to come, to put an end to the threat of malaria, endemic in mosquito-infected regions in which over half of the world’s population live. Malaria matters to us because Africa accounts for one of the highest disease burdens and the greatest number of mortalities in the world. Each year, almost one million Africans, mostly children, die of malaria. In addition, we lose a considerable number of working hours to the illness.

The Mosquirix or RTS, S malaria vaccine (developed from two proteins (RTS and S), announced by the European Union Human Medicine Regulatory Agency barely a fortnight ago is being offered “not-for-profit” by GlaxoSmithkline – GSK – (which sponsored the development of the vaccine in collaboration with the Malaria Vaccine Initiative, and a host of private and public sponsors, including The Global Fund, ExxonMobil Foundation, and the Bill and Melinda Gates Foundation, etc). Mosquirix will be distributed at cost with only a 5 percent mark up, which would be subsequently invested in research for newer vaccines, according to statements from the manufacturers – GlaxoSmithkline – GSK.

This is a welcome, and salutary, collaboration in social philanthropy among some of the world’s biggest business entities and the civic sector of non-governmental organisations like the Malaria Vaccine Initiative, The Global Fund, and the Bill and Melinda Gates Foundation, which have built credibility in brining attention while serving as missioners of global health care. It is just as well to know, also, that in a world increasingly ravaged by the morality of the teller machine, we can toast to one pleasant moment of the triumph of the humanistic instincts of social capital.

Malaria is a global health concern, affecting people in 104 malaria endemic countries and territories, with a burden of almost 300 million cases in 2014. Of the about two billion people living in malaria endemic locations, almost one million of them die every year, with 90 percent of the mortalities occurring in Africa alone, according to the World Malaria Report 2014.

However, the vaccine, targeted at the most dangerous of malaria carriers – the Plasmodium falciparum parasite seems to still be of largely limited use, effective only within a narrow age group. While it has been approved for use in children between the ages of six and 17 months, it is seen as having opened the door for the development of newer malaria vaccines that would cover wider age groups and people.

Several studies have shown malaria as having a deep-rooted link with poverty, with the poorest countries, usually with people living on less than US$I .25 a day carrying the highest burden. According to estimates by the World Health Organisation, of the six highest malaria-prevalent countries in Africa, Nigeria tops the incidence log, followed by the Democratic Republic of Congo, Tanzania, Uganda, Mozambique, and Cote d’Ivoire.

These six countries constitute a projected 47 percent (or 103 million) of malaria incidence in the world. South East Asia is the second most affected region, with India bearing the largest burden of about 24 million cases per year, and Indonesia and Myanmar following it.

The development of Mosquirix and the possibility of newer malaria vaccines signals the beginning of a post-malaria world that will gradually rely less on the usual prophylaxis and treatment including long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), and the artemisinin-based combination therapies (ACTs) that are presently pervasive and are leading to the redoubling of the resistance of mosquitoes to these.

However, what is probably the best of intentions of global pharmaceutical companies and research funds do not actually cut to the chase of the matter. Documented research confirm the existence of a more effective solution to the containment of malaria through the use of biolarvicides (the Bacillus thuringiensis and Bacillus spaericus that eat up mosquito eggs) developed by the Cubans decades ago, but which are yet to be sanctioned by the world’s major health regulators, despite their efficacy elsewhere (as in Vietnam). This also points to the double standard of the West in the elimination of a threat that leads to the death of over three thousand children in Africa every day.

When the West suffered from mosquito infestation and malaria in the 1950s, they adopted the policy of wiping out mosquitoes in its entirety through the use of chemical insecticides, such as DDT. Yet, the West has cautioned Africa and other malaria endemic regions through the decades not to follow the same course it took, due to claims of its negative impacts on the environment. Instead, they’ve continuously advocated prophylaxis and treatment as measures to control and not eliminate mosquitoes, before the advent of these new and potential vaccines.

Currently the World Health Organisation (WHO) has accepted that the application of biolarvicides is ecologically safe, sustainable, and have indeed recommended their use. Equally, the technical capacity to eliminate malaria through the use of chemical larvicides is available. Even ECOWAS as a regional body has not only proactively embraced the Cuban alternative to the campaign for the elimination of malaria at its 42nd Summit in Yamoussoukro, Cote D’Ivoire in February 2013, but has also moved towards the implementation of the transfer of this technology from the Cubans.

There are those who will, with merit, question why the West has stubbornly refused to support such a radical and effective means of combating malaria in its entirety – and within a shorter period of time – rather than invest in vaccines and therapies whose efficacy and control is still to be determined? Or could this be global capitalism seeking to recoup its pharmaceutical investments, at the cost of preventable deaths and corollary costs across the world?

Still, the bitter irony of this development is not lost on the moral vacuity of the African business and political class. Behind the glass palaces of most African cities the type of money that financed this vaccine is undoubtedly locked up as proceeds of crime. Without doubt too, the haemorrhage in corruption alone, even in one country like Nigeria, will pay for this type of initiative.

This is therefore one more wake up call to African leaders to take the bold and honourable step in redressing the context of governance that privileges the primary place of the citizen.

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