“Over millennia, its victims have included Neolithic dwellers, early Chinese and Greeks, princes, and paupers.”
Few ailments have reigned over mankind for centuries like malaria. Responsible for over half a million deaths each year, with 2/3rds of those being children under the age of five, the disease has claimed between 150 million and 300 million lives in the last century alone. Almost 5% of deaths in the 20th century have been attributed to malaria, according to Carter and Mendis, 2002. It is also spread throughout the globe, with 40% of the world's population living in areas where malaria is still a threat. However, about 95% of cases and deaths in 2021 belonged to sub-Saharan Africa.
Given the significant threat to human lives that malaria presents, the prospect of a vaccine that could eradicate the disease from our populations is extremely attractive. Not only from a humanitarian viewpoint, but a medical one too, as it would herald a new age of health and medicine. However, after decades of research and millions of dollars spent on it, an effective vaccine for malaria remains elusive, This is partly because of the malaria parasite's multi-stage life cycle and its ability to avoid detection by the human body's immune system. Parasites are much more complex than viruses or bacteria, and the malaria parasite is able to change its structure and proteins on its surface to effectively evade detection by the immune system.
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| Malaria Parasite |
The quest for a malaria vaccine which has been underway for a hundred years, was seemingly brought to an end with the announcement of a new vaccine called Mosquirix in 2021. Mosquirix was touted as not only being a first vaccine for malaria, but in fact, for any parasitic disease, amid much fanfare and jubilation. It also caused great celebration and publicity when the WHO announced that the RTS,S/AS01 malaria vaccine would be introduced in immunization services for children as a pilot implementation in certain parts of Africa that are disproportionately affected by the disease.
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| The new malaria vaccine. Image: Gavi |
While being hailed as the ultimate victory over the parasite that has killed so many and proven such a challenge for vaccine researchers on one hand, the jubilee was marred by claims of bioethical wrongdoing by the WHO. The British Medical Journal published reports of “serious breach of international ethical standards” by the WHO in the vaccine rollout program. According to the authors of the report -- members of the committee that issues bioethics guidelines for the WHO -- the issue lies in the lack of informed consent from the participants and their families. The WHO opted to require only “implied consent” for the vaccination, which entails considering participant presence at the site of vaccination as consent. This policy does not require parents to have read or understood the terms of the vaccination.
Consent is one of the most fundamental aspects of healthcare. The WHO's blatant violation of this natural human right shows utter disrespect for the patients by disregarding participants’ autonomy and ability to discern what is in their best interest. The issue is further exacerbated by the serious safety concerns of correlated meningitis, cerebral malaria, and increased death risk in young girls associated with the vaccine, not to mention an efficacy that can hardly be considered revolutionary at 39% -- a far cry from the WHO’s previously established goal of 75% efficacy for a malaria vaccine. The multiple safety and ethical issues hounding the rollout provoke serious questions about the vaccine's advantage and WHO's motive behind aggressively pushing the vaccine on Africa's population.
Amidst the controversy surrounding the Mosquirix vaccine, a new promise of malaria eradication arose thanks to COVID-19. The German pharma company BioNTech which gained world fame from its 95% effective mRNA vaccine for covid-19 (developed jointly with Pfizer) has set its sights on malaria next and has already initiated first-stage clinical trials of an mRNA vaccine for malaria that is based on a novel multi-antigen approach.
Bibliography
https://www.who.int/news-room/fact-sheets/detail/malaria
Borfitz, Deborah. “WHO Malaria Vaccine ‘Rollout’ In Africa Raises Ethical Questions” Clinical Research News, March 20, 2022.
Brown, Beatrice. “Is ‘Implied Consent’ Ethically Permissible in WHO’s Malaria Vaccine Pilot Introduction?” Bill of Health, March 11, 2022.
Duster, Troy. “Race and Reification in Science” In Science 307 (Feb. 18 2005): 1050-1.
World Health Organization. “Malaria: The malaria vaccine implementation programme (MVIP).” Accessed December 5th, 2022.
Brown, Carolyn. “Malaria vaccine not perfect, but still useful” National Library of Medicine (Sept 2015): 954-5.
Arrow, Panosian, and Gelband. “Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance.” National Academies Press (2004)
https://www.gavi.org/vaccineswork/groundbreaking-history-worlds-first-malaria-vaccine?gclid=Cj0KCQiA8t2eBhDeARIsAAVEga0cDWhmhN4ghGypoIk4mC-KmmbFe5tHVLJc0GfBaaCV6-qJCEq8LSYaAv5TEALw_wcB
https://investors.biontech.de/news-releases/news-release-details/biontech-initiates-phase-1-clinical-trial-malaria-vaccine
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