Friday, August 12 2022

WHO to roll out Africa’s first malaria vaccine

BLANTYRE, Malawi (AP) — As the World Health Organization announces the next step in its rollout of the world’s first licensed malaria vaccine to three African countries, concerns about its value come from an unlikely source: the Foundation Bill and Melinda Gates, arguably the vaccine’s biggest supporter.

The WHO approved the vaccine last fall as a “historic” breakthrough in the fight against malaria, but the Gates Foundation told The Associated Press this week it would no longer support the vaccine financially.

Some scientists say they are mystified by the move, warning it could leave millions of African children at risk of dying from malaria and undermine future efforts to solve intractable public health problems.

The vaccine, sold by GlaxoSmithKline as Mosquirix, is about 30% effective and requires four doses.

The malaria vaccine has “far lower efficacy than we would like,” Philip Welkhoff, director of malaria programs at the Gates Foundation, told the AP. Explaining his decision to end support after spending more than $200 million and several decades to bring the vaccine to market, he said the vaccine was relatively expensive and logistically difficult to deliver.

“If we’re trying to save that many lives with our existing funding, that cost-effectiveness matters,” he said.

The Gates Foundation’s decision to no longer support the rollout of the vaccine in Africa was made years ago after detailed deliberations, including on whether the foundation’s money would be better spent on other vaccines. against malaria, treatments or production capacity, Welkhoff said. Some of the resources that could have been used to get the vaccine to countries have been redirected to buy new insecticidal bed nets, for example.

“It’s not the best vaccine in the world, but there are ways to use it that could have a big impact,” said Alister Craig, dean of biological sciences at the Liverpool School of Tropical Medicine. The world is struggling to contain the spike in malaria seen since the coronavirus pandemic disrupted efforts to stop the parasitic disease, which killed more than 620,000 people in 2020 and caused 241 million cases, mostly among children aged under 5 in Africa, said Craig.

“It’s not like we have a lot of other alternatives,” Craig said. “There could be another approved vaccine in about five years, but that’s a lot of lives lost if we wait until then,” he said, referring to a vaccine being developed by the University of Washington. ‘Oxford. BioNTech, creator of the Pfizer COVID-19 vaccine, plans to apply the messenger RNA technology it used for the coronavirus to malaria, but that project is in its infancy.

Another big hurdle is availability; GSK says it can only produce around 15 million doses a year until 2028. The WHO estimates that to protect the 25 million children born in Africa each year, at least 100 million doses a year may be needed. Although there are plans to transfer the technology to an Indian drugmaker, it will be years before doses are produced.

“All the money in the world” would not alleviate short-term vaccine supply constraints, said Welkhoff of the Gates Foundation. He noted that the Gates Foundation continues to support the Gavi vaccine alliance, which is investing nearly $156 million to make the vaccine initially available in three African countries: Ghana, Kenya and Malawi.

“We are supporting rollout through Gavi funding, but have decided not to dedicate additional direct funding to expand vaccine supply,” Welkhoff said.

On Thursday, WHO and Gavi invited developing countries to apply for funding to pay for the malaria vaccine in their country.

“If distributed widely, the vaccine will help prevent millions of cases of malaria, save tens of thousands of lives and secure a brighter future for the continent,” said Dr Matshidiso Moeti, director of the for Africa.

The withdrawal of Gates Foundation financial support for the malaria vaccine could disrupt others, said Dr David Schellenberg of the London School of Hygiene and Tropical Medicine.

“There is a risk that this will discourage other people considering funding the malaria vaccine or even deter people working on other vaccines,” he said. He said combining the use of the vaccine with other measures, such as drug distribution during the peak malaria season, could significantly reduce cases and deaths.

“We still see people coming in with four or five episodes of malaria a year,” he said. “We don’t have a silver bullet, but we could make better use of the tools we have.”

A flawed vaccine rollout would still save lives, said Dr. Dyann Wirth, an infectious disease expert at Harvard University.

“We would like to have 100 million doses, but that kind of money doesn’t exist for malaria,” she said. “The 15 million doses we have still represent 15 million opportunities to protect children that we didn’t have before.” The Gates Foundation did its part to bring the vaccine to market and it is now up to countries, donors and other health organizations to ensure it is used, she said.

The vaccine, even with its imperfections, is eagerly awaited in Malawi.

Nolia Zidana, 32, said she was keen to get her two young sons vaccinated after watching malaria sicken them several times – and surviving it herself.

“Growing up with my parents and siblings, we were sick with malaria all the time,” said Zidana, who lives in Malawi’s central Ntcheu district. “My eldest son has had malaria countless times in the four years he has lived. When he was only 7 months old, twice my youngest son has already contracted malaria,” he said. she declared.

She said that although they sleep under mosquito nets, they sometimes get bitten before going to bed as they prepare meals for supper in the dark of the evening.

“We hear of other people using mosquito repellents or burning coils of mosquito repellent incense, which we can’t afford because we’re just hand-to-mouth peasants,” he said. she declared.

Dr Michael Kayange, from Malawi’s Ministry of Health, urged everyone in the country to take all possible measures to fight malaria. Vaccination itself is insufficient to stop the disease and people should adopt several strategies, he said.

“Even sleeping under a mosquito net, you have played your part in reducing the burden of malaria in the country,” he said.

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