The end of malaria?

By Stephen Kafeero

Promising new vaccine under trial provides hope to millions

British pharmaceutical company, GlaxoSmithKline, says a malaria vaccine could be on the market by 2015. This would be the first vaccine for the disease that has claimed millions of people especially in Sub-Saharan Africa.

The global NGO, Malaria Consortium, estimates that in Uganda malaria kills between 70,000 and 100,000 people every year. That is about 25% of all deaths and far more than those killed by HIV/AIDS. The majority of malaria victims are children under the age of five.

GlaxoSmithKline says it will move ahead to develop the RTS,S vaccine commercially. The vaccine is being developed with PATH Malaria Vaccine Initiative (MVI) through grant funding from the Bill & Melinda Gates Foundation and has the potential to prevent up to 100 million cases of the disease each year and save 200,000 lives.

Earlier studies on the vaccine suggested it was 65 percent effective in babies analysed six months after vaccination, and only around 50 percent in five to 17 month-olds.

Already there are malaria control measures such as mosquito nets, insecticides and anti-malaria drugs which have tried to reduce the malaria burden in the country but still many die.

Dr. Myers Lugemwa, of the Malaria Control Program in the Ministry of Health says that “no single magic bullet can eliminate malaria but rather multiple prolonged approaches to dent the disease.”

He says that the vaccines that are in the process of development are additional arsenals to the malaria control strategy.

“Uganda is lucky that our scientific teams are testing the same vaccine in Iganga, the efficiency of 47% alluded to is a big achievement as we try to push it beyond that percentage, trials will continue to see that 47% is surpassed but for the moment its good news especially for children aged 6weeks to 18 months,” he says.

In her budget speech the Minister of finance Maria Kiwanuka said the government was to develop and implement a comprehensive Strategy for Malaria Eradication to build on current efforts of prevention, diagnosis and treatment.

Also in a meeting with some members of the private sector at a business symposium held by United Against Malaria (UAM), she urged them to invest in the fight against the disease.

Challenges

In August this year, another vaccine, made by Sanaria, a Maryland, USA, based company, protected six volunteers who each got five doses over 20 weeks.  Although it provided them with 100% protection against infection during tests, the process involved was nearly impossible to reproduce in countries like Uganda where most malaria victims live.

GSK says their vaccine will be not-for-profit – but it will add 5% to the cost price which will go towards further research and development work on tropical diseases.

The pharmaceutical giant has spent US$350 million on the vaccine so far and expects to invest US$260 million more before it can be rolled out. The Bill and Melinda Gates Foundation also put in about $200m.

The vaccine appears to be more effective in infants from 5 months of age which implies that it may not be given at the same time as the basic immunisation for babies, such as diphtheria, whooping cough and tetanus, but later, like measles and pneumococcal vaccine. The introduction of a booster jab, at 18 months, is under trial to see if it can increase the duration of the vaccine’s protection.

Quick facts

• Globally, a child dies of malaria every 30 seconds.
• Uganda has the 4th largest Malaria burden in Africa, only surpassed by Nigeria, Democratic Republic of the Congo, and Tanzania and is closely followed by Mozambique and Cote d’Ivoire.
• The 6 countries account for an estimated 103 million (or 47%) of malaria cases according to the WHO report 2012. Every year, it is believed that over 660,000 people die from malaria worldwide, most of them small children under the age of five. There are about 219 million cases of the disease a year worldwide.
• Malaria accounts for 25-40% of outpatient visits, 15-20% of all hospital admissions and 9-14% of all hospital deaths.
• It is endemic in 95% of Uganda’s population and has negative economic effects, reducing the number of days a person can work by 7 days per episode of malaria. Furthermore, malaria-related expenditure is estimated to account for 34% of total expenditure for the poorest sections of society.
• In the 2013/14 financial year, Uganda is expected to spend about $23.4 million (about Shs60 billion) on the 13 million malaria cases seen in public health facilities annually.
• It has been calculated that a Ugandan person loses 23.4% of the years of their life to malaria.
• It takes about $9 (Shs 22,900) to treat simple malaria and about $60(about Shs 152,000) to treat a severe one.
• 350 children die every day due to Malaria in Uganda.
• Malaria is the main cause of infant underweight and premature births. One out of every two children is admitted to the hospital from malaria. 8-25% of the children admitted to the hospital die.
• 70% of child out patients die of malaria.
• On average, the Ugandan child suffers from six malaria episodes every year. It often causes stunted growth, childhood anemia, and mental retardation.
• Malaria is the number one cause of poverty in Uganda. It impedes a person’s income when: they must attend to themselves and others, pay for prevention and treatment, transportation to and from clinics, and funeral and burial costs. The poor can spend up to 25% of their income on malaria prevention and treatment.