The world’s first malaria vaccine will be rolled out in pilot projects in sub-Saharan Africa, the World Health Organization (WHO) has announced. Funding is now secured for the initial phase of the program, and vaccinations are due to begin in 2018.
The vaccine, known as RTS,S, acts against Plasmodium falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children.
“The pilot deployment of this first-generation vaccine marks a milestone in the fight against malaria,” said Dr. Pedro Alonso, Director of the WHO Global Malaria Program. “These pilot projects will provide the evidence we need from real-life settings to make informed decisions on whether to deploy the vaccine on a wide scale.”
The Global Fund to Fight AIDS, Tuberculosis, and Malaria approved $15 million for the malaria vaccine pilots on November 17, assuring full funding for the first phase of the program. Earlier this year, Gavi, the Vaccine Alliance, and UNITAID announced commitments of up to $27.5 million and $9.6 million, respectively, for the first four years of the vaccine program.
RTS,S was developed through a partnership between GlaxoSmithKline and the PATH Malaria Vaccine Initiative, with support from the Bill and Melinda Gates Foundation and from a network of African research centers.
In October 2015, two independent WHO advisory groups comprised of the world’s foremost experts on vaccines and malaria—the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Committee (MPAC)—recommended pilot implementation of the RTS,S vaccine in three to five settings in sub-Saharan Africa. These recommendations followed a July 2015 announcement that the European Medicines Agency had issued a positive scientific opinion of the RTS,S vaccine.
WHO officially adopted the SAGE-MPAC recommendations in January 2016 and has since worked to mobilize financial support for the pilots and to finalize the program design. The pilot program will evaluate the feasibility of delivering the required four doses of RTS,S; the impact of RTS,S on lives saved; and the safety of the vaccine in the context of routine use. It will also assess the extent to which the vaccine’s protective effect demonstrated in children 5 to 17 months of age in the phase 3 trial can be replicated in real-life settings.
RTS,S is the first malaria vaccine to successfully complete pivotal phase 3 testing. The phase 3 trial enrolled more than 15,000 infants and young children in seven countries in sub-Saharan Africa. Countries that participated in the phase 3 clinical trials will be prioritized for inclusion in the WHO pilot program. Consultations are ongoing and the names of the three selected countries will be announced in coming weeks.
The RTS,S vaccine is proposed as a tool to complement the existing package of WHO-recommended malaria preventive, diagnostic, and treatment measures and will be used in combination with the current interventions. Other tools include: long-lasting insecticidal bed-nets, spraying inside walls of dwellings with insecticides, preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective antimalarial medicines.
Deployment of these tools has already dramatically lowered malaria disease burden in many African settings. Between 2000 and 2015, the rate of new malaria cases in sub-Saharan Africa fell by 42% and malaria mortality rates fell by 66%. However, this region continues to account for approximately 90% of global malaria cases and deaths.
As RTS,S is only partially effective, it will be essential that any vaccinated patients with a fever be tested for malaria, and that all those with a confirmed malaria diagnosis are treated with high-quality, effective antimalarial medicines.
Source: WHO (link is external); November 17, 2016.
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