A new malaria vaccine by the University of Oxford has proved 77 per cent effective in early trials and is a potential major breakthrough against a disease which kills 400,000 people annually, mainly children.
Burnet’s Director and a malaria specialist, Professor Brendan Crabb AC spoke with ABC Radio Sydney’s Josh Szeps.
“The holy grail is a vaccine that’s cheap and effective and highly available. And you know, we just might have it. It’s a very big discovery announced in the last week by Oxford.” - Professor Brendan Crabb AC
Below is a snapshot of the wide-ranging interview about the devastating impact of malaria and vaccine development.
Josh Szeps, ABC Radio Sydney presenter
What was the challenge to developing a successful vaccine for malaria? What is the challenge?
Professor Brendan Crabb AC
For some pathogens, for some organisms that could cause disease in people it’s just really hard - HIV, hepatitis C, tuberculosis and malaria. For a lot of other things, it’s relatively straightforward. It’s never simple but relatively straightforward, you know, measles, mumps, rubella, diphtheria, tetanus, and so on. They worked pretty quickly and then even coronavirus worked pretty quickly. But that’s not to say there wasn’t a lot of sophisticated science that went into it. But some organisms and this malaria parasite, it’s just technically more complex. That’s the first reason. Secondly, they are infections of poverty largely, so there isn’t as much of a push to get it across the line, so investment matters, or lack of investment has mattered, but also complexity, they are really complicated organisms.
How does this new vaccine work?
It works by stopping the form of the parasite that enters you from a mosquito, a mosquito injects some parasites from its saliva glands into you and that goes to the liver. That’s the first stage of the life cycle. These parasites literally infect you and hang around there for a couple of weeks before they go into your blood and we’re much more familiar with the blood form. This vaccine makes antibodies that block the entry of coronavirus into ourselves, this vaccine does a similar thing to malaria parasites entering parasites.
Explain to us where malaria is worst and what the causes of it are. And obviously it’s a parasite. But why is the parasite successful in some places and not others? And what does it do when it gets into us?
Well, malaria is transmitted by mosquitoes. It’s an ancient disease, pretty much the first pandemic of infections we know about that jumped across from an animal species. In the case of malaria, about 50,000 years ago that happened.
It’s been pretty much the worst infection of humanity, perhaps killing up to 10 per cent of people who lived in our history. And it’s shaped our genomes.
It’s why we have lots of different blood groups. That’s why we have blood diseases like sickle cell anaemia and the human diseases that give you some resistance to malaria. This parasite is able to give you a disease that gives it protection. It’s also no doubt been why we migrated. You know, we’re all originally African, and we’re not African all of us anymore. Tropical diseases had a big say in that. So the tropics and sub-tropical region of the world is where malaria is. They are also almost universally poor regions of the world.
Malaria is associated with poverty. It drives poverty. It’s extensive, yes, it kills a lot of people. But it also causes debilitating disease in literally hundreds of millions of people - two, three or 400 million people every year. And that is economically crippling, as well as bad for health.
So it’s a major driver of poverty in the tropical and sub-tropical world. We just have to deal with it, of course for the health and wellbeing of those people, but it’s also a chance to prosperity for places like PNG in our region that has so much malaria.
While we’re all thinking about the coronavirus vaccines and getting our jabs, it may be that the most devastating pandemic in human history really, malaria is about to see a breakthrough. There’s a malaria vaccine, which has proven highly effective in a trial in Burkina Faso. When you say that 10 per cent of humans who ever existed may have died of malaria. Did I get that right? Is that what you said?
Yes, it’s hard to be precise, but we know that it’s had a huge and devastating impact on the world for a very long period of time. Of course, there was a time that malaria was in every country in the world, in the UK, Italy, Western Europe, and so on. In the America’s in the US Civil War, malaria killed more people than bullets, a lot more people than bullets, which is a story that isn’t well known. So it was everywhere.
And then as the tools to reduce malaria became better, we got rid of malaria from the more or less tropical regions of the world. So further away from the equator that worked quite well. But as we’ve gotten closer to the equator, it’s just too hard. There’s too much transmission. And that’s why these new tools are so important. You mentioned 400,000 child deaths a year, 20 years ago it was a million child deaths a year. So there’s a lot of improvement that’s been made in just those last few decades.
And is that mostly from things like mosquito nets and practical things that we can do or what’s causing that?
Two major tools, insecticide treated bed nets. So these are bed nets but they’ve got insecticide impregnated into them which has been an incredibly successful tool, and just testing and treating. So there are drugs for malaria but not many left, and there’s tests for malaria.
So why those gains stalled prior to COVID-19 was because parasites, just like the variants of coronavirus, become resistant to the drugs and resistant to the insecticide and even resistant to the test. They avoid the diagnostic test. So we need new tools.
And the holy grail is a vaccine cheap and effective and highly available. And you know, we just might have it. We really just might have it. It’s a very big discovery announced in the last week.
So this new vaccine from Oxford is the first to meet the World Health Organization goal of 75 per cent efficacy against malaria and is heading to larger trials now involving 4800 children across four countries to check that it actually works. What are the economics of this Brendan? If proven to be successful, is there some kind of global international effort which would be able to potentially provide this vaccine to people who can’t afford it?
Yes, there is a global international effort to both develop and provide vaccines and other interventions, particularly GAVI, Global Alliance for vaccines and immunisation, and the Global Fund for HIV, TB and malaria, these are major funds that Australia makes a decent commitment to and provided just the huge gains that I’ve mentioned over the last decade or so, already.
But the amount spent on malaria given its impact, which is quite literally a major driver of poverty for a third or so of the world … what we spend is a drop in the bucket.
What I think COVID-19 taught us is the value of investing. And in malaria’s case, we could really spend two, three or four times more, both on developing and distributing these interventions. And the rewards for the world would be phenomenal through malaria and HIV and TB. The world can be transformed.
We just have to be ambitious enough from an investment point of view. The Australian government gets it. They are incredibly generous. But they could do more, as could the rest of the rich world to make this go away forever.
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