Fight against malaria – game changer vaccine?

Despite enormous progress over the past 20 years, malaria is still one of the main causes of death for young children in poorer countries. In Africa alone, the worst-affected continent, around 500,000 infants die from malaria every year, according to the WHO – that's more than 1,000 every day. But pregnant women and people with weak immune systems are also particularly at risk.

What does this mean for development in the countries most affected?

Malaria is a brake on development. The disease places a massive burden on healthcare systems, especially in resource-poor African countries. Here, in the weeks following heavy rainfall, the already weak health facilities are often overwhelmed by the number of people suffering from severe malaria. In socio-economic terms, malaria leads to a loss of productivity, reduced school performance in children with long-term cognitive impairment and – of course – extremely high expenditure in the health sector.

The relationship between infectious diseases and climate change is complex. How could global warming affect the epidemiology of malaria?

In principle, malaria is now expected to spread in areas that were not previously affected by malaria, or not severely affected, such as the Ethiopian highlands. Floods and extreme rainfall could also increase the disease burden, as there would then be more breeding grounds for the vector, the anopheles mosquito.

This is what happened in Pakistan in 2022, where the number of malaria cases increased fivefold after uncharacteristically heavy monsoon rains. Will we see more malaria everywhere as global warming increases?

Yes and no: because in some areas it could even become too warm for the anopheles mosquito. Dengue fever could then become more prevalent there – transmitted by a different type of mosquito. Either way, the health situation will deteriorate, also with regard to malaria. And this is particularly true in countries that have the least resources available. They are dependent on international support. In general, however, we are concerned about the further spread of the disease, e.g. in the Global North. The tiger mosquito has already established itself in Germany, and the latest Lancet Countdown report on global health and climate change predicts that an additional 500 million people will be affected by malaria and other vector-borne diseases such as dengue and chikungunya fever.

Malaria-related deaths among young children have reduced drastically over the past 20 years – in Africa from over 1 million per year to around 500,000 today. The spread of insecticide-treated bed-nets and spraying insecticides for prevention, the introduction of rapid tests for diagnosis without a microscope and the use of a new generation of malaria drugs have been very important in this regard. And, of course, large-scale education campaigns for the most vulnerable population groups.

All of this requires a lot of money and technical expertise. What role does development cooperation play here?

In addition to long-term bilateral cooperation to strengthen health systems, the Global Fund to Fight AIDS, Tuberculosis and Malaria plays a prominent role. It has been financing the prevention, diagnosis, and treatment of malaria for more than 20 years. Germany is one of its most important donors.

And your own employer, the Global Vaccine Alliance Gavi?

The name says it all: our job is to finance vaccination programs and strengthen health systems. However, despite over 100 years of research, until recently there was no vaccine against malaria. In fact, malaria is the disease for which there have unfortunately been the most failures and discontinuations of vaccine research programs.

This has now changed. This year, Gavi will finance the roll-out of the first large-scale vaccination programs against malaria. How did this come about?

The two vaccines now available, known as RTS,S/ AS01 and R21/Matrix-M, are the result of decades of research and development in close international collaboration between, for example, the PATH Malaria Vaccine Initiative, the pharmaceutical company GlaxoSmithKline, Oxford University and the Bill & Melinda Gates Foundation. Gavi supported the studies and pilots in several countries as soon as promising vaccine candidates were identified. The malaria vaccine is now also the world's first vaccine against a parasitic disease in humans.

No, unfortunately the parasite is too resilient for that, almost insidious, if you can put it that way. But even if the vaccination cannot always prevent infection, the spread is massively reduced. And above all, the severe and fatal courses of malaria are decreasing: studies on R21/Matrix-M, for example, show that symptomatic cases of malaria have been reduced by 75 %.

However, only after three doses of vaccine and probably only for a limited time.

That is true. But with young children, it is precisely the initial infections that are severe and unfortunately often fatal. In this respect, the vaccines certainly have the potential to become real game changers in the fight against malaria.

What role will Gavi play in the distribution of the vaccines?

At least 28 countries in Africa are planning to introduce one of the two WHO-recommended malaria vaccines as part of their national vaccination programs. In 2024 alone, Gavi will support 18 countries not only with the financing of the vaccine, but also with the roll-out, i.e. storage, supply chains, awareness campaigns, training of health workers, etc. Close coordination with other development partners is particularly important here, and we are grateful that countries like Germany have been successfully promoting the strengthening of health systems in many bilateral partner countries for a long time. We can look back on good cooperation experiences with both KfW and GIZ.

One lesson learned from the Covid-19 pandemic was to strengthen the local production of vaccines in Africa. Germany alone is investing over EUR 500 million here via KfW and GIZ. The two new vaccines are being produced in England and India respectively. Why not in Africa, where the demand is highest?

In recent years, Gavi has done a lot to expand the number and regional distribution of vaccine producers. At the turn of the millennium, we sourced six vaccines from four producers in industrialized countries. This portfolio has since grown to over 20 suppliers who provide us with over 100 different formulations for 19 antigens. Most of these producers are based in emerging markets. For Gavi, this broader base of manufacturers translates into more competition, lower prices, and improved security of supply.

Africa is well on the way to establishing regional production facilities, and it is quite conceivable that the malaria vaccine could be produced on the African continent in the future. However, vaccine production is very complex, and many African countries do not currently have the necessary infrastructure or technological resources to produce such vaccines on a large scale.