"This is the culmination of 30 years of work", exclaims, all smiles, Brian Greenwood, researcher at the School of Hygiene and Tropical Medicine at the University of London, contacted by France 24. Wednesday 6 October, the World Health Organization (WHO) recommended the massive deployment of a first malaria vaccine in children living in sub-Saharan Africa and in areas at risk. A decisive step, for this scientist who has devoted his entire career to the question, but not final, as the challenges to eradicate this disease remain numerous.

A very old disease that manifests itself by fever, headaches and muscle aches then by cycles of chills, fever and sweating, malaria - or malaria - would kill a child every two minutes in the world, according to the WHO.

Of the 400,000 deaths recorded each year, 94% are on the African continent and mainly concern children under 5 years old. 

A first vaccine against the parasite

For a long time, the prospect of a malaria vaccine seemed an unattainable Holy Grail.

In total, more than 100 candidate vaccines have already been tested in humans against Plasmodium falciparum, the parasite responsible for the disease.

Without convincing results so far.

"It is a question here of developing a vaccine against a parasite, and not against a virus. And that makes the task much more difficult", explains to France 24 Benoît Gamain, research director at the CNRS, specialist in gestational malaria, c that is to say mainly affecting pregnant women.

"The parasite is a complex organism, with more than 5,000 genes to take into account, compared to dozens for a virus. It is therefore more difficult to find the right targets to develop an effective vaccine."

"In addition, the protein targeted by the vaccine must not mutate. Parasites are very good, more than viruses, at evading the host's immune response."

The vaccine that has managed to do well is Mosquirix, or RTS, S, developed by the British pharmaceutical giant GlaxoSmithKline (GSK).

"Scientists have been working on it since 1987, that is to say more than 30 years", recalls Benoît Gamain.

"It is the most developed to date."

Since 2019, Mosquirix has been the subject of a pilot program: more than 2.3 million doses have been administered to children in Ghana, Kenya and Malawi.

The results show that it "reduces malaria in its severe form by 30%," said Kate O'Brien, director of the immunization department at WHO. 

In detail, phase 3 clinical trials have shown that the vaccine, when given in four doses, prevents 4 in 10 cases of malaria, and 3 in 10 cases of severe, life-threatening malaria.

This therefore makes it the first vaccine, and the only one so far, to have shown efficacy in significantly reducing the number of cases.

Another tool in the antimalarial arsenal

"The WHO announcement therefore marks a historic breakthrough because it is the first time that a parasitic vaccine will be deployed on a large scale. But for all that, with its limited effectiveness, it is not the ideal vaccine" , nuance Benoît Gamain.

And the scientist continues: "This will not revolutionize health in sub-Saharan Africa but it should be seen as a new weapon in the fight against malaria."

While this vaccine will therefore not be the key to eradicating malaria, it is a new tool that is added to the preventive treatments and repellents already present in the antimalarial arsenal.

This tool is all the more important at a time when fears of parasite resistance to various treatments are increasing.

In addition, according to a study published in late August in the New England Journal of Medicine, led by Brian Greenwoord, a combination of vaccine and preventive treatment could reduce hospitalizations and deaths from the disease by 70% in young children. 

This study followed approximately 6,000 infants aged five to 17 months for three years in Burkina Faso and Mali.

The children received several doses of vaccine in parallel with antimalarial treatments at the onset of the rainy season, when the risk of contamination is greatest.

“It worked very well,” says Brian Greenwood. 

"This imperfect vaccine will always be better than any vaccine," he insists.

"But our study proves the importance of continuing to fund research, especially on these preventive treatments."

Towards more effective vaccines? 

At the same time, other vaccines are raising the hopes of the scientific community.

One of them, R21 / Matrix M, developed by the University of Oxford, has shown very promising results by showing, at the end of its phase II, an effectiveness of 77%.

The third phase began with nearly 5,000 children in Kenya, Tanzania, Burkina Faso and Mali.

The results are expected in 2023. 

In July, the BioNTech laboratory, for its part, indicated that it wanted to launch trials for a vaccine using messenger RNA technology, in the wake of the vaccines developed against Covid-19.

"The development of a messenger RNA vaccine does indeed bring hope", according to Benoît Gamain.

"Despite everything, if a vaccine using this technology was quickly developed for Covid-19, it is, in particular, because we knew the target to aim for: the Spike protein. It is not as obvious for malaria. therefore the task promises to be much more complex. "

>> The fight against malaria also suffers from Covid-19

"The next challenge is access to vaccines"

Before the massive deployment of the RTS, S vaccine, many challenges, this time logistical, will also arise.

The first, and not the least, concerns the financing of these vaccines. 

"It is essential that the vaccine be free," responded to France 24 Olivia Ngou, president of the NGO Impact Santé en Afrique.

"Malaria mainly affects the most vulnerable children in situations of extreme poverty. It is essential that they can benefit from this new weapon." 

"We will therefore have to quickly tackle the question of resources: who is going to finance? How high?", She asks, calling for the lifting of patents on vaccines.

"In this way, we can produce them in our territory and deploy them at a lower cost."

For its part, the Vaccine Alliance (Gavi) has already announced that it will examine, as well as with other relevant actors, "if and how to finance a new vaccination program against malaria in the countries from sub-Saharan Africa, ”in a statement released after the WHO announcement. 

"It will also raise the concrete question of access to care. The disease largely affects a refugee or nomadic population. How can we ensure that these children will be able to benefit from the four necessary doses?", She raises .

"And obviously, all of this will have to be accompanied by a major awareness campaign to reassure parents and encourage them to vaccinate their children."

"This announcement is a very big step forward, which gives us a lot of hope for the future", concludes Olivia Ngou.

"But these logistical obstacles will have to be tackled quickly."

"The work is far from over," abounds for his part Brian Greenwood.

"We must now develop a more effective vaccine, valid for other age groups, strengthen preventive treatments ... There are still many challenges."

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