India, a high malaria-endemic country, has made significant strides against malaria.
The WHO recommending ‘widespread use’ of RTS,S/AS01 (RTS,S), the world’s first malaria vaccine, marks the culmination of a century-long hunt for a malaria vaccine. To be sure, this is just the first and other candidates may follow soon. But the importance of the vaccine for the world can’t be emphasised enough. As per the World Malaria Report (WMR) 2020, there were 229 million cases of malaria and 409,000 related deaths reported in 2019; while these numbers represent a decline in the respective absolute numbers, the burden continues to be high.
What’s worse, children constitute over 50% of the cases of malaria mortality globally. The WHO’s recommendation of RTS,S is based on the results from an ongoing pilot in three African countries; with 2.3 million doses of the vaccine delivered so far, to 800,000 children, without any significant adverse effects, there is real world evidence of its safety.
There was some initial criticism of its limited efficacy—a malaria-prevention rate of 39% and a severe-malaria (which is a proximal indicator of related mortality) prevention rate of 29% among the inoculated children. However, the findings of a study conducted by the London School of Hygiene & Tropical Medicine justify reposing trust in the vaccine—there was a 70% reduction in hospitalisation or death among children given both RTS,S and preventive antimalarial drugs during the high-transmission season over either course of action alone.
Bear in mind, RTS,S acts against Plasmodium falciparum, the more virulent strain of the parasite that also happens to account for over 95% of the malarial cases across the globe. The fact that cases of resistance against anti-malarial (treatment) drugs, including artemisinin, are getting reported with increased frequency suggests vaccines will have to be relied upon more.
India, a high malaria-endemic country, has made significant strides against malaria. The WMR 2020 makes particular note of the fact that it reported the largest absolute decline in annual cases in the WHO’s Southeast Asian region—from 20 million in 2000 to 5.6 million in 2019. However, it still accounts for 86% of the cases in the region, and some of its poorest states make up, as the government acknowledges, a disproportionate share—Odisha, Chhattisgarh, Jharkhand, Meghalaya and Madhya Pradesh reported 45.5% of the country’s total malaria cases in 2019. Most important, the WMR 2017 had flagged poor malaria detection in the country, pegging the number of cases detected at a mere 8% of the actual.
Against such a backdrop, it is essential that the government—both the Centre and states —figure out a way to include the vaccine in the country’s vaccination efforts. Some will argue that the low efficacy will queer the economics of rolling out the vaccine, and point to the low absolute malaria mortality numbers to question the need.
But, even when malaria is not fatal, research shows, with repeated attacks, it alters the body’s immunity in ways that weaken defences against pathogens, especially among children. Besides, the African pilot shows it has had no negative impact on use of insecticide-treated bednets and health-seeking behaviour for febrile illnesses. Earlier this year, researchers at Oxford University’s Jenner Institute claimed that a malaria vaccine they had been working on reported 77% efficacy in a trial among 450 children in Burkina Faso. RTS,S could be a precursor, nudging people towards vaccine-seeking against malaria till a better candidate enters the picture.