Malaria remains a vexing public health problem for India. With nearly 4 lakh cases of malaria and 85 malarial deaths in 2018—these numbers are from the National Vector Borne Disease Control Programme, WHO pegged death alone at nearly 17,000 in 2017—it has one of the worst country-malaria-burden in the world. Indeed, official data is likely skimming the surface, with, as per The Indian Express, an estimated 60-80% of patients in urban areas treated at private establishments, most of which don’t report cases to the official data-collector.
What makes India’s problem particularly acute is that some of its poorest and most remote regions account for the bulk of the malaria burden. Odisha, Jharkhand, Chhattisgarh, Meghalaya, Arunachal Pradesh, Mizoram and tribal areas of Maharashtra and Madhya Pradesh report 90% of the notified cases.
Add to this the fact that many strains of the malarial parasite have rapidly developed resistance, and tackling malaria becomes a nightmare. Cholorquine, once the go-to drug for malaria, failed in the 1980s, artemisinin resistance was detected sometime in the late 2000s, and, in 2015, resistance to one of the partner drugs in artemisinin combination therapy (ACT) was reported. Against such a backdrop, the launch of the first malarial vaccine—RTS,S—in Africa should be manna from heaven; not just India, but most nations with a high malaria burden are either developing or poor African/South Asian nations. A vaccine is a far more economic solution in the long-run than drugs, and since it primes the immune system to fight off the pathogen, disease burden falls sharply with the threat of resistance nullified or minimised.
A two-year pilot vaccination project has kicked off in Malawi, and 3,60,000, children in three African nations—Malawi, Ghana and Kenya—will be inoculated each year. Pharma giant GSK that developed RTS,S will donate 10 million doses for the project. The vaccine was first reported by GSK in 1987, and, only in 2014, did it clear phase III clinical trials. RTS,S prompts the immune system to interfere in the first stages of the Plasmodium falciparum (the most lethal as well as the most prevalent malarial parasite species) life-cycle in the human body by preventing its entry into the human host’s liver from the latter’s bloodstream following a mosquito bite. Children in Africa who were part of the phase III trials received four doses of RTS,S, and the vaccine was shown to prevent 4 in 10 cases of malaria, 3 in 10 cases of severe malaria, 6 in 10 cases of severe malarial anaemia, the leading cause of malaria-related deaths in young children.
Once the pilot is completed in Africa, WHO will be reviewing the results, and based on the results, the vaccine could likely become part of the anti-malaria protocol. For India, if the vaccine is found effective, the key question then will be the cost to public health, especially if the vaccine is made part of the universal immunisation programme. But, given India aims to eliminate the disease by 2030 and high-burden states like Odisha have shown exceptional commitment, cost shouldn’t weigh too heavy if adoption is considered.
