RTS,S and the search for a malaria vaccine

Joe Cohen | 01 Jun 2006
Accra Daily Mail
Few scientists ever have the chance to see their daily work transformed into new medicines or vaccines that have the potential to save millions of lives. It is mind boggling to think that I may be one of the lucky few.

Indeed, earlier this year, I went with other scientists to visit the construction site for the plant that is destined to produce millions of doses of the malaria vaccine, known as RTS,S. For the past 20 years, I have been closely involved in the development of this vaccine of which I am one of the inventors.

This vaccine made history last year when the scientific journal The Lancet published the results of a clinical trial that proved it was effective for at least 18 months in reducing clinical malaria by 35 percent and severe malaria by 49 percent, in a study that involved about 2000 Mozambican children. If all goes well, this vaccine could be licensed as early as 2011-2012, and the new production plant in Belgium should be ready to begin supplying millions of doses each year to children in many of Africa's poorest countries.

As the world commemorates Africa Malaria Day, it is necessary to consider how important a step this vaccine may be, but also to recognize how many challenges remain. Malaria kills between one and three million people each year, mostly young African children, and is among the world's leading causes of childhood mortality. Malaria also robs Africa of crucial resources necessary for development - as much as US$12 billion each year in healthcare expenditures and lost productivity, a sum that is roughly equivalent to all the foreign aid that flows into Africa each year.

For too long, the world has considered a malaria vaccine as some kind of "pie in the sky." In the light of the recent scientific breakthrough resulting from the successful RTS,S clinical trial, we must rethink our views on the feasibility of vaccination against malaria. Now is the time for the world to start thinking about how to use the RTS,S vaccine with other existing or soon to be implemented malaria prevention tools such as insecticide treated bed nets, indoor pesticide spraying, and intermittent prospective treatment of infants (IPTi).

International organizations need to begin preparing demand forecasts, national agencies need to lay the groundwork so this vaccine can be approved as quickly as possible and introduced into national disease control strategies. Fundamentally, all people across Africa and the industrialized world need to begin building political support to ensure the resources, both financial and infrastructural, are in place to ensure that this vaccine reaches every child who needs it.

It will take a few more years to license the malaria vaccine, but we don't have to wait that long to start saving lives. Many countries are already far behind on immunizing children against diseases such as measles, rotavirus and Haemophilus influenzae type b disease, for which vaccines already exist.

Immunization is one of the most cost-effective public health interventions in history, yet funding for vaccines is only a fraction of what it needs to be. A recent report by the research group SmartPharma published in the journal Vaccine found that just doubling the money the world spends on vaccines could reduce vaccine-preventable deaths by half in five years. This will translate into millions of lives saved.

And that is only by providing vaccines that already exist. Major scientific hurdles need to be overcome if we are to develop effective vaccines for other diseases such as HIV/AIDS and TB that are devastating the developing world. We are committed, working in partnership, to address these challenges.

However, billions of dollars more will be needed to fund the development and purchase of these vaccines. New types of long-term financing that are currently making headlines, sponsored by forward thinking governments, could mean a positive overhaul of the short-term funding and aid mechanisms traditionally used. These new institutions include the UK-sponsored International Financing Facility for Immunisation and the G8-sponsored Advance Market Commitment for vaccines.

But financing for R&D and purchase is only part of the problem. Improving health in the developing world is a complex challenge. In many countries, major investment is required in healthcare infrastructure - hospitals, clinics, distribution networks - not only for immunization, but to provide daily healthcare. In particular, how these new vaccines will be introduced in low income countries and how long it will take regulatory authorities to approve them are two other hurdles that need to be overcome in order for these vaccines to get to the people who need them most as quickly as possible.

As excited as I was to tour our malaria vaccine manufacturing facility last year, I am sure that feeling will pale in comparison to how I will feel when the first dose of the vaccine is given to a child. It is heartening to think that the biggest challenge facing a malaria vaccine today is not scientific, but logistical.

Over the next few years, the world needs to move quickly so the production of the RTS,S vaccine can be scaled up so it is available to the 75 million babies born in Africa each year. On Africa Malaria Day this year, we should be proud of how far we have come, but also humbled and inspired by how much work remains to rid the world of malaria.

Joe Cohen is the inventor of the RTS,S malaria vaccine and Vice President of R & D, Vaccines for Emerging Diseases & HIV for GlaxoSmithKline Biologicals.