Various announcements have been made this week of a huge upcoming malaria vaccine trial among 16,000 African children. The Seattle Times describes the major health systems investments that have been underway to support this research trial.
The massive vaccine trials will be conducted in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. Dr. Christian Loucq, director of the Malaria Vaccine Initiative, said the project has been working over the past year to upgrade laboratory, computer and other equipment in those countries, train technicians, and even help develop local equivalents of the U.S. Food and Drug Administration to ensure the trials are properly monitored.
This is a indirect acknowledgment of the broader health systems challenges that create bottlenecks for implementing existing interventions such as long lasting insecticide treated nets, artemisinin-based combination therapy and intermittent preventive treatment for pregnant women.Â The success of these current interventions is essential for bring malaria levels close to elimination levels in endemic countries so that when an effective vaccine arrives, it will be able to carry malaria control efforts to the next level – eradication.
GlaxoSmithKline, one of the vaccine trial partners, has an active malaria support program that addresses malaria prevention and treatment activities in 8 African countries and so is very likely aware of the systems challenges facing implementation of existing interventions. The researchers are also realistic about their own challenges because they have been involved in malaria vaccine trials since 2003.Â The PATH Malaria Vaccine Initiative, the other partner in this endeavor, has other vaccine candidates in the pipeline ‘in case’.
Ultimately, the researchers realize that “even if their vaccine does not succeed, the widespread investment needed to conduct the trials means that Africa will be left with better communications, research and other infrastructure that could be used in the search for vaccines against other diseases such as AIDS.” What is needed though is ongoing, more thorough and concerted attention to improving health systems to deliver malaria and other primary health care interventions, not just building systems when and where a special research project is planned.
Better access to and use of health systems strengthening funds from the Global Fund is one step in this direction.