Malaria Vaccine Progress in Mozambique

Success of another malaria vaccine candidate is being celebrated. According to the New Scientist, “A vaccine against malaria would save hundreds of thousands of lives each year. Now it seems we’re much closer to finding one.” The report in The Lancet by Aponte et al. explains that the vaccine trial in Mozambique after three doses at 10 weeks, 14 weeks, and 18 weeks of age, “Vaccine efficacy for new infections was 65% over a 3-month follow-up after completion of immunizations. This efficacy estimate is higher than the 45% reduction reported in a previous trial in older children.”

Also of note, serious adverse events and side effects were not significantly different from the control group children who received Hepatitis B vaccine in addition to the normal childhood immunizations. BMJ News observed that, “This early trial was focused on safety. Bigger trials to assess efficacy could be next.”

Ultimately, any successful vaccine needs to address social and organizational issues in addition to safety and efficacy. The best health technologies are useless if people do not adopt them correctly. The fact that this new vaccine candidate could be integrated into a normal childhood vaccine schedule may address some of the organizational concerns, and the similar level of reactions to existing vaccines may help with acceptability concerns.

Consumer expectations and beliefs may provide additional hurdles. Malaria endemic communities have many ideas about what constitutes ‘malaria’. Various conditions ranging from ‘ordinary’ malaria to yellow fever and typhoid have been conflated under the umbrella of ‘malaria’ illness in parts of West Africa. That coupled with the fact that as currently constituted, this vaccine candidate may leave 35% of children unprotected may raise doubts in the community about the perceived efficacy of the shots.

One cannot blithely say, “Health education will handle such problems.” Health educators cannot convince people to adopt something that runs strongly counter to their experiences. The answer therefore is for researchers to continue to work (with increased donor funding) to perfect the malaria vaccine candidates and make them more acceptable to the public. Only when there is a dialog between the public and public health professionals and researchers can innovations that are both efficacious and acceptable be developed.

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