Search for a malaria vaccine continues, despite challenges

My six year-old son is fascinated with monsters, dinosaurs, and vicious killers of all types. But he has a hard time understanding why, whenever he asks me to name the deadliest creature on the planet, I tell him it’s the mosquito. If we lived in sub-Saharan Africa, he’d understand that what I’m referring to is the global plague of malaria.

A previous posting looked at new research into the main causes of death for adolescents and young adults, but death rates among those younger than 5 years are an often-used metric for population health.

Of the 3 billion people threatened by malaria each year, some 250 million become infected, and nearly a million die, 85%--800,000-- are children under the age of 5. Anti-malarial efforts center around four basic strategies: Insecticide treated nets, anti malaria drugs, indoor spraying with insecticides, and intermittent treatment of pregnant women. Studies have found that effectively implementing these measures can quickly cut infection and death rates in half. Vector control is also key: Eliminating or reducing the environmental factors that harbor the mosquito that transmits the disease. This includes appropriate sanitation, proper drainage to prevent standing water, and suitably bug-proofed housing.

Since malaria is primarily a disease of the poor and underdeveloped, these strategies are severely hampered by funding and infrastructure shortfalls, as well as under-investment in human capitol. In fact, according to the WHO, “Lack of human resources or capacity at country / inter-country level is the key constraint to developing, implementing and sustaining malaria control.”

These are all good reasons to work on a malaria vaccine. Recent research is shedding light on why such a vaccine is proving so difficult to concoct. The basic vaccine development strategy aims to identify proteins from malaria-causing parasites that, when injected into humans, would arm the human immune system with antibodies capable of fighting off infection from the parasites themselves. Unfortunately, new genetic analysis of P. falciparum, the most dangerous of the five potential malaria-causing parasites, has found that the bug wears a constantly-changing protein coating with 214 possible mutations.  This makes it potentially much more challenging to identify which proteins to isolate for vaccine development.

Efforts continue despite these technical difficulties, backed by resources and expertise from organizations including the WHO, USAID, and the Jenner Institute at Oxford University. With the most promising vaccine candidate about to enter large scale, “phase 3” human trials, I’m hopeful that the lowly mosquito will soon be reduced to the villain status attributed by my son:  Nothing more than an itchy nuisance of damp summer evenings. Of course that’s what they are in wealthier nations, and the accusation has been raised that diseases of poverty, such as malaria, do not receive sufficient attention specifically because there is no profit to be made in combating them (unlike HIV, for example, which is a scourge among the wealthy as well as the poor.) Would you agree with that assessment, that business models drive treatment innovation and disease eradication strategies?