Malaria's Evolving Grip: Can the New Vaccine Counter the Elusive Parasite?

In the ongoing battle against malaria, a disease that has plagued humanity for centuries, two new players have entered the field, a variant and vaccine. A new variant of the disease has emerged, threatening to undo years of progress. But not all is grim. A promising new vaccine offers a beacon of hope in these challenging times. As the world grapples with these developments, the question arises - is this a concluding effective measure for malaria in Africa? This article delves into the characteristics of the new variant, the potential of the new vaccine, and their combined implications for the future of malaria control.

An Elusive parasite
A little recap of what we learned in school about malaria. Malaria is a disease caused by an infected Anopheles mosquito which produces the plasmodium parasite. However, according to the World Health Organization (WHO), the parasites have five different variants, they are; Plasmodium (P.) falciparum, P. malariae, P. vivax, P. ovale, and P. knowlesi [1] . The newest is the P. falciparum.

Genomic surveillance by Ethiopian and Brown University researchers revealed the P. falciparum variant resistant to artemisinin and diagnostics in Africa. This finding was published on August 1st, 2023. According to the East African news, prior to the study, resistant strains of the malaria parasite had been found in Uganda, Tanzania, and Rwanda.

The new variant has shown resistance to current treatments and can evade locally available diagnostic tests. The emergence of this new variant could potentially lead to an increase in malaria cases and deaths, and pose a significant challenge to malaria control efforts and elimination.

Jeffrey Bailey, an associate professor of transnational research and pathology and laboratory medicine at Brown University gives more insight into the new variant in The East African publication, “… it will be harder to detect infected people, and then when infected people are treated with antimalarial drugs, that may not work to stop them from spreading the disease. [2] ”

WHO reported a disproportionately high share of malaria in Africa, standing at 95 to 96 percent of cases and deaths respectively. The latest World Malaria Report stood at 247 million cases for Africa in 2021 [3] .

A new vaccine
In the face of this challenge, a new vaccine, R21/Matrix-M , offers a glimmer of hope. Developed by the Jenner Institute at the University of Oxford and Serum Institute of India. The vaccine has shown promising results in early trials, with an efficacy rate of 75% during twelve months, in areas with highly seasonal malaria transmission, following a 3-dose series [4] . The WHO has recommended the use of this vaccine, marking a significant milestone in the fight against malaria. The complexity of the parasite’s life cycle has posed challenges for malaria vaccine development over the years. R21/Matrix-M targets the first stage of the parasite’s life cycle (the plasmodium sporozoite) that enters the body, keeping it from multiplying or metamorphosing.

Ghana is the first African country to approve the vaccine R21/Matrix-M in the world. The vaccine is found to be cost-effective, as prices stand at US$ 2 – US$ 4 per dose, according to WHO. The prices are still being compared to other childhood vaccines hence, providing greater accessibility and impact to the fight against malaria.

Comparative analysis
In 2021, the WHO approved the first malaria vaccine RTS,S. However, the new vaccine R21/Matrix-M, offers several advantages when compared to the previous vaccine. It has a higher efficacy rate, cost-effective, and readily available. These factors make it a promising tool in the fight against malaria.

Impact
Speaking to the BBC, Prof Adrian Hill, Director of the Jenner Institute at the University of Oxford said, "We expect R21 to make a major impact on malaria mortality in children in the coming years, and in the longer term [it] will contribute to overall final goal of malaria eradication and elimination. [5] "

The Serum Institute of India is preparing to produce between 100-200 million doses per year, with a vaccine factory being constructed in Accra, Ghana. Adar Poonawalla, CEO of the Serum Institute, said: "Developing a vaccine to greatly impact this huge disease burden has been extraordinarily difficult." He added that Ghana, as the first country to approve the vaccine, represents a "significant milestone in our efforts to combat malaria around the world".

The emergence of a new variant and the introduction of a new vaccine represent significant developments in this ongoing chronicle. While the new variant poses a formidable challenge, the new vaccine offers a beacon of hope. As we continue to navigate this complex narrative, one thing is clear - the fight against malaria is a dynamic and evolving battle, and every new development brings us one step closer to a malaria-free world.

[1] Types of Malaria Parasites | Stanford Health Care

[2] https://www.theeastafrican.co.ke/tea/science-health/new-strains-of-malaria-causing-parasite-a-new-danger-4370076

[3] New strains of malaria-causing parasite a new danger in the Horn - The East African

[4] https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization

[5] https://www.bbc.com/news/health-65252511