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A vaccine, which for decades has been elusive to scientists, could be close.
The hopeful candidate, which is called ‘RTS,S’, is in a phase three trial involving more than 15,000 children in seven African countries. This is the farthest any malaria vaccine has come: just one stage from possible approval for widespread use.
Two year-old Philip Ouma is one of the children participating in the trial at one of three sites in Kenya. After getting three initial doses of the vaccine more than a year and a half ago, he’s now being given a booster shot, if indeed he’s getting the real thing.
In this so-called ‘blind trial’, some of the children are not getting the real vaccine, enabling researchers to compare the results. As an incentive, even those who aren’t getting the actual vaccine are given free health care for any ailment.
Philip’s mother, Rosemary, decided to enroll him in the trial not just for the free care, but also because she knows how debilitating malaria can be. Her three other children have repeatedly been sickened by the disease, placing an enormous strain on the family.
Indeed the whole community is strained in this part of western Kenya, where malaria accounts for nearly one-third of all deaths among children.
Simon Kariuki, who’s a lead investigator in the trial, grew up with the disease all around him. “Malaria here is a huge, huge problem,” he says. “It’s the number one killer of young children. It’s a heavy burden on women during pregnancy and is a major cause of poverty.”
The RTS,S vaccine targets plasmodium falciparum malaria, the most deadly form of the disease.
It’s been developed by GlaxoSmithKline, along with a host of partners like the PATH Malaria Vaccine Initiative, funded by the Bill and Melinda Gates Foundation.
Another partner is the U.S.-based Centers for Disease Control and Prevention (CDC), which works alongside ‘KEMRI’, Kenya’s main research institute.
Kayla Laserson is the director of the partnership. She says the trial has been very smooth. “The kind of effort to make this trial happen was tremendous and it’s gone incredibly well,” she says. “This is as close as we've ever been so there’s also a certain excitement around it.”
Even without a vaccine, progress has been made against malaria in recent years. But around 800,000 people still die of the disease annually, with millions more sickened.
Advances have been made with wide distribution of insecticide-treated bednets and greater access to malaria drugs. But fear of resistance to anti-malarial medications is increasing, and the drugs are only prescribed after a patient contracts the disease. A vaccine would do the opposite by seeking to prevent infection in the first place.
In the case of RTS,S, preliminary results just released from 6,000 of the children in the trial – all between the ages of five months and 17-months - showed about a 50% drop in cases.
That’s a significant amount, though it also shows that this is not a silver bullet against malaria.
Dr. Louis Macareo, who directs a trial center run by the U.S.-based Walter Reed Army Institute of Research, which has been closely involved in developing this vaccine, says the secret to this vaccine’s success is that it bolsters the immune system as soon as it’s attacked by malaria.
“When you get malaria it spawns off a cascade of events in your body where your body produces antibodies that fight against the malaria,” explains Macareo. “What we try to duplicate with the vaccine is to stimulate the body’s immune system to produce similar antibodies.”
Results from a younger age group in this trial – infants between six and 12 weeks old – are expected by the end of next year.
The vaccine’s makers say results from longer-term analysis for all age groups should be available by the end of 2014.
If it meets expectations, the World Health Organization says it could recommend the vaccine as early as 2015.
Rollout talks are already underway. “Certainly the preparations for it are there,” says Laserson, “to go straight from discovery that this is in fact efficacious to... policy, to implementation, all those conversations are happening, so everyone is ready.”
In the meantime, the toddlers are reluctantly getting their jabs, unaware that they could be making history.