In areas where malaria is not endemic, mosquitoes can be nothing more than a bothersome pest (even a satirical state bird for those of us in the American South). However, malaria affects over half of the world’s population and can cause severe illness and death for many at-risk populations, including pregnant women, people living with HIV/AIDS and children, mainly in tropical and sub-tropical countries. According to the World Health Organization (WHO), malaria claims the lives of an estimated 627,000 people every year with children accounting for 77 percent of all malaria deaths worldwide.
In October 2021, WHO made an announcement the public health community had dreamed of for over a century and worked towards for decades: the recommendation of a malaria vaccine that could save tens of thousands of lives each year.
“This long-awaited malaria vaccine is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus during his impassioned announcement of the recommendation. “Malaria has been with us for millennia and the malaria vaccine has been a long-held but unattainable dream.”
On World Malaria Day, we celebrate this enormous achievement in malaria control and elimination. Distributed to over 1 million children in Ghana, Kenya and Malawi, the RTS,S malaria vaccine, in addition to increasing access to malaria prevention overall, showed success in its ability to save and improve lives. As a result, countries where malaria is endemic will now have the opportunity to consider whether to adopt this powerful new public health tool as part of their national malaria control plans.
The RTS,S vaccine. Photo Credit: WHO
A child receiving the RTS,S malaria vaccine as part of Kenya's Malaria Vaccine implementation Programme. Photo credit: GAVI
A member of the Kenyan Malaria Vaccine Programme Evaluation preparing a test. Photo credit: Nelli Westercamp, PhD.
The CDC Foundation proudly took part in the Kenya pilot program that informed this recommendation. Working alongside the Centers for Diseases Control and Prevention (CDC), the Kenyan Ministry of Health and other international and in-country partners, the pilot team evaluated the impact of the vaccine in preventing severe malaria and death and the vaccine’s safety in routine use.
“It has been a deeply rewarding experience to be a part of the Malaria Vaccine Implementation Pilot and to be able to directly contribute the evidence that informed the recent WHO recommendation of the vaccine,” said Nelli Westercamp, PhD, a CDC epidemiologist who participated in the evaluation of the pilot implementation. “After 60 years of research, this first malaria vaccine is a major leap forward in malaria control and a much-needed addition to the current malaria prevention toolkit.”
However, our work combatting malaria does not end with the vaccine. For over twenty years, the CDC Foundation has furthered malaria research by supporting CDC’s insectary. The insectary—which houses over 60 different strains of mosquitos—provides researchers with insight into mosquito life cycles and behaviors, allowing them to test insecticides and observe patterns in insecticide resistance. These findings inform almost every mosquito control strategy used to fight malaria around the world.
The insectary of the Division of Parasitic Diseases and Malaria of the CDC in Atlanta, Georgia. Photo credit: David Snyder
Alice Sutcliffe, a Guest Researcher at the Division of Parasitic Diseases and Malaria of the CDC, working with live mosquitoes at the insectary. Photo credit: David Snyder
Researchers test the efficacy of pesticides used to control mosquito populations by exposing the insects to pesticide-treated bed nets. Photo credit: David Snyder
As with most pathogens, the Plasmodium parasites which cause malaria can rapidly develop resistance to various antimalarial treatments and therapies. As new resistance emerges, researchers must quickly adapt their strategies to ensure people are receiving the best treatment possible. Timely detection is critical, particularly in Africa where the use of ineffective antimalarial treatments could set malaria control back decades. It is vital that we make research on antimalarial resistance a global priority.
For 15 years, the PMI-supported Antimalarial Resistance Monitoring in Africa (PARMA) initiative, created by CDC as co-implementers of the U.S. President’s Malaria Initiative (PMI), has provided intensive eight-week trainings in antimalarial resistance monitoring for lab scientists from all over Africa, who come to Atlanta and train in CDC’s cutting-edge Malaria Lab.
This year, the CDC Foundation, in partnership with the Bill & Melinda Gates Foundation, is supporting a CDC and PMI initiative to establish the first PARMA hub in Africa at Université Cheikh Anta Diop in Dakar, Senegal. Once completed, this state-of-the-art hub will become a training and support center for nearby countries like Guinea and Cameroon, where scientists will gain a deeper understanding of antimalarial resistance at the molecular level.
A young child is tested by a member of the Kenyan Malaria Vaccine Programme Evaluation Team. Photo credit: Nelli Westercamp, PhD.
Noreen (left) with son Elian (right), the first child to receive the RTS,S malaria vaccine in Kenya through routine immunization as part of the pilot programme. 3 years later, Elian is fully vaccinated and healthy. Photo credit: WHO
This long-awaited malaria vaccine is a breakthrough for science, child health and malaria control.
Malaria is a complex and ever-evolving disease. Insecticide-treated bed nets, the easiest and most widespread protection against mosquitoes, do not last forever. Antimalarial therapies must constantly be adapted to account for emerging resistance. Malaria control requires multi-faceted strategies, constant vigilance and commitment by the global health community to continue researching and innovating. The new RTS,S vaccine, more successful than researchers ever thought possible, could save the lives of 40,000 to 80,000 African children each year, according to WHO estimates. Coupled with the new Senegalese PARMA hub and ongoing research made possible by CDC’s insectary, these advances are the latest tools in our kit to control this deadly disease and save lives.
Header image credit: World Health Organization.
