Have we defeated malaria?

The roll-out of a new affordable vaccine, combined with breakthroughs in the genetic modification of mosquitos, means that a world free of malaria is "finally within sight," Adar Poonawalla, chief executive of India-based drugs manufacturer the Serum Institute, has said.

Malaria is caused by a parasite carried by some types of mosquito, and is prevalent in tropical climates. Although the vast majority of people infected with malaria recover, the disease can be deadly, especially among small children. A commonly repeated claim is that half of all the human beings who have ever existed on Earth have been killed by malaria – equivalent to around 54.5 billion people. 

Today malaria is responsible for the deaths of more than 600,000 people a year, according to a 2022 report from the World Health Organization (WHO). Of those, 95% of these occur in Africa, and 80% of victims are under the age of five. 

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Following decades of research and development, this month babies in the Ivory Coast and South Sudan became the first to receive a dose of the R21 vaccine, hailed as a game-changer by scientists who believe it could see the complete eradication of malaria within a decade.

How does the new vaccine work?

Developed by the Jenner Institute at Oxford University, R21 targets the first stage of the parasite's life cycle before it gets to the liver, and is combined with an immune-boosting agent, or adjuvant, made by the US company Novavax.

Trials have shown it to be 79% effective at preventing the disease in young people, and its production capacity and low price give it a "huge advantage" over the only other malaria vaccine, RTS,S, which was released earlier this year, The Times reported. At around $4 (£3.10) a dose of R21 is less than half the cost of its rival, and the Serum Institute, which manufactures the vaccine, claims it could produce 100 million doses a year.

"Cost is absolutely the key question", said Poonawalla. "If this was a $10 vaccine, just forget it, you wouldn't be able to reach the kind of countries we have because the budgets just wouldn't allow it. We've spent so many years – blood, sweat and money – developing this with Oxford. After all this effort and going through the regulatory process, we're finally here. This is a great moment."

Having launched in the Ivory Coast and South Sudan, targeted at children under three, the vaccine roll-out will expand to a further 15 countries in Africa – including the Central African Republic, Democratic Republic of Congo, Ghana, Mozambique, Uganda and Nigeria – by the end of the year, with another 15 African nations due to follow.

While children are the focus, trials are also set to start for pregnant women – another at-risk group – before being expanded to other adults, with the potential of becoming a travellers' vaccine within a few years. Efforts are also under way to develop a variant of the vaccine to combat a different strain of malaria that's common in India and South America.

What else is being done?

The WHO Global Malaria Programme goal is to reduce cases of malaria by 90% before 2030.

Measures in place to achieve this include the "early detection and diagnosis of malaria cases", said Al Jazeera, as well as the mass distribution of affordable vaccines, "the use of insecticide-treated nets and indoor residual spraying", as well as building awareness and expanding necessary health facilities in affected areas.

In May, the BBC reported that tens of thousands of genetically modified mosquitos had been released in Djibouti in an effort to stop the spread of an invasive species that transmits malaria.

The "friendly non-biting male Anopheles stephensi mosquitos" were developed by Oxitec, a UK-based biotechnology company, and carry a gene that "kills female offspring before they reach maturity". This is crucial, said the broadcaster, as "only female mosquitos bite and transmit malaria and other viral diseases."

Despite huge strides made in recent years the WHO warned that some challenges remain. "Countries, sub-national areas and communities are situated at different points along the path towards malaria elimination, and their rate of progress will differ depending on the level of investment, biological determinants (related to the affected populations, the parasites and the vectors), environmental factors, strength of health systems, and social, demographic, political and economic realities," it said in a recent report.

Nevertheless, the WHO remains optimistic that its ambitious objectives can be met, going so far as to classify malaria as being in the "final stage" of elimination.

"I think the whole thing is doable, not in the next five years, but maybe in the next 10," said Sir Adrian Hill, director of the Jenner Institute at Oxford, adding that for the first time in history, "eradication is beginning to look really credible".