The taming of Malaria

Distribution of vaccines a ‘challenge’ and costs ‘considerable’ but rollout still marks landmark moment in history

A female anopheles mosquito sitting on a vine in West Bengal, India
Female anopheles mosquitos are the main carriers of malaria
(Image credit: Soumyabrata Roy/NurPhoto via Getty Images)

According to an oft-repeated factoid, half of all the human beings who have ever existed on Earth have been killed by malaria – equivalent to around 54.5 billion people.

Some sceptics have questioned whether the mosquito-borne illness really has claimed that many lives. BBC journalist Tim Harford investigated the issue on his podcast More or Less in 2013, interviewing Brian Faragher, emeritus professor of medical statistics at Liverpool School of Tropical Medicine.

Faragher told Harford that “it’s difficult to find evidence to support that claim”. Instead, analysis of historic data suggested the true total percentage of people who have died from malaria “is probably somewhere between” 4% and 5%, he suggested.

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That still equates to a huge number of lives, but the good news is that numbers of both malaria infections and deaths have been falling in recent decades.

In 2000, nearly 900,000 people died of malaria, mostly in poorer regions of the world, such as sub-Saharan Africa. But since then, insecticide-treated bed nets, antimalarial medications and the spraying of homes with insecticides has significantly reduced the problem. In Africa alone, these interventions are estimated to have prevented 663 million malaria cases between the start of the century and 2015.

And since then, a “new hope in the fight against malaria arrived”, said Vox, “via the world’s first-ever malaria vaccine”, which will be rolled across 12 African countries over the next two years.

An initial 18 million doses of the vaccine have been earmarked for the countries where the risk of malaria to children is the greatest, according to a statement from the global vaccine alliance Gavi, the World Health Organization (WHO) and Unicef.

“This vaccine has the potential to be very impactful in the fight against malaria, and when broadly deployed alongside other interventions, it can prevent tens of thousands of deaths every year,” said Thabani Maphosa, managing director of country programmes delivery at Gavi.

Another 16 African countries have asked for access to the vaccine and “will be hoping for supplies when production has been scaled up”, The Guardian said.

Over the past four years, the vaccine, known as RTS,S/AS01, has been given to more than 1.7 million children in Ghana, Kenya and Malawi. The result has been “both a substantial reduction in severe malaria and a fall in child deaths”, Gavi said.

The vaccine “is being heralded as a game changer”, said The Irish Times, delivering immediate hope to a continent where almost half a million children under the age of five die of malaria each year.

Another vaccine, known as R21/Matrix-M, developed at Oxford University, is also awaiting WHO pre-qualification.

The next challenge with both vaccines will be distribution. More than 400 million children live in Africa, “and this number is expected to grow”, said Vox. The RTS,S vaccine is a four-dose regime, while R21 involves three doses. So even if only 200 million children are deemed eligible, up to 800 million doses will be needed.

The costs will also be considerable. At an estimated $8 per dose (£6), the vaccination campaign is forecast to cost between $4.8 and $6.4 billion (£3.7bn and £5bn). Even at the lower end of this calculation, this would be “higher than the GDP of over a dozen African countries”, Vox noted.

But despite such barriers, the planned rollout marks a landmark moment in history.

Currently, “nearly every minute, a child under five years old dies of malaria”, said Unicef associate director of immunisation Ephrem T. Lemango. “For a long time, these deaths have been preventable and treatable – but the rollout of this vaccine will give children, especially in Africa, an even better chance at surviving.”

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Arion McNicoll is a freelance writer at The Week Digital and was previously the UK website’s editor. He has also held senior editorial roles at CNN, The Times and The Sunday Times. Along with his writing work, he co-hosts “Today in History with The Retrospectors”, Rethink Audio’s flagship daily podcast, and is a regular panellist (and occasional stand-in host) on “The Week Unwrapped”. He is also a judge for The Publisher Podcast Awards.