BLANTYRE, Malawi (AP) – As the World Health Organization announces the next step in rolling out the world’s first licensed malaria vaccine in three African countries, concerns about its value are coming from an unlikely source : The Bill and Melinda Gates Foundation, probably. the biggest supporter of the vaccine.
The WHO endorsed the vaccine last fall as a “historic” breakthrough in the fight against malaria, but the Gates Foundation told The Associated Press this week that it will no longer provide direct financial support for the vaccine, although it will fund a alliance that supports the vaccine.
Some scientists say they are baffled by the decision, warning that it could leave millions of African children at risk of dying from malaria and undermine future efforts to solve intractable public health problems.
The vaccine, sold by GlaxoSmithKline as Mosquirix, is 30% effective and requires four doses.
The malaria vaccine has “far less efficacy than we would like,” Philip Welkhoff, director of malaria programs at the Gates Foundation, told the AP. Explaining his decision to end support after spending more than $200 million and several decades to get the vaccine to market, he said the vaccine is relatively expensive and logistically difficult to deliver.
“If we’re trying to save that many lives with our existing funding, that return is important,” he said. The Gates Foundation will continue to provide financial support to Gavi, a vaccine alliance that is also supported by the WHO and the World Bank.
“We are supporting the rollout through Gavi funding, but we decided not to commit additional direct funds to expand vaccine supply,” Welkhoff said.
The Gates Foundation’s decision to walk away from supporting vaccine deployment in Africa was made years ago after detailed deliberations, including whether the foundation’s money would be better spent on other vaccines, treatments or capacity production against malaria, Welkhoff said. Some of the resources that could have gone to getting the vaccine to the countries have been redirected to buy new insecticide nets, for example.
“It’s not the biggest vaccine in the world, but there are ways to use it that could have a big impact,” said Alister Craig, dean of biological sciences at the Liverpool School of Tropical Medicine. The world is struggling to contain the rise in malaria seen since the coronavirus pandemic disrupted efforts to stop the parasitic disease, which killed more than 620,000 people in 2020 and caused 241 million cases, mostly in young children of 5 years in Africa, Craig said.
“It’s not like we have many other alternatives,” Craig said. “There could be another vaccine approved in about five years, but that’s a lot of lives lost if we wait until then,” he said, referring to a vaccine being developed by the University of Oxford. BioNTech, maker of the Pfizer COVID-19 vaccine, plans to apply the messenger RNA technology it used for the coronavirus to malaria, but that project is in its infancy.
Another big obstacle is availability; GSK says it can only produce about 15 million doses a year until 2028. The WHO estimates that to protect the 25 million children born in Africa each year, at least 100 million doses could be needed each year . Although there are plans to transfer the technology to an Indian drug maker, it will be years before any doses are produced.
“All the money in the world” would not ease the vaccine’s short-term supply constraints, said the Gates Foundation’s Welkhoff. He noted that the Gates Foundation continues to support the Gavi vaccine alliance, which is investing nearly $156 million to make the vaccine available initially in three African countries: Ghana, Kenya and Malawi.
On Thursday, WHO and Gavi invited developing countries to apply for funding to pay for the malaria vaccine in their countries.
“If delivered on a large scale, the vaccine will help prevent millions of malaria cases, save tens of thousands of lives and ensure a brighter future for the continent,” said Dr Matshidiso Moeti, WHO Africa Director .
The Gates Foundation’s withdrawal of financial support for the malaria vaccine could discourage others, said Dr David Schellenberg of the London School of Hygiene and Tropical Medicine.
“There is a risk that this could discourage others who are considering funding the malaria vaccine or even be a disincentive for people working on other vaccines,” he said. He said that combining the use of the vaccine with other measures, such as the distribution of drugs during the peak malaria season, could dramatically reduce cases and deaths.
“We still see people coming in with four or five episodes of malaria a year,” he said. “We don’t have a magic bullet, but we could make better use of the tools we have.”
An imperfect vaccine rollout would still save lives, said Dr. Dyann Wirth, an infectious disease expert at Harvard University.
“We would like to have 100 million doses, but that kind of money doesn’t exist for malaria,” he said. “The 15 million doses we have are still 15 million opportunities to protect children that we didn’t have before.” The Gates Foundation had done its part to bring the vaccine to market and it was now up to countries, donors and other health organizations to ensure it was used, he said.
The vaccine, even with its imperfections, is eagerly awaited in Malawi.
Nolia Zidana, 32, said she is keen to immunize her two young children after seeing them get sick numerous times from malaria and surviving it herself.
“Growing up with my parents and siblings, we were sick with malaria all the time,” said Zidana, who lives in Malawi’s central Ntcheu district. “My eldest son has had malaria countless times in the four years he has been living. When he was only 7 months old, my youngest son has already suffered from malaria twice,” she said.
He said that even though they sleep under mosquito nets, they are sometimes bitten before bed while preparing meals for dinner in the dark of the evening.
“We hear that other people use mosquito repellents or burn coils of anti-mosquito incense, which we cannot afford as we are just hand-to-mouth farmers,” he said.
Dr. Michael Kayange of Malawi’s Ministry of Health urged everyone in the country to take all possible measures to curb malaria. Vaccination alone is insufficient to stop the disease, and people should adopt multiple strategies, he said.
“Even by sleeping under a mosquito net, you have played your part in reducing the burden of malaria in the country,” he said.
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Cheng reported from London.
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