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, perhaps the most the big supporter of the vaccine.
The WHO approved 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 offer direct financial support for the vaccine, although it will fund an alliance supporting the vaccine.
Some scientists say they are puzzled by the decision, warning that it could put millions of African children at risk of dying from malaria, as well as undermine future efforts to solve intractable public health problems.
The vaccine, sold by GlaxoSmithKline as Mosquirix, is about 30% effective and requires four doses.
The malaria vaccine has “much lower efficacy than we would like,” Philip Wellhoff, director of the Gates Foundation’s malaria programs, told the AP. Explaining his decision to end support after spending more than $200 million and several decades to bring the vaccine to market, he said the injection was relatively expensive and logistically challenging to deliver.
“If we’re trying to save as many lives as possible with our existing funding, that profitability matters,” he said. The Gates Foundation will continue its financial support for Gavi, a vaccine alliance that is also supported by the WHO and the World Bank.
“We are supporting the roll-out through Gavi funding, but we have decided not to allocate additional direct funding to expand supply of the vaccine,” Welkhoff said.
The Gates Foundation’s decision to drop support for the vaccine’s distribution in Africa was made years ago after detailed deliberations, including whether the foundation’s money would be better spent on other malaria vaccines, treatments or manufacturing capacity, Wellhoff said. Some of the resources that might have gone to getting the vaccine to countries have been diverted, for example, to buying new insecticidal nets.
“It’s not the best vaccine in the world, but there are ways of using it that can have a big impact,” said Alistair Craig, dean of biological sciences at the Liverpool School of Tropical Medicine. The world is struggling to contain a surge in malaria seen after the coronavirus pandemic hampered efforts to stop the parasitic disease, which killed more than 620,000 people in 2020 and caused 241 million cases, mainly in children under 5 in Africa , Craig said.
“It’s not like we have many other alternatives,” Craig said. “There may 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 developed by the University of Oxford. BioNTech, the maker of Pfizer’s COVID-19 vaccine, plans to apply the messenger RNA technology it uses for the coronavirus to malaria, but that project is in its infancy.
Another big hurdle is availability; GSK says it can only produce about 15 million doses a year until 2028. The WHO estimates that at least 100 million doses may be needed each year to protect the 25 million children born in Africa each year. Although there are plans to transfer the technology to an Indian drugmaker, it will be years before doses are produced.
“All the money in the world” won’t ease short-term supply constraints on the vaccine, said the Gates Foundation’s Wellhoff. He noted that the Gates Foundation continues to support the Gavi vaccine alliance, which has invested nearly $156 million to make the shot initially available in three African countries: Ghana, Kenya and Malawi.
On Thursday, the WHO and Gavi invited developing countries to apply for funding to pay for the malaria vaccine in their countries.
“If delivered at 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 funding for the malaria vaccine could unsettle others, said Dr. David Schellenberg of the London School of Hygiene and Tropical Medicine.
“There is a risk that this will discourage others considering malaria vaccine funding, or even deter people working on other vaccines,” he said. He said combining the use of the vaccine with other measures, such as distributing 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.”
Imperfect introduction of the vaccine would still save lives, said Dr. Diane Wirth, an infectious disease expert at Harvard University.
“We would like to have 100 million doses, but that kind of money does not exist for malaria,” she said. “The 15 million doses we have are still 15 million opportunities to protect children that we didn’t have before.” The Gates Foundation has done its part to bring the vaccine to market, and now it’s up to countries, donors and other health organizations to ensure its use, she said.
The vaccine, even with its imperfections, is eagerly awaited in Malawi.
Nolia Zidana, 32, said she wanted to immunize her two young sons after seeing them sick with malaria many times – and herself a survivor.
“Growing up with my parents and siblings, we were sick with malaria all the time,” said Zidana, who lives in Malawi’s central Ncheu district. “My older son has had malaria countless times in the four years he’s been around. By the time he was just 7 months old, my twice-younger son was already suffering from malaria,” she said.
She said that although they sleep under mosquito nets, they are sometimes bitten before bed while preparing food for dinner in the dark in the evening.
“We hear that other people are using mosquito repellants or burning mosquito coils with incense, which we cannot afford as we are just rural farmers living hand to mouth,” she said.
Dr. Michael Kayange of Malawi’s Ministry of Health urged everyone in the country to take all possible measures to curb malaria. Immunization alone is insufficient to stop the disease, and people must adopt multiple strategies, he said.
“Even just 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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