BLANTYRE, Malawi — As the World Health Organization announces the next step in its rollout of the world’s first authorized malaria vaccine in three African countries, concerns about its value have come from an unlikely source: the Bill and Melinda Gates Foundation, arguably the vaccine’s biggest backer.
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 it will no longer financially support the shot.
Some scientists say they’re mystified by that decision, warning it could leave millions of African children at risk of dying from malaria as well as undermine future efforts to solve intractable problems in public health.
GlaxoSmithKline’s Mosquirix vaccine is around 30% effective. The four-dose doses of the vaccine are necessary.
The malaria vaccine has “a much lower efficacy than we would like,” Philip Welkhoff, the Gates Foundation’s director of malaria programs, told the AP. After spending over $200 million on the vaccine and many decades to get it to market, the Gates Foundation director of malaria programs Philip Welkhoff explained that the shot was relatively costly and difficult to deliver.
“If we’re trying to save as many lives with our existing funding, that cost-effectiveness matters,” he said.
The Gates Foundation’s decision to pivot away from supporting the rollout of the vaccine 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 production capacity, Welkhoff said. For example, some of the funds that could have been used to get the vaccine to the countries were redirected for the purchase of new insecticidal mosquito nets.
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“It’s not the greatest vaccine in the world, but there are ways of using it that could have a big impact,” said Alister Craig, dean of biological sciences at Liverpool School of Tropical Medicine. Craig explained that there is a global crisis in controlling the epidemic of malaria in the wake of the outbreak caused by coronavirus, which has killed over 620,000 people and left 241 million children in Africa.
“It’s not like we have a lot of 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 shot being developed by Oxford University. BioNTech is the creator of Pfizer’s COVID-19 vaccine. However, the company plans to use the same messenger RNA technology that it developed for malaria. This project is still in its infancy.
Accessibility is another problem. GSK claims it cannot produce more than 15 million doses annually until 2028. WHO suggests that at most 100 million doses are required each year to safeguard the 25 million African children. While there is talk of transferring the technology to an Indian pharmaceutical company, production will not occur for many years.
“All the money in the world” wouldn’t alleviate the vaccine’s short-term supply constraints, said Welkhoff, of the Gates Foundation. The Gates Foundation is still supporting vaccines alliance Gavi. It has invested nearly $156million to make the shot available initially in Ghana, Kenya, and Malawi.
“We’re supporting the roll-out via the Gavi funding, but we decided we would not dedicate additional direct funding to extend the supply of the vaccine,” Welkhoff said.
Gavi and WHO invited countries developing nations to apply for funding for malaria vaccines.
“If delivered to scale, the vaccine will help to prevent millions of cases of malaria, save tens of thousands of lives and ensure a brighter future for the continent,” said Dr. Matshidiso Moeti, WHO’s Africa director.
The Gates Foundation’s withdrawal of financial support for the malaria vaccine might unnerve others, Dr. David Schellenberg of the London School of Hygiene and Tropical Medicine, said.
“There is a risk that this could discourage others who are considering financing the malaria vaccine or even be a disincentive for people working on other vaccines,” he said. He said that combining the vaccine’s use with other measures, like distributing drugs during malaria’s peak 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 do have.”
A flawed rollout would save lives, according to Dr. Dyann Wirth at Harvard University.
“We would love to have 100 million doses, but that kind of money doesn’t exist for malaria,” she said. “The 15 million doses we have is still 15 million opportunities to protect children that we didn’t previously have.” The Gates Foundation had done its part in bringing the vaccine to market and it is now up to countries, donors and other health organizations to ensure it is used, she said.
Malawians are eagerly waiting for the vaccine, despite its shortcomings.
Nolia Zidana, 32, said she is keen to get her two young sons immunized after seeing malaria sicken them numerous times — and surviving it herself.
“Growing up with my parents and siblings, we have been sick from malaria all the time,” said Zidana, who lives in Malawi’s central Ntcheu district. “My elder son has had malaria countless times within the four years that he has been around. While just at 7 months old, twice my younger son has already been down with malaria,” she said.
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According to her, even though they have mosquito nets on their beds at night, they can still be bitten by the insects while they prepare dinner in the darkness of the night.
“We hear other people use mosquito repellents or burn anti-mosquito incense coils, which we cannot afford as we are just peasant farmers that live from hand to mouth,” she said.
Dr. Michael Kayange of Malawi’s Ministry of Health, urged everyone in the country to take whatever measures they can to curb malaria. The only way to prevent the disease is by immunization, but people need to adopt other strategies.
“Even just by sleeping under a mosquito net, you have played your role in reducing the malaria burden in the country,” he said.
Cheng This report was made in London.
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