Brake-Through

Brake-Through

The malaria vaccine is continuing good news in the battle against disease in Africa, but it’s not a cause for great celebration. I’m a bit peeved, in fact, with the PR-rollout of Mosquirix by GlaxoSmithKline which strikes me more as an attempt by the pharma to remain relevant after the failure of its Sanofi–GSK Covid vaccine.

Here’s the thing. Mosquirix has been around in some form since 1987. Much improved, its efficacy is still as low as 26% (the highest in any study was 50%) and only for toddlers. It’s not effective against young adults and older.

As I wrote multiple times over the years the vaccine’s development was spearheaded by Walter Reed and funded relentlessly by the Bill and Melinda Gates Foundation. It took nearly thirty years of tweaking before the European Medicines Agency (the EU’s FDA) approved it for general use in toddlers.

I’m irked that the media including one of my favorite people, Rachel Maddow, didn’t nuance WHO’s announcement approving Mosquirix but rather treated it as some major step in the fight against malaria and disease in general.

It’s not. This is not a major step but actually quite a small step in a continuing journey in the battle against malaria.

Treating this story differently – as virtually all the media did – avoids the singular, heart-breaking question as to why the developed world could use oil and DDT to eradicate its malaria but now doesn’t let the developing world do so.

Instead, the former slave owners who denounce child trafficking in a likewise manner spend two generations of human beings dying (a million per year in Africa) tweaking their elaborate science when Chicago, New York, London and Brussels all eradicated malaria by the middle of the last century.

Mosquirix is a complicated protein subunit vaccine. This is an older vaccine type where very specific proteins that are designed to attack (as antigens) certain parts of the disease are farmed in such nutrients as yeast.

Microbiologist and Univ. of Illinois professor Stephen Farrand explains, “Mosquirix is a complicated protein subunit vaccine with a modern twist. It is composed of a complex of proteins,” the central-most one “called CSP, that induces production of antibodies… Unfortunately, this malarial protein does not do its job very well. So the protein is fused to other proteins” to improve its efficacy.

That trial-and-error has governed the development of the vaccine over the last 30 years. They’ve finally reached a point that WHO believes it worthwhile to approve it for widespread use.

Malaria is not a virus but a parasite. Vaccines that prevent parasitic diseases do so by creating bullets (proteins) targeted to blow to smithereens specific stages of the parasite’s life in its host. More successful vaccines like those for Covid don’t have to worry about multiple stages of a virus. They trick the body into being ever ready with its own much better wider ranging arsenal for just one target.

Parasites are more like their living host than viruses: they multiply themselves. (Viruses have to use the host’s cells to multiply.) Most parasites that cause disease have multiple life stages. Malaria has seven. So if you don’t completely wipe out at least one of the stages, the parasite continues to exponentially infect its host ultimately overwhelming the limiting of one of its stages.

What the dozens of iterations of Mosquirix over the years have done is add new bullets for the seven stages of malaria, while trying to figure out which stage might be the most important one to focus on.

It’s definitely getting better and right now there doesn’t seem to be a better way to work towards a good preventative medicine. And ironically because it’s children – and particularly babies – who succumb to malaria in a much greater percentage than older people, the particular mysterious physiology of youngness might be helpful to a protein subunit vaccine in a way it isn’t for the new model mRNA virus vaccines.

It certainly proves true with Mosquirix, which is the reason WHO’s approval is limited to very young children. It’s not clear at all why age matters to the efficacy of this vaccine, but it does. But since the vast majority of malaria fatalities are very young children it’s a perfect fit.

So congratulations you legion of scientists and relentless philanthropists and with time the efficacy will undoubtedly improve even more.

But let’s get the story right. This is no breakthrough, just one more sludge in the western world’s endless attempt to remake the developing world in an image quite unlike its own.