Ask the Pharmacist

Q) I understand there is a new vaccine for malaria that is somewhat controversial. What can you tell me about it?

A) Many of us are tired of reading and/or listening to the whole vaccine debate and therefore may tune out instantly with the discussion of yet another vaccine. This new malaria vaccine, however, is worth discussing for a couple of reasons. Malaria is, and has been, a massive worldwide health issue for seemingly forever.

In 2019, the number of malaria cases worldwide was estimated at 229 million which is a number that is hard to wrap your head around. The disease also does far more than just make you sick; It kills about half a million people each year. To make matters worse, two-thirds of these occur in children under the age of 5 hailing from sub-Saharan Africa, a region that is subjected to a litany of other challenges.

The disease’s mortality rates have also proven stubbornly resistant to change despite the use of newer and better drugs for both its treatment and preventions. One of these preventions includes a large uptick in the use of insecticide impregnated bed nets that are designed to repel the mosquitos. It is a well-known fact that mosquitos are the transporters of malaria.

It is a relatively rare disease in the developed world (the United States sees about 2,000 cases a year with the vast majority occurring in adults who have been travelling/ working in Africa) but the burden this disease imposes on Africa is one of the main reasons this continent continues to struggle in just about every facet of development.

One would think the introduction of a vaccine that helps prevent this killer disease would be greeted with widespread accolades, but this particular vaccine is not without its controversies. This explains why, despite the fact that it was developed way back in 2001, it is only now being approved for use.

Controversial vaccines are not a new topic here in Canada, but unlike the various COVID shots (where logical, fact-based arguments are lacking regarding how risks outweigh their benefits) there are some legitimate reasons for concern with the malaria vaccine which has been given the name, Mosquirix. That it was rushed in its development is definitely not one of those concerns, however.

The quest for a malarial vaccine has been underway for over a hundred years and this particular vaccine has been 30 years in the making at a cost of more than US$750 million (which was largely provided by the Bill and Melinda Gates foundation, no doubt with the fake sinister intent of ultimately installing 5G in the brains of little Sudanese children everywhere….). This sort of timeline and expenditure exemplifies just how difficult the vaccine development has proven to be.

The main problem lies with the microscopic single-celled parasite (Plasmodium) that is injected into one’s body when bit by one of the 41 species of female mosquitoes that may carry the bug. Plasmodium is extremely complex and adaptable to the point that it is able to continually alter its form making the process of locating an easily identifiable target on it (such as the “crown” on the COVID virus) extremely difficult. To further complicate matters, Plasmodium itself is not just one parasite but in fact is six different species that are all known to give humans malaria.

The controversies surrounding the vaccine are also complex and have led to much debate within the scientific community. The first is that the vaccine itself is not incredibly effective. It seems to prevent about 4 in 10 cases of malaria which pales in comparison to say the MMR vaccine’s 97% effectiveness against measles. Still, even modest results such as this could result in saving the lives of tens of thousands of children each year. Unfortunately, its effectiveness seems to wane over time with some parts of Africa showing even rebound surges in malaria years later.

As well, the clinical trials showed that recipients of the vaccine have a ten times higher rate of meningitis, a higher rate of a very rare but serious form of malaria (cerebral) and a doubling of death from all causes in girls who had received the vaccine. These are all obviously hugely significant health issues but collectively they are not even close to the biggest controversy that surrounds this vaccine.

There has been widespread outrage in the scientific community when it became known that the WHO did not use proper informed consent during a pilot study conducted after the initial trials. Informed consent is when a patient is properly informed about the potential risks, benefits and alternatives to any treatment they are being offered so that they can make an educated decision as to whether to go forward or not. It is the standard of care everywhere regardless of whether you are being offered a simple antibiotic or complicated open-heart surgery.

The lack of its use harkens back to some of medicine’s darkest days when the Nazis and far too many other governments and drug manufacturers willingly used vulnerable populations (i.e. minorities such as those of Jewish, gypsy and black descent) as virtual guinea pigs in order to find out about their drugs on the human body. Nobody is saying that the WHO is engaging in those sorts of practices but it is disturbing that proper consent may not have been able to be given to the parents of these children.

For instance, they were apparently not informed that the vaccine was associated with an increased risk of death in female children which is not an irrelevant detail by any means. Practices such as these contribute to a lack of trust in life-saving medical interventions by the local populace. Despite all this, the vaccine has been approved and that is because the case for any drug is always about weighing the risks versus the benefits.  There are risks with any vaccine, perhaps particularly so with Mosquirix.

That being said, that same pilot rollout in three African countries that was concluded recently produced data that ran contrary to the adverse effects seen in the initial clinical trials and caused the WHO to declare that the vaccine is safe in their opinion, although clearly more follow-up is needed.

The benefits are also indisputably massive despite its modest efficacy. It is estimated that this vaccine could prevent 5.4 million cases a year and 23,000 deaths in children under the age of 5. What’s more, a very recent trial in which the vaccine was combined with preventative drugs in children showed that this dual approach was much more effective in preventing severe disease, hospitalization and death (a 73% reduction!!!) than either method alone. These results were beyond the wildest dreams of the scientists who ran the study and bring great expectations for the future.

Let’s pray this is one hope for this beleaguered continent that actually comes to fruition. For more information about this or any other health related questions, contact your pharmacist.