https://blogs.sciencemag.org/pipeline/archives/2021/04/23/great-malaria-vaccine-news Skip to main content ScienceMag.org Search X [ ] Advanced Search * Contents * News * Careers * Journals Share In the pipeline Derek Lowe's commentary on drug discovery and the pharma industry. An editorially independent blog from the publishers of Science Translational Medicine. All content is Derek's own, and he does not in any way speak for his employer. Derek Lowe By Derek Lowe * * * Infectious Diseases Great Malaria Vaccine News By Derek Lowe 23 April, 2021 Excellent news today: we have word of the most effective malaria vaccine yet discovered. A year-long trial in Burkina Faso has shown 77% efficacy, which is by far the record, and which opens the way to potentially relieving a nearly incalculable burden of disease and human suffering. This is a collaboration between the University of Oxford (Jenner Institute et al.), the KEMRI Wellcome Trust in Kenya, the London School of Hygiene and Tropical Medicine, Novavax, the Serum Institute of India, and especially the Institut de Recherche en Sciences de la Sante in Nanoro, Burkina Faso. Let's talk about Nanoro a bit. It's in central Burkina Faso, west/northwest of the capital Ouagadougou. Here are some shots of city, town, and rural village life in this part of the country (panel B is in Nanoro itself). The town is in a climate zone with a classic tropical pattern: hardly any rain at all in the hot season (December, January, February) and then a monsoon season in the summer and fall. That brings on masses of mosquitos, and malaria is an absolute scourge. Past studies from the Nanoro health sciences institute make this terrifyingly clear. Here's one where they looked a cohort of 734 infants born in the area for the first year of their lives. It's thought that children of this age have some malaria protection due to antibodies passed on from their mothers, but as the paper says, in areas of high transmission this can be overwhelmed. In those 734 infants, they recorded 717 clinical incidents of malaria infection, with the incidence rate strongly increasing as their first year went on and the great majority of these occurring in the rainy season. This 2010-2014 study from Nanoro shows the strong correlation of local malaria cases with rainfall and temperature (with a few weeks lag, as expected), and also with socioeconomic status (in exactly the direction you're thinking). This is the clearly the sort of region where real-world tests of a malaria vaccine need to be carried out. This new vaccine (R21) uses a circumsporozoite protein (CSP) antigen - that's a highly conserved protein of the parasite, involved in several functions as the parasite makes the move from mosquito to human and into different human tissues such as the salivary glands. This has been a vaccine ingredient before, such as in the RTS,S vaccine (the first one ever licensed), but R21 has a much higher proportion of CSP assembled into a virus-like particle. It also uses the exact same adjuvant from Novavax (Matrix-M) that they are using in their coronavirus vaccine - you can't keep a good adjuvant down, and this Chilean-soapbark-based one seems to really kick the immune system up under all circumstances. The team previously run an "age-de-escalation" trial in Kenya, showing that the vaccine seemed safe as you moved down to children and infants. That led to this trial, in 450 children aged 5 to 17 months in the Nanoro area, in three groups: 150 children with 5 micrograms vaccine and 25 micrograms adjuvant, a second 150 at 5/50, and a third getting rabies vaccine as a control. Three shots were given in the May-August period, largely before the yearly transmission period, and everyone got a booster shot one year later. The participants, their families, and the local study team were all blinded to the group assignments. Antibodies were measured at several intervals over the next year, and malaria cases were of course monitored. The higher-adjuvant cohort showed 77% vaccine efficacy, and the lower-adjuvant one showed 74% with (as you'd expect) overlapping confidence intervals. The first group had significantly higher antibody levels, though, and they're currently doing an additional year of follow-up to see how long the protection lasts and if these doses differentiate themselves. The antibody levels at the one-year mark in both groups were significantly higher than with the RTS,S vaccine, and in particular, antibodies against the repeat section in the middle of the circumsporozite protein seemed to correlate strongly with protection. No safety problems so far. The team is now planning a larger Phase III at five different African site, with varying seasonality and malaria loads. The Serum Institute is manufacturing the vaccine itself, and they say that they have a large-scale production route. The Novavax adjuvant is currently in a bit shorter supply due to the coronavirus pandemic, but it's still easier to manufacture and scale than the one used in the RTS,S vaccine. And while the dosing schedule used in this trial is a demanding one, I hope that the Phase III will help to establish the best balance between the logistics of dosing and malaria protection. Overall, this is definitely the best malaria vaccine candidate the world has yet seen, and that is unequivocal good news. Congratulations and thanks to the widespread group of researchers who have made this possible - and especially, thanks to 450 infants and toddlers in central Burkina Faso and to their parents. You have done the world a great service. 42 comments on "Great Malaria Vaccine News" 1. [da2] Alex says: 23 April, 2021 at 12:36 pm I wonder if this works against falciparum malaria or vivax, ovale, and the other types as well. In Southeast Asia there are many strains of malaria that are fully resistant to ACT, which would make this vaccine a true life saver there. Reply 1. [45b] Derek Lowe says: 23 April, 2021 at 12:56 pm I think that Burkina Faso is 100% falciparum. And I see from the literature that people have worked on the CSPs from vivax, etc., as well as with the falciparum one used in this trial, so maybe the same approach can work! Reply 1. [608] Mimi Emig says: 24 April, 2021 at 12:06 pm The paper states this vaccine targets P. falciparum. Since this is the most deadly form of malaria, it makes sense to go after this first. Reply 1. [d9a] Clem says: 24 April, 2021 at 6:52 pm that really depends! I would say it is just as important to consider ones that are more prevalent in a wider area and to consider the absolute number of people who die. If one has a death rate of 30% and the second one 15% but the second one kills 10X as many people in a year that would be the one to go after. Reply 2. [bec] Sulphonamide says: 23 April, 2021 at 12:51 pm A stunning effort indeed - amazing how suddenly something as immovable and insoluble as malaria can suddenly (if it all works out of course - but even so this is a gargantuan improvement on anything we've seen before) be seismically shifted by investment and the coming together of the required technologies (hasn't even required mRNA vaccines). But presumably there are enough non-human hosts that malaria will always be waiting in the wings ready to come back at the slightest dip in investment, break in supplies or social upheaval? Still wonder if gene drives for controlling the mosquito vectors might not be a more economical way to eradicate (or as near as) the disease, if we can sort out the environmental ethics of it. Either way, there goes a much loved final year dissertation topic - hopefully its TB equivalent will also be nearing the end of its shelf life. Reply 3. [0de] Eric says: 23 April, 2021 at 12:57 pm Hmmmm, maybe should have bought that Novavax stock after all. Reply 4. [661] Anon says: 23 April, 2021 at 1:01 pm Any concerns about drug resistance?? Reply 1. [4af] Mister B. says: 23 April, 2021 at 1:12 pm I don't know how "vaccine resistance" would work but this was my second thoughts after a big loud, YUUUUUP ! That's super good news Derek, thank you very for this ! Reply 1. [a50] Anon says: 23 April, 2021 at 1:33 pm I don't know the difference between this and antimalarials either. I was just curious. Hopefully someone will explain here. Reply 1. [156] metaphysician says: 23 April, 2021 at 2:43 pm They key difference, from my layman's perspective, is that antimalaria drugs are basically poisons that have to target the parasite. It can evolve resistance via various means, like pumping them back out. A vaccine targets the immune system, and the immune system is scary powerful from a microorganism perspective. The parasite would either have to evolve defenses against the many vectors of attack, or else avoid drawing notice in the first place. That is presumably why this vaccine targets a highly conserved protein: its something malaria *can't* change to evade detection, not without crippling the organism. If the immune system twigs to that protein, then curtains. ( Simple becoming invulnerable to the various forms of immune attack is, as i understand it, close to impossible. The immune system is *really* good at killing things in a variety of ways. Once it decides that you are an invader, it *will* kill you, even if it also kills the host. ) Reply 1. [4a1] Microbiologist says: 23 April, 2021 at 3:59 pm Another difference between antimicrobials and vaccines causing resistance is the population size they generally act on. Antimicrobials are given in response to an infection when the microbial population is large and may contain enough genetic diversity to find a resistant mutant. Vaccines act before infection and therefore only need to stop a much smaller, and likely less diverse, population of microbes. 2. [633] RandomStranger says: 24 April, 2021 at 4:34 pm HIV begs to differ. 2. [eab] A Nonny Mouse says: 23 April, 2021 at 5:49 pm Lots of new antimalarial drugs being developed by MMV. Sorted a few processes out for them in the past. A couple moving forward.. Reply 2. [49d] Not-an-epidemiologist says: 23 April, 2021 at 9:30 pm I don't know how "vaccine resistance" would work but this was my second thoughts after a big loud, YUUUUUP ! I've linked to this review article before, but in general -- vaccine resistance is rare (much less common than drug resistance), and even when it does arise there is generally still some protection offered by vaccines. Influenza is very much the exception, not the rule. https://www.pnas.org/content/115/51/12878.short Reply 5. [1cf] CET says: 23 April, 2021 at 1:04 pm I remember when I was somewhat younger, I wanted to go into drug development because I wanted to be part of something that would actually make a difference to people. It is amazing to see this kind of achievement. In terms of lives saved, suffering averted, and human potential unlocked...I can't think of anything this big since....polio? The discovery of antibiotics? Reply 6. [386] Rick Sheridan says: 23 April, 2021 at 2:31 pm Terrific news, and good on the institutes participating such as KEMRI-Wellcome. Been needing to hear good news in health lately, especially related to Africa and emerging markets. Reply 7. [992] J says: 23 April, 2021 at 2:36 pm 'Malaria vaccine hailed as potential breakthrough' https://www.bbc.co.uk/news/health-56858158 Reply 8. [92f] ScientistSailor says: 23 April, 2021 at 3:37 pm Will this be good enough to eradicate it? Reply 1. [6f2] sgcox says: 23 April, 2021 at 4:37 pm Yes, but only after we inoculate all the live stock and ideally wild animals in Africa, most of America and South Asia. I heard lions have a particularly strong antivax sentiments. Reply 1. [3b7] notaparasitologist says: 24 April, 2021 at 1:42 pm Less of a problem than you might think, because P.falciparum is almost exclusive to primates. Reply 1. [92f] ScientistSailor says: 24 April, 2021 at 3:56 pm Yes. and only one species of mosquito spreads it to humans... Reply 9. [70b] lapsed chemist says: 23 April, 2021 at 3:47 pm What a great start to the weekend! This is a milestone achievement - well done to all the scientists involved - past and present! Reply 10. [2f6] dearieme says: 23 April, 2021 at 5:41 pm President Micron has announced that this jab is from Oxford and is therefore quasi-ineffective. Reply 1. [c68] Marko says: 23 April, 2021 at 5:51 pm He has just now changed his mind. Reply 2. [2f6] WST says: 24 April, 2021 at 3:04 am I tried to trace this statement by president Macron and could not find it. Macron is 43 and declared that he will wait his turn, he had covid in December. Only article suggesting Macron is against AZ was from Daily Mail, quoting a journalist from Russia Today. RT and Sputnik journalists are not invited to presidents briefings and are not regarded by the official France as news agencies but rather a Russian propaganda outlet, so reports of what Macron said by an RT journalist is not a first hand account. Right now Macron has initiated large scale communication effort in support for AZ and J&J vaccination. In other words, yet another episode of Russian destabilisation campaign against AstraZeneca. (AZ and Sputnik combined clinical trial that was supposed to start 30/3 is not recruiting yet, most likely will never do) Reply 1. [eab] A Nonny Mouse says: 24 April, 2021 at 9:50 am BY RYM MOMTAZ January 29, 2021 4:52 pm PARIS -- French President Emmanual Macron said Friday the AstraZeneca coronavirus vaccine appeared to be "quasi-ineffective" on people older than 65 -- just hours before the EU's drugs regulator approved it for use on all adults. "The real problem on AstraZeneca is that it doesn't work the way we were expecting it to," Macron told a group of reporters, including POLITICO, in Paris. "We're waiting for the EMA [European Medicines Agency] results, but today everything points to thinking it is quasi-ineffective on people older than 65, some say those 60 years or older." Reply 1. [2f6] WST says: 24 April, 2021 at 10:08 am The date.... it was just after the false claim in "Handelsblatt and Bild" that AZ is 8% effective in elderly. Macron has overacted, no question, but so did quite few EU politicians. This controversy did not took more then a week ebb out. It is misleading to use this quote of Macron today without this context. Feb 25, 2021, Reuters quotes Macron: ""In view of the latest scientific studies, the efficacy of the AstraZeneca vaccine has been proven," Macron told reporters after a virtual European Union summit. "My turn will come, but I've got time. If that's the vaccine that's offered to me, I will take it, of course." Reply 1. [c68] Marko says: 24 April, 2021 at 12:56 pm Wait, I thought it was all Russian disinfo, with no basis in fact ? Macron jumped the gun, so mocking him for it is fair game, as it would be for anyone else who made such a careless and damaging blunder. 2. [2f6] WST says: 24 April, 2021 at 3:51 pm ...and you were right ! 1. Macron never got vaccinated 2. Macron did not complain about efficiency of the his hypothetical jab Two false statement in one sentence completely out of the thread context, bit too much for the regular boneheads.-)) 3. [c68] Marko says: 24 April, 2021 at 4:12 pm This is the start of the thread: "President Micron has announced that this jab [the malaria vaccine] is from Oxford and is therefore quasi-ineffective." This was clearly an appropriately sarcastic and mocking shot at Macron, referring to his earlier blunder regarding the AZ vaccine, which you recognized as such. You then claimed you could find no evidence of that earlier statement and that it was all part of a Russian disinfo campaign. Now that Macron's earlier statement has been substantiated, rather than simply manning-up and admitting your error, you're dissembling. Pretty lame. 4. [2f6] WST says: 24 April, 2021 at 4:42 pm I"m sorry, I thought the thread was about malaria vaccine. 2. [f8b] Jonas says: 24 April, 2021 at 12:51 pm I would not just blame the Russians. There has a lot of dirty water thrown at the Oxford and AstraZeneca effort from people all over, even Australia. I often wondered if they have vested interests in the likes of Pfizer -or just hated the idea of not for profit products that may press down profits across the industry generally. We may never know. Reply 11. [37a] BF Ansari says: 24 April, 2021 at 1:37 am yes, this could be great news. Reply 12. [f8b] Jonas says: 24 April, 2021 at 5:21 am So reading this article and associated press media pieces, it seems that this is not the discovery of hitherto elusive effective vaccine, but also assured accessible development? If so, this is massive! Since when are vaccine scientists thinking ahead to practical issues such as mass manufacturing and accessibility AND actually incorporating this into a plan? Reply 13. [93e] Michael says: 24 April, 2021 at 9:00 am Is there any indication of whether this vaccine will, in addition to preventing initial cases of malaria, prevent relapses in people who have previously been infected and are prone to them? Reply 1. [c08] Christian Weisgerber says: 24 April, 2021 at 9:52 am This vaccine candidate is against P. falciparum malaria, which is non-relapsing. Reply 14. [413] marp says: 24 April, 2021 at 12:08 pm This is fantastic! I had no idea vaccines could be discovered! All the ones I know of were invented by humans. Was it hiding under a rock at the bottom of the ocean, maybe? Reply 1. [6f2] sgcox says: 24 April, 2021 at 12:35 pm Yes, this is a good one ! When I run HTS against enzyme #15 and find a good hit, I discovered it, not invented it, right ? Then, when chemist makes 100 analogues and stumbles on say meta-chlorine which jumps the potency, did she/he invented it or discovered ? Of course, it will be claimed in JMC paper it was rationally designed. But why did you make other 100 inactive compounds prior to the breakthrough if this was indeed the case ? There will as usual the post-hock structural based design analysis as well, once after many heroic efforts, biologists get the target finally crystallised with that all important compound, etc. So what is discovered and what is invented in drug discovery ? Same with vaccines - hundreds were invented and only few were discovered to be effective. Now, discuss Reply 1. [4c7] Druid says: 24 April, 2021 at 3:19 pm Inventions have to be invented to be patentable, apart from all the discoveries (eg pre-existing DNA or amino acid sequences) that the patent office lets through for some reason no-one understands. But your assays are purposely-designed tests for the action designed into the invented compound, unless your assays are random. Even screening assays were designed for a purpose; that's why assays are intellectual property. On the other hand, anything from a library run through a set of screening assays is a discovery (as it already exists) and therefore not patentable (except that in some countries the chemistry used to make the compound is patentable). In my opinion. See you in court where someone who studied law instead of chemistry can decide. Reply 2. [f8b] Jonas says: 24 April, 2021 at 12:45 pm The vaccine was designed in a deliberate way, so was invented! But you have run a trial to "discover" how effective it is -of at all. This news comes from an arito le about the trial. Reply 15. [5ec] JasonP says: 24 April, 2021 at 1:46 pm Does this mean that the only use left for Hydroxychloroquine is early treatment of asymptomatic COVID-19??? Reply 16. [c34] APAJ says: 24 April, 2021 at 2:31 pm Ah! True dedication to science: "[...] 450 children aged 5 to 17 months [...] . The participants [...] were all blinded to the group assignments." 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