Habiba Suleiman, 29, a district malaria surveillance officer in Zanzibar, naps with her little girl Rahma under a mosquito net in 2015.

First-Ever Approval for Malaria Vaccine

Since the 1940s, researchers have tested more than 140 potential malaria vaccines in humans. Before this week, none had received approval from global health authorities.

On Wednesday, the World Health Organization recommended that children in areas with moderate to high transmission of the malaria parasite Plasmodium falciparum receive the vaccine Mosquirix, initially called RTS,S, developed by the British drugmaker GlaxoSmithKline. Given in four doses, the vaccine significantly cuts rates of severe malaria infection.

“This is a historic moment,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

The stakes could hardly be higher. According to the most recent WHO figures, 409,000 people died from malaria in 2019, including 274,000 small children. Most live in sub-Saharan Africa. Worldwide, there were approximately 229 million cases of the disease that year.

RTS,S was first created in 1987, and it has actually been in use for years: The shot underwent a large trial between 2009 and 2014, and a pilot study launched in 2019 distributed doses to 800,000 children in Ghana, Kenya, and Malawi. Compared to other childhood vaccinations, Mosquirix’s effect is modest: The most recent data suggests that it cuts the rate of severe malaria by 30 percent.

Still, some public health experts hope even a small boost could translate into tens of thousands of lives saved each year, and the WHO decision — pending approval from the world’s principal vaccine distributor in poor areas, Gavi — could expand its use across the continent. Others have cautioned that the relatively low efficacy and limited funds could blunt the vaccine’s impact.

Developing a malaria vaccine has been vexingly slow. A working vaccine for a parasitic disease (as opposed to one caused by a bacteria or virus) had never before been approved for humans. Researchers have a limited understanding of how the immune system responds to malaria parasites, and the parasites have a genetic diversity that further complicates attempts to develop effective vaccines.

Some of those delays, though, may also be about priorities. Unlike other global pathogens that have been quelled with vaccination — from measles to smallpox — malaria almost exclusively plagues poor communities. In December 2020, the development website Devex noted that global spending on malaria research and development had averaged just $600 million per year between 2007 and 2018 — a relatively modest investment for such a devastating pathogen. (By comparison, the United States alone spent $11 billion on Covid-19 vaccine R&D in 2020.) The lack of robust funding, according to Devex, had slowed vaccine development.

Still, in recent years, some experts have expressed cautious optimism about momentum in malaria vaccine development. In April, early trials involving 450 children suggested that another vaccine candidate, dubbed R21, could be 77 percent effective at preventing malaria, at least for one year. New techniques, a paper in the journal NPJ Vaccines noted in 2020, “promise to expand on RTS,S and improve existing vaccine candidates.”

In Africa, some people have greeted the vaccine eagerly. “When I was young, my family was prone to malaria attacks,” Phoebe Wetende, a hairdresser in western Kenya, told Reuters. “I could miss school because I am admitted to the hospital,” she added. Wetende enrolled her daughter in the recent pilot for RTS,S. According to Reuters, the two-year-old just received her fourth and final dose on Thursday.

Also in the News:

• With his tenure as head of the nation’s premiere biomedical research agency spanning 12 years and three presidential administrations, Francis Collins announced on Tuesday that he plans to step down by the end of the year. Appointed as director of the National Institutes of Health by President Barack Obama in 2009, Collins, a geneticist and physician who had previously overseen the Human Genome Project, was known as a brilliant scientist who deftly courted support from both sides of an evermore bitterly divided Washington. Along the way, he grew the agency’s budget by more than a third, and he garnered praise for his unflappable demeanor and steady leadership — even as the administration of President Donald J. Trump, who kept Collins on at NIH when he arrived in 2017, sought to undermine public faith in scientific institutions. Collins did not wholly escape criticism, of course: NIH decisions to curb certain types of stem cell research, for example, as well as its sluggish response to issues of sexual harassment and the lack of diversity in biomedical research fields, received frequent complaints over the years. Still, news of Collins’s looming departure was met with near-universal tones of admiration, particularly for his leadership during the Covid-19 pandemic — a topic on which Collins himself expressed some regret. He had hoped, he told The New York Times, to leverage his own Christian faith in an effort to bridge a growing chasm between pandemic-era science and conservative evangelicals, but progress was elusive. “That’s a heartbreak,” he said. “We are supposed to be people of truth.” (Multiple sources)

• Facebook, WhatsApp, and Instagram suffered global outages on Monday, lasting around six hours and affecting billions of users worldwide. During the shutdown, the internet was rife with conspiracy theories that Facebook’s family of products had gone down because of hackers. But the issue appears to be the result of more mundane technical difficulties. The outages came during a turbulent week for the social media company: On Sunday, a whistleblower appeared on the CBS News show “60 Minutes” and claimed that Facebook prioritizes profits over users, allowing misinformation and hate speech to flourish on the platform. The whistleblower, former Facebook product manager Frances Haugen, also testified before the U.S. Senate on Tuesday. In her testimony, Haugen emphasized the negative impact of Instagram on the mental health of teens and young kids, an issue recognized internally at Facebook, according to documents Haugen provided to The Wall Street Journal. Haugen also criticized the company’s lack of transparency. “Almost no one outside of Facebook knows what happens inside of Facebook,” she said. Haugen charged that the company has done little to monitor misinformation in non-English-speaking countries, helping fuel recent violence in Ethiopia. And she said the company’s unit tasked with addressing cyberespionage is severely understaffed. In an open letter Tuesday, Facebook founder Mark Zuckeberg challenged Haugen’s allegations. (Multiple Sources)

• The 2021 Nobel Prizes were announced this week, and — as is so often the case — the new class of laureates is raising eyebrows in part because of who was left out. The prize in Physiology or Medicine went to biologists David Julius and Ardem Patapoutian for work that helped uncover the molecular basis for how humans sense temperature and touch. Syukuro Manabe, Klaus Hasselmann, and Giorgio Parisi shared the physics prize for their work on complex systems, including developing early climate models that presaged the dangers of rising atmospheric carbon levels. Rounding out this year’s science laureates were Benjamin List and David MacMillan, who won the Chemistry Nobel for pioneering a new class of molecules that can be used to help construct other molecules. (The technique they developed makes it possible for chemists to synthesize many organic molecules far more efficiently than before.) Many prognosticators had expected the Nobel committee to honor research that laid the groundwork for the mRNA vaccines currently being deployed against Covid-19. Although experts say that recognition is likely to come eventually, it will have to wait at least another year. Also missing from this year’s class of science laureates: women. After a historic 2020 that saw three women win Nobels in physics and chemistry, this year all seven science laureates were men. (Multiple Sources)

• And finally: A study published Tuesday in the British Journal of Dermatology explains why some individuals who contract Covid-19 develop the condition Covid toe. Those afflicted with the ailment develop something researchers call chilblain-like lesions — inflamed red or purple skin on their toes (and sometimes fingers). Covid toe can be painful enough to hinder walking and limit sufferers’ ability to comfortably don footwear. The condition most often develops in children and teenagers, but Covid toe can occur in any age group. In April 2020, the authors of the new study examined 50 patients with the lesions. They also studied 13 individuals who had developed a similar condition prior to the pandemic. The authors concluded that the body’s aggressive immune response to the virus caused the phenomenon. The rash, they say, results from a certain kind of antibody mistakenly attacking the body’s own tissue, as well as activity from an antiviral protein called type 1 interferon. In an interview with the BBC, podiatrist Ivan Bristow, who was not part of the study, said the condition usually fades on its own. But treatment is sometimes necessary, he said, and the new research “will help to develop new treatments to manage it more effectively.” (BBC News)

“Also in the News” items are compiled and written by Undark staff. Lucas Haugen, Sudhi Oberoi, Ashley Smart, and Tom Zeller Jr. contributed to this roundup.

Michael Schulson is a contributing editor for Undark. His work has also been published by Aeon, NPR, Pacific Standard, Scientific American, Slate, and Wired, among other publications.