Steady Progress Toward a Malaria Vaccine

Kirsten E. Lyke

Disclosures

Curr Opin Infect Dis. 2017;30(5):463-470. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Great progress has been made in reducing malaria morbidity and mortality, yet the parasite continues to cause a startling 200 million infections and 500 000 deaths annually. Malaria vaccine development is pushing new boundaries by steady advancement toward a licensed product.

Recent findings: Despite 50 years of research, the complexity of Plasmoidum falciparum confounds all attempts to eradicate the organism. This very complexity has pushed the boundaries of vaccine development to new heights, yet it remains to be seen if an affordable vaccine can provide durable and high-level protection. Novel vaccines such as RTS,S/AS01E are on the edge of licensure, but old techniques have resurged with the ability to deliver vialed, whole organism vaccines. Novel adjuvants, multistage/multiantigen approaches and transmission blocking vaccines all contribute to a multipronged battle plan to conquer malaria.

Summary: Vaccines are the most cost-effective tools to control infectious diseases, yet the complexity of malaria has frustrated all attempts to develop an effective product. This review concentrates on recent advances in malaria vaccine development that lend hope that a vaccine can be produced and malaria eradicated.

Introduction

Malaria has spanned human evolution causing more death than any other infectious disease. The Plasmodium falciparum malaria burden for 2016 was estimated at 212 million infections with 429 000 deaths.[1] The marathon to develop a malaria vaccine has stretched into 50 years of continuous research. However, the climate in which this effort continues dramatically changed with the infusion of international financing via the Global Fund and the President's Malaria Initiative. Between 2000 and 2013, malaria incidence fell by 30% and mortality fell by 47% globally, contributing to an estimated 4.3 million lives saved.[2] Malaria interventions such as the distribution of bed nets, indoor residual spraying and artemisinin-based therapies have all contributed to this success.[3] The progress revitalized the goal to eradicate malaria,[4] but mortality remains startling high. Fragile gains have plateaued and are imperiled by global economic instability, lack of reliable financing and regional conflicts. Moreover, the Ebola outbreak in West Africa illustrates the fragility of infrastructure in resource-limited nations threatened with health crises. In order to harness momentum and raise global consciousness of both the successes and obstacles in combating malaria, the WHO compiled a technical strategy, calling for a 90% reduction of malaria incidence and mortality and a malaria vaccine with at least 75% protective efficacy by 2030, securely placing the world on a path toward malaria elimination.[5] Malaria vaccine development is a cost-effective and critical tool for protection from the parasite and in its ultimate elimination.[6]

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