The world’s first malaria vaccine — Mosquirix — has been endorsed and recommended by the World Health Organization on Wednesday.

Calling it “a historic moment” WHO Director-General Tedros Adhanom Ghebreyesus said, “The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control. Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

And it is truly historic — a giant step in the fight against the mosquito-borne disease that kills more than 4,00,000 people a year globally, and remains a primary cause of childhood illness and death in sub-Saharan Africa. In fact, a child dies of malaria every two minutes in Africa, and the mosquito-borne disease annually claims the lives of more than 2,60,000 African children under the age of five, according to WHO. The health body estimates that Africa accounts for 94% of all malaria cases and deaths across the globe. In a continent of 1.3 billion people, the number is massive.

In Africa, malaria is far deadlier than Covid-19

To put this in perspective, in 2019 alone, malaria claimed 3.8 lakh lives in Africa, according to WHO. Compare this with 2.12 lakh deaths from Covid-19 in the past 18 months.

The WHO’s recommendation of the widespread use of Mosquirix comes from the results from an ongoing pilot programme in Ghana, Kenya and Malawi that has reached more than 8,00,000 children since 2019.

Is Mosquirix the only vaccine for malaria?

There have been many potential candidates for malarial vaccines, which have been an area of intense research since the 1960s. RTS,S/ASO1 (RTS.S), or Mosquirix was conceived of and created in the 1980s by GlaxoSmithKline (then known as SmithKline Beecham Biologicals), and has been found the most effective so far. It was approved for use by the European Medicines Agency (EMA) in July 2015.

Mosquirix has many ‘firsts’ to its credit. For starters, it is the world’s first licensed malaria vaccine. It is also the first vaccine licensed for use against a human parasitic disease of any kind.

Shortly after EMA approved it, WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC) jointly recommended a pilot implementation of the vaccine in Africa in October 2015. The pilot project was launched in 2019 in Malawi, Ghana and Kenya and it is the basis of this project that WHO has recommended Mosquirix.

How is the vaccine administered?

Mosquirix can only be obtained with a prescription. The vaccine is given as a 0.5 ml injection into a muscle of the thigh or around the shoulder. According to European Medicines Agency (EMA), it is to be administered to children aged between 6 weeks and 17 months.

The vaccine should be provided in a schedule of four doses. The child is given three injections with one month between each injection. A fourth injection is recommended 18 months after the third.

How does it work?

According to EMA, the active substance in Mosquirix is made up of proteins found on the surface of the Plasmodium falciparum parasites and the hepatitis B virus. When the vaccine is administered, the immune system recognises the ‘foreign’ proteins from the parasite and makes antibodies against them. The system will then be able to produce antibodies more rapidly when the child is naturally exposed to malaria parasites in the future. While it also helps protect against liver infection with the hepatitis B virus, EMA warns that the vaccine should not be used only for this purpose.

What is its efficacy?

According to WHO, an analysis of the vaccine says that it had 30% effectiveness in preventing severe cases of malaria in children. And it is rather safe too. To date, more than 2.3 million doses of the vaccine have been administered in three African countries, and the vaccine has had a favourable safety profile, says the WHO.

Though it is touted to be the most successful among all vaccines, Mosquirix does face challenges and the primary one being that its protection fades after several months. Despite that, the scientists say the vaccine could have a major impact against malaria in Africa.

Azra Ghani, chair of infectious diseases at Imperial College London, said she and colleagues estimate that giving the malaria vaccine to children in Africa might result in a 30% reduction overall, with up to eight million fewer cases and as many as 40,000 fewer deaths per year.

In a continent that dreads malaria more than Covid-19, Mosquirix will go beyond saving lives. Considering the number of African infants that succumb to the mosquito’s kiss of death, Mosquirix will save generations.