A research team at Oxford University led by Irish vaccinologist Prof Adrian Hill has developed the most effective malaria vaccine to date. It brings the prospect of significantly reducing the death toll of a disease that kills 400,000 mostly small children every year.
The vaccine developed at the Jenner Institute, which also developed the AstraZeneca Covid-19 vaccine, showed up to 77 per cent efficacy in a trial of 450 children in Burkina Faso over 12 months. Known as R21/Matrix-M, it has been in development since 2012.
It is significantly more potent than the only other available vaccine with a favourable safety profile and was well-tolerated – it is the first to achieve the World Health Organisation-specified 75 per cent efficacy goal against the mosquito-borne parasite disease.
Larger trials are now beginning, involving 4,800 children in four countries, Prof Hill told The Irish Times.
The vaccine has the potential to cut the death toll dramatically, he believed. “What we’re hoping to do is take that 400,000 down to tens of thousands in the next five years, which would be absolutely fantastic,” he said.
The data has been released in advance of World Malaria Day this weekend but a peer-reviewed study is due to be published by The Lancet shortly.
Covid-19 lessons
The team hope the vaccine can be approved for use within the next two years, building on the speed and lessons learned through rapid development of Covid-19 jabs.
"Malaria killed at least four times as many more people in Africa last year as Covid did," Prof Hill noted, "And nobody for a moment questioned whether Covid should have an emergency use review and authorisation in Africa – of course it did, very quickly.
Prof Hill added: “So why shouldn’t a disease that firstly kills children rather than older people, certainly killed an awful lot more, be prioritised for emergency use authorisation in Africa?”
“I’m making the argument as forcefully as I can, that because malaria kills a lot more people than Covid in Africa, you should think about emergency-use authorisation for a malaria vaccine for use in Africa. And that’s never been done before.”
A fast-track approach could save 1.5 million lives over five years, he predicted – the usual rollout period for a vaccine at this stage of development.
The vaccine is set to be manufactured at large scale and low-cost, he said – through a deal with the Serum Institute of India, which is involved in manufacturing the AstraZeneca Covid-19 vaccine.
“With the commitment by our commercial partner, the Serum Institute of India, to manufacture at least 200 million doses annually in the coming years,” he said, subject to regulatory approval rollout of the jab could happen from early 2023.
Doses were administered from early May 2019 to early August 2019, largely prior to the peak malaria season. The researchers report a vaccine efficacy of 77 per cent in a higher-dose adjuvant group, and 71 per cent in the lower-dose adjuvant group, over 12 months of follow-up, with no serious adverse events.
Following these results, the trial funded by the EU was extended with a booster vaccination administered prior to the next malaria season one year later.
Malaria research is the Jenner Institute's largest programme, said Prof Hill, who his originally from Dublin – Prof Sam McConkey of the Royal College of Surgeons in Ireland, a well-known figure to the Irish public during the Covid-19 pandemic, "was one of our first stars on malaria", he noted.
AZ vaccine a year on
With Friday being the one-year anniversary of the first dose of the Oxford Covid vaccine being administered, Prof Hill acknowledged it had been a challenging time, though 300 million doses have been administered in 170 countries.
“We always knew we probably could make a vaccine and figure out how it would work,” he said. But they also realised once that happened, everybody would want a vaccine, and as a consequence “we could see the problem coming” – given the most vaccines ever administered in a year was 500 million doses.
Yet, in spite of supply difficulties 800 million Covid vaccines of various types were administered in the first quarter of 2020 from a standing start. The task, nonetheless, is “clearly huge . . . you cannot supply the world in three months”, he said.
“You only learn by making, and it’s very expensive stuff,” Prof Hill added.
His team always knew there would be a bottleneck, separate to issues the EU encountered due to problems at Belgium’s AstraZeneca plant, and lack of authorisation which initially prevented vaccine imports from India.
With more vaccines coming on stream, Prof Hill predicted deliveries would double in the second quarter of 2021, with potential to double again in the third and fourth quarters.
He confirmed they are launching a study investigating the delivery of their vaccine using a nasal spray “which might be particularly convenient and more acceptable to people who are not happy with needles”. It could also prevent upper tract infection and prevent blood clots, and may prove to be better that intramuscular injection, he added.
Thirty healthy Oxford-based volunteers aged 18-40 will receive the vaccine through an intranasal spray device, similar to many over-the-counter hay fever nasal sprays.
