Over the summer we we reported the curious story behind a National Institutes of Health study, which had found a third of malaria medications taken around the world are fake. Most commentary on the research intimated that unscrupulous, large, likely Chinese pharmaceutical companies were to blame. It turned out the dummy pills were actually produced by small criminal syndicates, shoestring counterfeit operations run in garages and back rooms, pushing fake meds in convincing packaging to customers in their own communities. Fortunately, none of this would matter soon, we thought—because a promising vaccine against malaria was on the way. In a generation malaria would be, if not gone, certainly on its heels.
This week, the final trial on that promising vaccine will appear in the New England Journal of Medicine—and the surprising results are not encouraging. After an earlier trial showed that more than sixty percent of older children vaccinated would become resistant to the disease, follow-up trials on infants have fallen disappointingly short. In the latest trial, only thirty percent of children showed resistance, and that appears likely to wane dramatically after the first year.
It’s a huge setback for the program and will delay deployment by years—the hope had been 2015. Instead, the weapons against the disease will continue to be what they have been for decades: affordable treatments, reliable medicines, and public information. Some commentary, notably from voices in malarial regions, questioned this week whether the encouraging results from earlier tests had led to false expectations. That the vaccine is a high-profile project backed heavily by the Gates Foundation and numerous celebrity voices doesn’t help. Indian daily The Hindu took care to note how high previous success had set the bar. Doubts, the paper points out, were in the fine print and the footnotes—incautiously, it now seems:
The vaccine has been developed primarily for infants and children in sub-Saharan Africa. The reasons are obvious: of the 216 million cases of malaria and 6,55,000 malaria-related deaths in 2010, a majority of deaths took place in African countries.
Even as many newspapers went overboard last year based on results from the older age group, the 2011 Editorial accompanying the paper in The New England Journal of Medicine explicitly stated: “there does not seem to be a clear scientific reason why this trial has been reported with less than half the efficacy results available.”
The 2011 paper concluded with a rider that the “vaccine has the potential to have an important effect on the burden of malaria in young African children.” The rider was: the “vaccine efficacy among younger infants and the duration of protection will be critical to determining how this vaccine could be used effectively to control malaria.”
In that sense, the latest results do dampen the high spirits seen last year. The last word is yet to be pronounced. One has to wait till 2014 when the complete data is analysed and the outcome is known. Only then can it be said with any certainty if the vaccine will indeed be included for use in the African countries as per WHO recommendations. WHO had taken the unusual decision last year when it had “recommended” its use in the African countries as early as 2015.