Do we really need a malaria vaccine?

While various interventions have been implemented to control the burden of malaria in India, a recent study has said that a vaccine has the potential to eradicate the disease in India, especially if it is included in the immunization schedule for children. He urged health policy makers to target the populations and ensure quick buy-in towards the goal of eliminating malaria from India.

In October 2021, WHO approved the RTS,S/AS01 (RTS,S) malaria vaccine for administration in four scheduled doses to 5-month-old infants to reduce the burden and severity of malaria in Africa. sub-Saharan and other regions. with moderate to high malaria transmission by Plasmodium falciparum.

At the Asia-Pacific Leaders’ Conclave on Malaria Elimination on Monday, NITI Aayog member Dr. VK Paul congratulated countries in the South Asia-Pacific region for achieving a significant decrease in malaria cases. He emphasized the goal of making malaria history with a focus on working in the most marginalized and vulnerable communities with an intersectoral approach. He said India needed to work quickly on developing a malaria vaccine “to have additional weapons” against the disease.

However, Dr. Sanjay Rai, a professor at the AIIMS Center for Community Medicine DelhiHe said that since India is not in a high endemic zone, pushing for a vaccine might be a bit too ambitious. Excerpts from an interaction:

Can a malaria vaccine work in India?

India is in a lower endemic region now and we have less than 100 deaths reported from the last two to three years. The WHO had recommended a vaccine for Africa during Covid based on a study aimed at high and moderate endemic countries. 95 percent of deaths worldwide came from sub-Saharan countries, especially in children. Deaths occurred there due to Plasmodium falciparum, but in India it is not the main culprit in malaria cases. In India, most states have reported Plasmodium Vivax and the vaccine is not effective against it. It will give some immunity against the parasite, but Vivax is not a very serious variant. We are not in a highly endemic area, so vaccinations are not recommended. In Africa, a large number of deaths occurred in children due to Plasmodium falciparum. We have a mixed type of malaria parasite, Plasmodium P Vivax being the majority.

Before launching any vaccine or any program, we must do a cost-benefit analysis. WHO has conducted this assessment only in high-burden countries where it is cost-effective. In low burden countries, vaccination is not very cost effective. Also, so far only one vaccine has been approved.

Does Plasmodium P Vivax need a vaccine?

Not many deaths have been recorded, so it is not considered a dangerous parasite. We really don’t have approved vaccines for low endemic countries. While the WHO has approved vaccines for high-burden countries, it also faces a supply-demand mismatch.

How to tackle malaria then?

Many countries like Sri Lanka, Maldives and China, which were high burden countries, eliminated malaria through control measures alone. If we adopt effective controls, it is possible to reach zero cases and fatalities. We need to work on source reduction and control mosquito breeding, use bed nets, etc.

There are various control measures under the National Vector Disease Control Program. In fact, cases have been declining in India for the past 10 years. All malaria-related indicators, such as the positivity rate and the annual incidence of parasites, are also gradually declining. So we are going in the right direction, but control measures need to be accelerated.