In 1991, Robert Desowitz wrote about the early efforts to develop a vaccine to protect against malaria - a tale of great expense, effort (even some scandal), and failure. Twenty years later a lot more effort and expense has been poured into the problem but the picture doesn’t look much better.
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A vaccine in human trials today may be ready by 2015, but if it comes to pass it will probably only prevent about 50% of malaria cases in vaccinated individuals in Africa. That’s not stellar performance, and it raises a serious concern that it might actually result in unnecessary cases of malaria if people feel a false sense of security and become careless about other prevention measures.
Another problem is cost: the vaccine is likely to be expensive, and it’s valid to ask where the money will come from and whether it wouldn’t be better spent elsewhere. We know that other prevention measures work against malaria when they are consistently applied: down from a high of 178 countries with endemic malaria in the early 1900s, 99 countries have it today. In some countries still affected, the annual death toll today is only in the single or double digits, compared with a death toll from AIDS in the hundreds of thousands (Kelland and Hirschler).
According to the WHO, more than 33 million people are living with AIDS, with 2.6 million newly infected in 2009 and 1.8 million deaths (Global Summary of the AIDS Epidemic , 2009 ). One third of humanity is infected with the organism that causes tuberculosis and TB killed 1.7 million in 2009 (Tuberculosis: Fact Sheet No. 104 ) In 2008, there were 247 million cases of malaria, with nearly a million deaths (Malaria: Fact Sheet No. 94 )
If there’s only so much money to fight infectious diseases in the developing world, where should we spend it?
Sadly, perhaps it’s still not the right time for a malaria vaccine.
Desowitz, Robert S. The Malaria Capers. New York: Norton, 1991
Kelland, Kate, and Ben Hirschler. “Special report: The Cost of a Malaria-Fee World.” Reuters Health Information Dec 22, 2010