A Health Surveilance Assistant prepares to give a dose of the Malaria Vaccinne into the first recipient on April 23, 2019 at Mitundu Community hospital in Malawi's capital district of Lilongwe on the first day of the Malaria vaccine implementation pilot programme in Malawi aiming to immunise 120,000 children aged two years and under to assess the effectiveness of the pilot vaccine and whether the delivery process is feasible. - Malawi spearhead today large scale pilot tests for the world's most advanced experimental malaria vaccine in a bid to prevent the disease that kills hundreds of thousands across Africa each year. After more than three decades in development and almost $1 billion in investment, the cutting-edge trial will be rolled out in Malawi's capital Lilongwe this week and then in Kenya and Ghana next week. (Photo by AMOS GUMULIRA / AFP)AMOS GUMULIRA/AFP/Getty Images
Vaccine delivery: The pilot test has begun in Malawi © AFP

A large-scale pilot of a vaccine that could prevent some of the 250,000 child deaths each year from malaria has begun in Malawi after successful clinical trials.

The vaccine — called RTS,S — acts against the most deadly malaria parasite and has been in development by GlaxoSmithKline for more than three decades. According to the World Health Organization, it is the first vaccine to demonstrate it can significantly reduce cases of malaria in children.

In clinical trials, the vaccine was found to prevent about four in 10 cases of malaria, as well as reducing malarial anaemia, the reason most children die from the disease, by 60 per cent. The vaccine does not claim full protection from malaria and must be used alongside existing prevention methods.

The WHO estimates that there were 219m cases of malaria and 435,000 deaths in 2017. Ninety-three per cent of deaths from malaria are in Africa. In some low-income countries, the infectious disease is the sixth-biggest cause of death.

The Malawi pilot, together with similar operations in Kenya and Ghana, will vaccinate about 360,000 children a year over five years. If successful, the WHO could recommend its use worldwide.

“We have seen tremendous gains from bed nets and other measures to control malaria in the last 15 years, but progress has stalled and even reversed in some areas,” said Tedros Adhanom Ghebreyesus, WHO director-general.

Slow progress has been attributed to a lack of investment in efforts to combat the disease and growing resistance to insecticides. “We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there,” Mr Adhanom added.

The pilots are being funded by three international financing agencies: the Global Fund to Fight Aids, Tuberculosis and Malaria; UN-backed Unitaid; and Gavi, the vaccines alliance. They will be implemented by local ministries of health in co-ordination with the WHO. GSK is donating up to 10m vaccine doses.

By the end of the five-year pilot, about $1bn will have been spent on the vaccine’s development, including $700m from GSK.

Seth Berkley, chief executive of Gavi, said: “Malaria is still one of the biggest killers of children worldwide. That is why it is so important to have new tools.”

New vaccines can take more than a decade to develop. Sian Clarke, professor of epidemiology and global health at the London School of Hygiene and Tropical Medicine, said that malaria was a particularly complex disease. “The antigens on the malaria parasite are highly variable, so it is much harder to develop a vaccine,” Professor Clarke said.

The new vaccine was “imperfect” in offering only partial immunity for a limited amount of time and should not be regarded as a cure, cautioned Prof Clarke. Success also depends on children receiving a booster treatment at the age of two.

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