TOMALI, Malawi (AP) – A pinch in the leg, a shriek and a thread of tears. One baby after another in Malawi is receiving the first and only vaccine against malaria, one of the deadliest and most stubborn diseases in history.
The nation of South Africa is launching the shots in an unusual pilot program along with Kenya and Ghana. Unlike established vaccines that offer almost complete protection, this new one is only 40% effective. But experts say it is worth a try as progress against malaria progresses: resistance to treatment is growing and the global decline in cases has stabilized.
With the vaccine, the hope is to help young children during the most dangerous period of their lives. Propagated by mosquito bites, malaria kills more than 400,000 people every year, two-thirds of them under 5 and most in Africa.
Charity Nangware, seven months old, received an injection on a rainy December day at a health clinic in Migowi City. He watched curiously as the needle slid on his thigh, then he twisted his face with a howl.
“I am very excited about this,” said his mother, Esther Gonjani, who suffers from malaria, chills and fever at least once a year and misses a week of field work when one of her children is ill. “They explained that it was not perfect, but I feel sure it will relieve the pain.”
Malaria escapes little – “malungo” in the local Chichewa language – especially during the five-month rainy season. Stagnant puddles, where mosquitoes breed, surround brick and straw houses and line dirt roads through tea plantations or fields of corn and sugarcane.
In the town of Tomali, the nearest health clinic is two hours away by bicycle. The longer it takes to get care, the more dangerous malaria can be. Clinic teams offer basic medical care during visits once or twice a month, carrying the malaria vaccine and other vaccines in portable refrigerators.
Malaria treatment occupies a good part of its time during the rainy season, according to Daisy Chikonde, a local health worker.
“If this vaccine works, it will reduce the burden,” he said.
Resident Doriga Ephrem said proudly that her 5-month-old daughter, Grace, did not cry when she received the malaria vaccine.
When he learned of the vaccine, Ephrem said his first thought was “protection is here.” However, health workers explained that the vaccine is not intended to replace antimalarial medications or the insecticide-treated bed net that she deploys every night while the sun goes down. and mosquitoes rise from the shadows.
“We even took our dinners inside the net to avoid mosquitoes,” he said.
It took three decades of research to develop the new vaccine, which works against the most common and deadly of the five species of parasites that cause malaria. The complex life cycle of the parasite is a great challenge. It changes the forms at different stages of the infection and is much harder to detect than germs.
“We don’t have any vaccine against parasites in routine use. This is unknown territory,” said Ashley Birkett, who runs the PATH Malaria Vaccine Initiative, a nonprofit organization that helped drug maker GlaxoSmithKline to develop the vaccine, Mosquirix.
The bite of an infected mosquito sends immature parasites called sporozoites to the bloodstream. If they reach the liver, they will ripen and multiply before being thrown back into the blood to cause the debilitating symptoms of malaria. At that point, treatment requires medications that kill parasites.
Mosquirix uses a part of the parasite, a protein found only on the surface of the sporozoites, with the hope of blocking the stage of liver infection. When a vaccinated child is bitten, the immune system must recognize the parasite and start making antibodies against it.
Scientists are also looking for next-generation alternatives. In the pipeline there is an experimental vaccine made of whole malaria parasites dissected from the salivary glands of mosquitoes but weakened so that they do not make people sick. Sanaria Inc. has been testing its vaccine in adults and is planning a large late-stage study on the island of Bioko in Equatorial Guinea.
And the US National Institutes of Health. UU. Initial tests will soon begin if people regularly inject antibodies made in the laboratory, instead of relying on the immune system that produces them, could offer temporary protection during the malaria season. Think of them as “potentially short-term vaccines,” said Dr. Robert Seder of the NIH at a recent meeting of the American Society for Tropical Medicine and Hygiene.
For now, only babies in parts of Malawi, Kenya and Ghana are eligible for the Mosquirix vaccine. After the vaccine was approved in 2015, the World Health Organization said it first wanted a pilot launch to see how well it worked in some countries, in real conditions, before recommending that the vaccine be administered more widely in Africa.
“Everyone is eager to get it,” said Temwa Mzengeza, who oversees the Malawi vaccine programs. Those eager for vaccines include her husband, whom she had to stop trying to get them, she said.
Mzengeza used to get malaria several times a year until he began following his own tips for sleeping under a net every night. Unlike many other types of infections, people can contract malaria repeatedly, accumulating only partial immunity.
In the pilot program that started last year, 360,000 children in all three countries should get vaccinated annually. The first dose is given at approximately 5 months of age and the fourth final booster near the child’s second birthday.
Experts say it’s too early to know how well the vaccine is working. They are attentive to deaths from malaria, serious infections and cases of meningitis, something that was reported during the studies but which is definitely not related to the vaccine.
“Doing something completely new for malaria is exciting,” said researcher Don Mathanga, who leads the evaluation in Malawi.
The rainy season has brought new challenges, making some rural roads impassable and complicating efforts to locate children due to a vaccine. So far, in Malawi, the first dose reached approximately half of the selected children, approximately 35,000. That fell to 26,000 for the second dose and 20,000 for the third.
That is not surprising for a new vaccine, Mzengeza said. “It will recover over time.”
At the health clinic in Migowi, in the highlands of southern Malawi, workers see signs of hope. Henry Kadzuwa explains the vaccine to the mothers who wait in the clinic. He said there was a drop in malaria cases to 40 in the first five months of the program, compared with 78 in the same period in 2018.
Although he wants his 3-year-old daughter, Angel, to get the vaccine, “he is protecting my community. It also makes my job easier,” Kadzuwa said. The Migowi area has one of the highest rates of malaria in the country, and a worn paper log in the clinic’s laboratory lists dozens of cases.
At the clinic, Agnes Ngubale said she had malaria several years ago and wants to protect her 6-month-old daughter, Lydia, from the disease.
“I want her to be healthy and free,” he said. “I want her to be a doctor.”
And he has memorized the time of Lydia’s second dose: “Next month, the same date.”
Neergaard reported from Washington.
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