Mosquito-borne disease malaria is responsible for around 435,000 deaths per year, and 80-90% of those deaths occur in rural sub-Saharan Africa. However, there was no vaccine until a few years back to prevent this disease. Finally, after 100 years of effort, a vaccine has become a beacon of hope. The World Health Organization (WHO) endorsed a vaccine to fight malaria on October 6, 2021. After conducting pilot vaccination programs in Ghana, Kenya and Malawi, the WHO said it could now be used in children's bodies to prevent moderate to high levels of malaria in sub-Saharan Africa and other regions. 

Six years ago, Mosquirix based 'RTS, S' proved to be effective and getting endorsed from WHO is considered a historic event.

What is Mosquirix Vaccine?

Mosquirix is a malaria vaccine for children aged 6 weeks to 17 months. Additionally, it can also protect against liver infection due to the hepatitis B virus. However, the European Medicines Agency (EMA) suggests not using the vaccine solely for liver infection purposes.

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GlaxoSmithKline or GSK invented the vaccine back in 1987. But, they went through many development processes, and today's outcome took more than three decades. However, since the invention Mosquirix has faced some challenges as the protection faded after a few months and required up to four doses.

The European Medicine Agency approved this in 2015. In one experiment, Mosquirix was found 30% effective when applied 4 times to children.

The World Health Organization has set a target of vaccinating 360,000 children each year in three countries. GSK and Bill & Melinda Gates Foundation have funded about $750 million for the vaccine. Currently, the company is providing 1 crore vaccines free of cost in the ongoing project. Later, they are planning to recoup the money invested through large-scale projects.

Read: UN endorses world's 1st malaria vaccine as 'historic moment'

Since 2019, around 2.3 million doses have been applied to infants in Kenya, Ghana and Malawi on a large scale, which was coordinated by the WHO.

Usage of Mosquirix

A 0.5 ml Mosquirix injection is given into the muscle around the shoulder or in the muscle of the thigh. The child will need to take three injections in three months with one month gap between each dose. Further, a fourth dose is also necessary after 18 months of the third dose. However, a prescription is required to get the vaccine.

How does Mosquirix RTS, S work?

According to the European Medicines Agency's researchers, the active substance in Mosquirix is basically made up of proteins found on the Plasmodium falciparum parasites' surface. When it enters into the body, the immune system takes it as a foreign protein and eventually builds antibodies against them.

What does RTS,S stand for?

RTS,S is mainly the scientific name of the malaria vaccine candidate. The 'R' means the "central repeat region of Plasmodium (P.) falciparum circumsporozoite protein (CSP)." The 'T' stands for the T-cell epitopes of the CSP, and the 'S' stands for hepatitis B surface antigen (HBsAg).

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Efficiency of Mosquirix

Although Mosquirix did not meet the WHO's benchmark of 70% efficiency, it got approval as it is 30% effective in preventing severe cases of malaria in children. However, scientists are working relentlessly to improve it and may find a way in the long run. Despite all these, WHO approved Mosquirix as it is highly effective in preventing P. falciparum malaria in children.

Mosquirix timeline

As we already know that it is a result of 30+ years of continuous research. However, it has faced multiple challenges, including funding as well as a lack of sustainable clinical successes.

According to the European Medical Agency, a phase III trial was instructed in November 2012, which provided modest protection against both severe and clinical malaria in young infants.

After 11 months, the preliminary result of phase III suggested that Mosquirix or RTS,S reduced the number of cases by 50% among young children and 25% among infants. Later the study was finished in 2014. 

Read: African children should get world's 1st malaria vaccine: UN

In 2014 GSK applied for a marketing license to EMA with an aim to guarantee sustained availability. Nevertheless, GSK treated this project as a non-profit initiative as most of the funds came from Bill & Melinda Gates Foundation. 

Later in 2015, EMA endorsed Mosquirix to use children aged 6 weeks to 17 months. Then a pilot project in three different locations was started to check the efficiency of the vaccine on April 23, 2019, in Malawi, April 30, 2019, in Ghana and September 13, 29 in Kenya. Finally, last week WHO-approved it for broad use in children.

Are there side effects of Mosquirix?

According to the side effect of RTS,S is rare. But some temporary side effects may include pain, fever and convulsions.

Why is malaria so difficult to deal with?

As scientists have discovered the Covid vaccine within a year, people may be wondering why it took so long for malaria! Malaria is caused by a parasite that is much more disguised and sophisticated than the virus that causes covid. The comparison between the two is much like a comparison between a 'person and a cabbage'. The malaria parasite has the ability to penetrate our immune system. So anyone may be attacked by malaria again and again before the person gets the slightest protection.

Read Malaria drugs' promise for coronavirus spurs hope, shortages

As a result, the invention of the malaria vaccine was not easy at all. It is based on the complex life cycle of two species of humans and mosquitoes. This is the main reason why the vaccine is only 30% percent effective. Even then, it is still a significant achievement and will pave the way for more robust vaccines.

Final words

Not to mention, Mosquirix based 'RTS, S' is a major breakthrough in the race of medical science against the life-threatening malaria disease. However, celebrating the success of inventing the long-awaited malaria vaccine, is accompanied with some challenges. The biggest challenge for WHO is funding to make the vaccine available for the African children. Therefore, other malaria control measures such as pesticides, mosquito nets, etc., are not going to be replaced now. Vaccines, as well as other preventive measures, need to be put in place to bring the malaria mortality rate closer to zero. World’s first Malaria vaccine shows hope but finding a fully effective vaccine against Malaria disease is still a long way to go. 

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