A trial combining vaccinations and prevention drugs has substantially lowered the number of children dying of malaria in two African countries, according to researchers.
The results of the study, published in the New England Journal of Medicine, have been hailed as “very striking”, especially at a time when decades-long progress on combating malaria has stalled in some countries.
Led by the London School of Hygiene & Tropical Medicine (LSHTM), the trial showed a 70% reduction in hospitalisation or death when young children were given both seasonal vaccinations and antimalarial drugs compared to using just one intervention.
Researchers believe the approach could prevent some of the 400,000 deaths from the mosquito-borne disease every year, most of them children. In 2019, more than 90% of the estimated 230m cases of malaria occurred in Africa.
Some countries, such as Eritrea, Sudan and Colombia, have seen a significant resurgence of malaria in recent years.
The LSHTM research followed more than 6,000 children aged between five and 17 months over three years in Burkina Faso and Mali. They were given the world’s first malaria vaccine, RTS,S and four courses of antimalarial medications sulfadoxine-pyrimethamine and amodiaquine, known as seasonal malaria chemoprevention (SMC), during the rainy season, a time of high transmission.
The vaccine is being implemented in a large-scale pilot programme in Ghana, Kenya, and Malawi. The SMC is the current intervention used in Burkina Faso and Mali.
“The results of the trial were much more successful than we had anticipated,” said the study’s co-lead author Daniel Chandramohan from LSHTM. “Our work has shown a combination approach using a malaria vaccine seasonally – similar to how countries use influenza vaccine – has the potential to save millions of young lives in the African Sahel. Importantly, we didn’t observe any new concerning pattern of side-effects.”
The trial found that incidences of hospitalisation and death among those given a combination of the RTS,S vaccine and SMC reduced by 70.5% and 72.9% respectively, compared with when they were given SMC alone. A similar improvement was found when the combination approach was compared with using the vaccine alone.
The research was conducted with Burkina Faso’s Institut de Recherche en Sciences de la Santé and the Malaria Research and Training Centre at Mali’s University of Science, in Bamako.
Pedro Alonso, director of the World Health Organization malaria programme, has welcomed the “innovative use” of a malaria vaccine.
“RTS,S is the first malaria vaccine that has already reached more than 740,000 children through routine childhood vaccination in Ghana, Kenya and Malawi in a landmark pilot implementation, through which more than 2.1m malaria vaccine doses have been delivered.
“The level of vaccine uptake by families over a relatively short period shows strong community demand for the vaccine and the capacity of childhood vaccination programmes to deliver it.”
In July a separate study led by LSHTM found that more than 8 billion people could be at risk of malaria and dengue fever by 2080 if greenhouse gas emissions continue to rise at current levels, as global temperatures would lengthen transmission seasons by more than a month for malaria and four months for dengue.