Nov 10 2012

the elusive malaria vaccine: no Salk in this story (yet)

Category: Uncategorized<ADMINNICENAME> @ 12:25 PM

The headline says it all: InĀ  Clinical Trial, Malaria Vaccine Candidate Produces Disappointing Results

Three shots of the vaccine, known as RTS, S or Mosquirix and produced by GlaxoSmithKline, gave babies fewer than 12 weeks old 31 percent protection against detectable malaria and 37 percent protection against severe malaria, according to an announcement by the company at a vaccines conference in Cape Town.

If it chooses to persist with its experimental malaria vaccine, the global pharma giant, GSK, will be going against the entire history of vaccines. Drug efficacy is general 75 percent or higher (much). GSK expected 50 percent and proceeded because donors paying all trial costs. At only 33 percent effectiveness, many African governments likely won’t want to distribute the vaccine. The heavier costs fall on the distribution, actually; and with African health-workers stretched and in short supply, and with so much “low-hanging fruit” available in the form of straight-forward public health actions, there are enormous opportunity penalties for concentrating on low-outcome activities, which is what the GSK malaria vaccine appears to be, given these new trial results.
The human problem, on the individual level, is that you are telling African parents that for every 3 kids they vaccinate against malaria, two will still die if the disease strikes with full force. That’s not even a vaccine at that rate. It’s not even a prophylactic. Nearly all vaccines in use today are plus 50 percent effective (and, often, nearly 100 percent effective).
The disappointing trial results raises the uncomfortable question of whether GSK completely misunderstood the science behind malaria disease. Because the cost of performing the clinical trials, which have been the most expensive ever conducted on African soil, were underwritten by others, GSK has incurred no financial penalty, only a cost to the company’s reputation for drug development. The big question now is whether the Bill Gates foundation and other underwriters of malaria research will continue to cover the costs of testing a vaccine whose health benefits must be weighed against those that can be delivered in other areas at the same cost.

On the frontier of public-health medicine, such decisions are not easy to make.

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