MOSQUIRIX: FIRST MALARIA VACCINE

Cameroon has achieved a significant milestone by initiating the regular administration of Mosquirix, marking the launch of the world's first malaria vaccine program tailored for children.

Key Points about Mosquirix:

1. Targeted Malaria Strain: Mosquirix, also known as RTS, S/AS01, is an injectable vaccine specifically designed to target Plasmodium falciparum, the most prevalent malaria strain in Africa.
2. Development and Origin: Developed by GlaxoSmithKline, a British pharmaceutical company, the vaccine's development began in 1987.
3. Mechanism of Action: 
   1. The active components of Mosquirix consist of proteins found on the surface of Plasmodium falciparum parasites.
   2. The vaccine's objective is to stimulate the immune system to defend against the initial stages of malaria.
   3. It specifically targets the period when parasites enter the human bloodstream through mosquito bites and infect liver cells.
4. Comprehensive Protection: In addition to targeting malaria, RTS, S/AS01 provides protection against the Hepatitis B virus, contributing to a broader immunization scope.
5. Effectiveness and Approval:
   1.  The vaccine is about 30% effective in preventing severe cases of malaria in children.
   2. It is the first and only approved malaria vaccine.
   3. The European Union's drugs regulator approved it in 2015, considering its benefits outweigh potential risks.
   4. Rare side effects may include fever, occasionally leading to temporary convulsions.

Challenges Associated with Mosquirix (RTS,S/AS01) Vaccine:

1. Inconvenient Administration:
   1. The vaccination process requires four injections before a child turns 2.
   2. The intervals between doses may not align with the routine vaccine schedules for other diseases, posing an inconvenience for parents.
2. Partial Effectiveness:
   1. Clinical testing involving over 10,000 African children (2009-2014) revealed that the vaccine's protection against detectable malaria infections is limited to approximately 40%.
   2. The vaccine shows only partial effectiveness in preventing malaria.
3. Limited Duration of Protection:
   1. The duration of protection offered by the vaccine remains uncertain.
   2. Previous trials, spanning four years, raise questions about the long-term effectiveness of the vaccine.
4. Risk of Resistance Development:
   1. The vaccine's efficacy is lower against parasite strains with poor genetic matches.
   2. Concerns exist about the potential evolution of parasite resistance to the vaccine over time, similar to trends observed with drug resistance.

About Malaria 

1. Nature:
   • Malaria is a mosquito-borne blood disease caused by Plasmodium protozoa.
2. Cause:
   • Life-threatening, it is caused by Plasmodium parasites transmitted through infected female Anopheles mosquitoes.
3. Transmission:
   • Parasites multiply in the liver cells, then attack Red Blood Cells (RBCs) after transmission via mosquito bites.
   • Five parasite species cause Malaria in humans, with Plasmodium falciparum and Plasmodium vivax posing the greatest threat.
4. Distribution:
   • Predominantly found in tropical and subtropical areas of Africa, South America, and Asia.
5. Symptoms:
   • Symptoms include fever and flu-like illness with chills, headache, muscle ache, and fatigue.

Burden of Malaria:

1. Globally in 2022, there were an estimated 249 million malaria cases and 608 000 malaria deaths in 85 countries.
2. According to the World Malaria Report 2019, India represents 3% of the global malaria burden. Despite being the highest malaria burden country of the SEA region, India showed a reduction in reported malaria cases of 49% and deaths of 50.5% compared with 2017.
3. In 2020, India contributed 1.7% of malaria cases and 1.2% deaths globally.

Countries that Eliminated Malaria:

• Till now, 44 countries have received WHO certification as malaria-free. 
• Among them the recent countries got certified are as follows: -
• United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019), El Salvador (2021), China (2021), Azerbaijan (2023), Tajikistan (2023), Belize (2023), and Cabo Verde (2024).

Countries achieving at least 3 consecutive years of zero indigenous malaria cases are eligible to apply for WHO certification of malaria elimination.

Initiatives to Curb Malaria:
Global Initiatives:

1. Eradication Potential:
   • WHO's 'E-2025 Initiative' identifies 25 countries with potential malaria eradication by 2025.
   • Global technical strategy for malaria 2016-2030 aims to reduce incidence and mortality rates by at least 40% by 2020, 75% by 2025, and 90% by 2030.
2. High Burden to High Impact (HBHI):
   • WHO's HBHI initiative is implemented in 11 high malaria burden countries, including India.
   • HBHI started in West Bengal, Jharkhand, Chhattisgarh, and Madhya Pradesh.

Indian Initiatives:

1. Elimination Target:
   • Government of India targets malaria elimination by 2027.
   • National Framework for Malaria Elimination (2016-2030) developed.
2. Strategic Plan:
   • National Strategic Plan for Malaria Elimination (2017-2022) shifts focus from control to elimination.
   • Aims to end malaria in 571 districts out of India’s 678 by 2022.
3. Research Alliance:
   • Malaria Elimination Research Alliance-India (MERA-India) by Indian Council of Medical Research (ICMR).
   • Collaboration of partners working on malaria control.

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