On the eve of World Malaria Day (April 25) there is a reference to a Nature editorial in MalariaWorld. ‘Malaria deaths should be falling — not rising’ has the subheading ‘The tools exist to end this killer disease. It is the money and the will that are lacking’. This is an interesting complaint considering just three weeks ago here it was reported here that vaccines are cost ineffective. The malaria expenditure costs with immunisation are over 20 times the cost without!
The Nature editorial starts by saying ‘There will be little to celebrate on World Malaria Day on 25 April. Global malaria cases, which stood at 238 million in 2018, had climbed to 282 million by 2024, the latest year for which figures are available. Deaths from the disease rose from 575,000 to 610,000 over the same period’. It goes on to say ‘Deplorably, this is happening despite the advent of vaccines. In October, it will be five years since the World Health Organization (WHO) recommended the world’s first malaria vaccine, RTS,S. This was hailed at the time as a tool that would “change the course of public health history” by WHO director-general Tedros Adhanom Ghebreyesus. A second vaccine, R21, was recommended two years later.’
Followers of this column are well aware that clinical trials of these vaccines were carried out without a placebo control, but instead with Rabies vaccines that would be expected to worsen the health of recipients. Under conventional medical treatment a course of malaria vaccinations does not begin unless there has been a bite by a suspect rabid animal because of the side-effects. We will not address broader questions concerning rabies here.
Malaria vaccines were tested in trials with Rabies vaccines used as controls instead of harmless placebos (Rabipur manufactured by GSK, Marburg, Germany and owned by Bavarian Nordic, Hellerup, Denmark was used as the control in RTS,S study). Abhayrab, manufactured by Indian Immunologicals Limited, was used as control in trial of R21.
There is a widespread belief that vaccines helped reduce the incidence of many diseases in the developed world, but careful analysis of data found that most of the decrease of incidence of these illnesses occurred before vaccines were introduced (see ‘Dissolving Illusions’ by Bystrianyk and Humphries). The Nature editorial even refers to the recent elimination of malaria in Egypt and Cabo Verde that was achieved without vaccines.
The real problem for the malaria business is addressed in the sub-heading, money. The article despairs that Robert F. Kennedy Jr has said that the United States will no longer contribute to Gavi, The Bill and Melinda Gates business that promotes vaccines in many countries. And we know that vaccines are cost ineffective and cannot be paid for with the scant resources of many of the affected countries.
As an aside, why is April 25 World Malaria Day? It was Africa Malaria Day from 2001 but we cannot find an explanation of the significance of this date. Please let us know in comments if you know.