Giving young children the world's first malaria vaccine RTS,S/AS01E alongside antimalarial drugs before the rainy season has led to a significant reduction in life-threatening malaria cases and deaths for over five years, according to a landmark study.
Results published in The Lancet Infectious Diseases show the vaccine-drug combination reduced clinical malaria episodes, including cases of severe malaria in children and deaths, by nearly two-thirds compared with either method given alone in settings of highly seasonal transmission.
The study began in 2017 in Burkina Faso and Mali, two countries with a very high burden of malaria, and followed more than 5,000 children over a total of five years.
It was coordinated by the London School of Hygiene & Tropical Medicine (LSHTM), with partners including the Institut des Sciences et Techniques (INSTech), Institut de Recherche en Sciences de la Santé (IRSS), Burkina Faso, the Malaria Research and Training Center (MRTC), Mali, and PATH, USA. The RTS,S vaccine was provided by GSK.
In addition to the study's findings - which by themselves are remarkable - we can say that children who received the RTS,S-drug combination and also used bednets likely had greater than 90% protection against malaria episodes during the study.
This points to the importance of ensuring access to multiple malaria prevention tools for reducing the tremendous burden of malaria disease and death in these highly seasonal settings."
Brian Greenwood, Professor of Clinical Tropical Medicine at LSHTM
In many areas of sub-Saharan Africa, malaria is transmitted by mosquitoes all year round. But in a significant portion of the continent, transmission is seasonal with peaks of disease and death linked to the rainy season. Despite ongoing work to prevent infection, malaria still kills tens of thousands of children each year and many more are hospitalised.
According to study partners Alassane Dicko of MRTC, Jean-Bosco Ouedraogo of INSTech and Ashley Birkett of PATH, the next steps are for regulators, policymakers, and donors to ensure that these life-saving interventions are implemented in areas of seasonal malaria transmission.
Professor Greenwood added: "This study points to what is possible when all the available tools are brought to bear, although new and improved tools and approaches are still needed if we are to end malaria altogether."
Dicko, A., et al. (2023) Seasonal vaccination with RTS,S/AS01E vaccine with or without seasonal malaria chemoprevention in children until they reach five years of age in Burkina Faso and Mali: a double-blind, randomised controlled Phase 3 trial. The Lancet Infectious Diseases. doi.org/10.1016/S1473-3099(23)00368-7.