The WHO Recommendations on the RTS,S Malaria Vaccine: an Unprecedented Achievement

The Barcelona Institute for Global Health (ISGlobal) and the Manhiça Health Research Center (CISM) in Mozambique applaud the recommendations on the world's first vaccine against malaria, and in fact, the first vaccine ever against a parasite. Both institutions have worked tirelessly over the last 15 years to help develop the RTS,S (Mosquirix^TM) vaccine, that was given the green light by the WHO for its large-scale implementation in three to five pilot regions in order to better assess its impact in the field. 

ISGlobal and CISM, together with the support of the Hospital Clinic of Barcelona, the University of Barcelona, the Spanish International Cooperation Agency (AECID) and the Mozambican ministry of health, among other institutions, provided early proof-of-concept studies on the safety and partial efficacy of the vaccine that led to the phase 3 clinical trial, the first of its type in Africa. Currently, ISGlobal is coordinating studies on the immune response to the RTS,S vaccine that will provide a better understanding of its protective mechanisms and will allow the improvement of this and other vaccines.

For Antoni Plasència, director of ISGlobal, this is a historical moment for global health and adds "We are proud to have contributed, together with our Mozambican colleagues, to the development of a tool that represents a key step in the fight against malaria and will have a direct impact on the health of millions of children at risk of contracting the disease. We are also grateful to the Catalan and Spanish institutions that supported our research and without whom the work performed here and in Mozambique would not have been possible".

In a meeting at WHO headquarters in Geneva, Switzerland, this week, advisory experts on immunization and on malaria reviewed the scientific evidence on the vaccine and announced their conclusions this Friday 23^rd of October. The experts underline the threats of multi-drug resistant parasites and pyrethroid-resistant mosquitoes and underline the need for new tools to combat malaria. In this context, they point out, the vaccine can represent an additional ally in the fight against the disease. 

The vaccine confers partial protection to small children and needs four doses to sustain sufficient immunity. For these reasons, the experts recommend that, before its wide implementation, the vaccine should be evaluated by 3-5 pilot studies in different regions of sub-Saharan Africa. The goal is to implement it outside the context of a clinical trial and assess its feasibility in routine vaccination programs, its impact on child mortality and its safety at large scale. The four vaccine doses will be administered to children between 5 and 18 months of age. 

In the long run, the experts recommend that the vaccine should also be investigated in the context of malaria elimination. This is a goal in which ISGlobal is fully engaged in the South of Mozambique, in collaboration with the CISM and with support of "la Caixa contra la Malaria" program.  

In this regard, Eusébio Macete, director of the CISM, underlined the importance of counting with clinical research centers of excellence in Africa, capable of undertaking rigorous and high-quality clinical trials that meet the highest standards and allow recommendations like those given today by the WHO.