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R21/Matrix-M vaccine

Oct 5, 2023: The Times of India

How India-made vaccine is leading global fight against malaria

The World Health Organisation’s approval for the vaccine manufactured by Serum could result in it being used in multiple nations where malaria still claims hundreds of lives

An India-made vaccine could make prevention of malaria much cheaper, and more accessible, at home and in nations where the parasitic disease claims hundreds of lives annually. Oxford University developed the three-dose R21/Matrix-M vaccine with help from the Serum Institute of India. Research suggests it is more than 75% effective and that protection is maintained for at least another year with a booster. WHO Director-General Tedros Adhanom Ghebreyesus said on October 4 that the World Health Organisation was approving the new malaria vaccine based on the advice of two expert groups, recommending its use in children at risk of the disease."As a malaria researcher, I used to dream of the day we would have a safe and effective vaccine against malaria. Now we have two," Tedros said. The vaccine could cost between $2 to $4 and could be available in some countries next year if funders agree to buy it.Why the vaccine matters? Malaria is one of the world’s neglected diseases with 95% of cases, and 96% of deaths occurring in Africa, many of them in the poorer countries of the continent. India has seen malaria cases fall steadily over the last three decades, however, a WHO report pointed out that 79% of cases in the Southeast Asia region were reported in the country.A paper documenting the development of the vaccines, points out that the main difficulties were that the parasite (P falciparum) has an extremely complex life cycle and a very good evasion of the human immune system.“Growing a sufficient number of whole parasites to generate an immune response is also a major challenge in order to develop a vaccine,” the paper points out. Another factor is the fact that malaria largely affects people in poorer countries and pharmaceutical companies weren’t keen on investing in research on a vaccine for it.Why the Made in India vaccine mattersIn 2021, the WHO gave its approval for the use of a vaccine developed by GSK. However, one issue with the vaccine is the fact that it’s not available in large enough quantities. Around 18 million doses will be available till 2025.Another issue is that the GSK vaccine, which is known as Mosquirix, is only about 30% effective, requires four doses and protection fades within months. It is also more expensive. Serum says it can produce 100 million doses of the vaccine a year, with 20mn already in stock. It expects to start distribution next year, says Serum’s chief Adar Poonawalla. The R21 vaccine in trials showed efficacy for over a year and, in some cases, a booster dose was needed after 18 months. The vaccine works to induce an immune response in the early stages of infection and prevent the invasion of liver cells by the parasite. Why more nations are likely to pick R21The WHO has said the GSK and Serum vaccines had shown similar efficacy in separate trials and, given there hasn’t been a head-to-head trial, there was no evidence showing which vaccine performed better. The agency has left it to countries to decide which product to use based on various factors, including affordability and supply.However, the Bill & Melinda Gates Foundation, one of the GSK vaccine's biggest backers, stepped back in 2022 from financially supporting its rollout, saying it was less effective than officials would like and that funding would be better used elsewhere.The foundation said it has continued helping with the vaccine rollout by supporting Gavi, a global vaccines alliance that is buying the GSK shots for distribution in poorer countries.Alister Craig, an emeritus professor at the Liverpool School of Tropical Medicine, says he would recommend countries trying to get the GSK vaccine switch to the Oxford vaccine instead.If the new vaccine is rolled out widely across Africa, it could dramatically reduce the amount of severe illness and deaths caused by malaria in a few years, Craig said.Serum’s Poonawalla says 28 African countries have expressed interest in the vaccine and 18 are ready to receive it. Shipments will primarily be distributed via agencies like Unicef and Gavi as many countries won’t have the money to pay for them, the Vaccine Alliance, he says.Will this end malaria?Not just yet. "This is one more tool we will now have, but it's not going to replace bed nets and spraying insecticides," John Johnson with Doctors Without Borders told AP. "This is not the vaccine that's going to stop malaria."Neither of the malaria vaccines stops transmission so immunisation campaigns alone won't be enough to stop epidemics. Efforts to curb the disease are also being complicated by increasing reports of resistance to the main drugs used to treat malaria and the spread of invasive mosquito species."You would be foolish to think that this vaccine is going to be the end of the malaria story," Craig said.with inputs from Rajesh Sharma and AP

See also

Drugs and Pharmaceuticals: India

Drugs, pharmaceuticals, medical devices made by Indians

Hindustan Syringes & Medical Devices

Serum Institute of India

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