My long journey in search of malaria vaccine

“My work is to protect African children against malaria and every day, when I see them and their parents suffering, I feel compelled to do something.”
This mantra drives one of the principal investigators on the malaria vaccine, Dr Lucas Otieno.

With the approval of European drug regulators a fortnight ago, he is optimistic that malaria control and eventual elimination is nigh.

And even though it could take another two years before it is available for use in Kenya, RTS,S is good news for scientists because the vaccine has shown potential to prevent millions of malaria cases that account for about half of outpatient attendance in health facilities in high burden areas.

The development of RTS is one of the longest ongoing vaccine projects dating back to 1984 in a collaborative project between GlaxoSmithKline and the Walter Reed Army Institute of Research and even though Dr Otieno has been on the malaria trail since 2005, he draws fulfillment in being part of the dream research team.

“It is gratifying to work in an area which involves a lot of creativity which at the same time has potential to alleviate suffering and even save so many lives,” said Dr Otieno, also the Deputy Director in charge of Clinical Operations at Kemri/Walter Reed Project, Kisumu.

Proven results

Other researchers working against the Plasmodium falciparum, malaria parasite, were drawn from Tanzania, Malawi, Mozambique, Ghana, Burkina Faso and Gabon.

The phase three efficacy and safety trial, published in The Lancet showed that RTS,S helped protect many children and infants from clinical malaria over a three to four year period and with a booster of the vaccine, the overall efficacy against severe malaria in five- to 17-month-old children was 32.2 per cent.

Malaria kills about 584,000 people per year, mainly children under five years in sub-Saharan Africa and there has been great concern about the disease in Nyanza and Western that remain high burden areas of malaria in Kenya.

Dr Otieno acknowledged that with the efficacy expressed by the malaria vaccine candidate, this could complement existing control interventions like insecticide treated bed nets, use of interventions like drugs (artemisinin based combination therapies), and environmental controls.

“The impact of the vaccine was greater in areas of higher malaria transmission like Siaya where in older children more than 6,000 cases of clinical malaria were prevented for every 1,000 children vaccinated,” Dr Otieno added.

So how did studying mosquitoes become a passion and career? Dr Otieno said the role of the modern researcher in the face of emerging diseases and increasing social problems is well reflected in the words of Dr Rudolf Virchow, an early-day physician.

“If disease is an expression of individual life under unfavourable circumstances, then epidemics must be indicative of mass disturbances.”

“I was certain on an international health career so after college I looked towards research or working for a medical organisation and that’s how I ended up here,” he said, adding that one of his role models is acclaimed Belgian Scientist, Paul Janssen.

Dr Janssen was a 20th Century distinguished scientist who helped save millions of lives through his contribution to the discovery and development of over 80 medicines, four of which remain on the World Health Organisation’s (WHO) list of essential medicines.

An award to recognise Dr Janssen’s work was also established by Johnson & Johnson and today celebrates scientists with breakthrough research globally.

Eyes on WHO

“I think he is the world’s greatest medical researcher and entrepreneur,” Dr Otieno said, adding innovator, engineer and investor Elon Musk to his list due to the exemplary boldness of his ambitions.

“From the challenges we have in Africa, we require mindsets similar to those of Elon Musk. We need his kind of drive,” he said.

What next?

All eyes are now on the WHO which is expected to formulate a policy recommendation on use of the malaria vaccine.

This would pave way for its use in national immunisation programmes once approved by national regulatory authorities.

Dr Otieno added that Ministries of Health in countries where malaria is a public health problem will also have to decide whether the vaccine candidate can be rolled out for use in at-risk populations.

He said because malaria vaccine is considered a first generation vaccine, the team will strive to improve it in future.

“If we have an effective and approved tool for use against malaria, I’d hate to see it sit on the shelf when I do my rounds in the pediatric ward full of sick kids,” he said.

Dr Otieno is also involved in studies for pneumonia and polio vaccines and is also part of a team working to alleviate public health problems.