Thirty years of mosquitoes, failed trials and few financial rewards: The rocky road to creating the world's first malaria vaccine

 
Sarah Spickernell
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Malaria is transmitted by biting mosquitoes (Source: Getty)
“I screamed with joy and pulled up at the side of the highway, but when I tried to push the clutch and start the car I couldn't because I was too overwhelmed,” says Moncef Slaoui as he recalls the moment he found out all the bites, blood and days spent poring over lab results had finally paid off.
He and his team at GSK had been tasked with finding a vaccine for Malaria, but a decade of failed trials weighed heavily on their hearts and diminished their hopes. At last, he received a call informing him that the new mixture he had come up with had managed to protect six out of eight people in an experiment in the US. This, he would soon discover, was going to change everything.
“At the time, we were trying to use antibodies to kill the parasite, but I said we should try and use the body’s T cells – a different kind of immune cell,” he says. “I think I actually broke down and cried when I found out it had been successful.”
That was 1997, and almost 20 years later Mosquirix, the world’s first Malaria vaccine to make it through to the last stage of efficacy and safety trials, is about to be dispatched to sub-Saharan Africa and prepared for a staged immunisation programme in the world’s most afflicted area.

So far, GSK has invested more than £236m into the vaccine's development and expects to spend a further £130m to £160m. But unlike many other pharmaceutical endeavours, the company will not make any profit from the vaccine – the price will just reflect the cost of manufacture plus a five per cent margin for reinvestment in research of the disease.
It was this that swung it for Slaoui, who was invited to join the research desk as a scientist in the 1980s after he completed his post-doctorate in the Belgium.
I never had any interest in going into the pharmaceuticals industry as I thought it was wrong on some levels. But when I was presented with the idea of a not-for-profit vaccine, I changed my mind.
Becoming part of the research group in Belgium, he soon found out just how far the team's willingness to sacrifice itself for those in need would be tested.
“Some of our researchers actually put their arms in boxes full of malaria-infected mosquitoes,” he explains. “They had to keep them there and feel the bites until they had been so thoroughly attacked they knew there was a good chance of infection.”
They would then have to spend five days waiting in fear and anticipation to see if they would get sick. If they did, which had consistently been the case until the 1998 trial, it meant the vaccine being tested hadn’t protected them. If they remained healthy, it meant they were on to something.
But that “something” made no appearance for many years, and in most cases a new medicine would have been ditched somewhere along the way. With the malaria project, however, giving up was never even considered a possibility. “Not once was it even put on hold,” he says.
The reason, according to Slaoui, is that while it was clear from the start that the malaria vaccine would bring GSK no profit, the resulting technology could be transferred to the development of more lucrative vaccines for other diseases.
"It recently helped us make a breakthrough in treating shingles, for example, which is economically very significant for GSK. The company understood the project led to opportunities beyond malaria, leading to a win-win for achieving ethical and business objectives.”
In the case of the GSK volunteers, none actually contracted a serious form of the disease or died – the experiments were tightly controlled and the parasites engineered not to cause full-blown malaria.
But for millions of Africans, the experience is far less forgiving. Over 90 per cent of malaria-related deaths occur in the continent each year, and although combined attempts to control the disease have brought the infection rate down 26 per cent over the last 15 years, there are still an estimated 128m people suffering from it.
The new vaccine, which has just been given the green light by European regulators, is aimed at immunising children. The next stage will be a decision by the World Health Organisation (WHO) on how best to make the vaccine available, and support from governments and other funders must also be obtained. All this means the vaccine will not be put to use until 2017, according to WHO.
It isn’t 100 per cent effective and no one believes it will wipe malaria off the face of the planet, but Slaoui, now chairman of GSK's vaccine business in the US, has faith in its ability to dramatically reduce the burden.
When you see a line of mothers queuing up in desperation, it can be a very difficult experience. How can we say no, we won’t vaccinate your three children because only two of them will be protected and that’s not good enough? It won't protect everyone against the disease, but it will save thousands of lives.
While the approval of Mosquirix is as good an outcome as Slaoui and his team could have hoped for when they took on the job, the struggle doesn't end here. They are already working on an improved version of the vaccine, which they hope could lead to 100 per cent protection in the not too distant future.
"In 10 years time, with everything already developed and undergoing development, maybe then I'll tell you the end of malaria is on its way.”

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