Chandrakant Lahariya | Nobel Boost: New Malaria Vaccine; TB Vaccine Next?

The first week of October 2023 was very significant for vaccine development at the global level. First, two scientists -- Katalin Kariko and Drew Weissman -- were named as winners of 2023 Nobel Prize for Medicine and Physiology, for the research and development of mRNA based Covid-19 vaccines. Second, the World Health Organisation recommended another malaria vaccine R21/Matrix-M. This is the second ever vaccine recommended against malaria.

Vaccines are proven and life-saving interventions, every year vaccines save millions of lives and prevent severe disease and hospitalisation. If the world has come out of the Covid-19 pandemic, a lot of credit goes to the Covid-19 vaccines. Though the vaccines are difficult to develop, yet, it is rarer that vaccine researchers get a Nobel Prize. In fact, the other Nobel Prize awarded for vaccine research was in 1951 to Max Theiler for his development of the yellow fever vaccine.

We often hear that mRNA-based vaccines were developed in less than 10 months. That is only partially true. This vaccine could develop only on the foundation of the hard work and research of many scientists and researchers over the last three decades. A natural question is what makes mRNA-based vaccine development stand out and prize-worthy?  The answer is that mRNA is a vaccine platform which opens the window for the development of other vaccines and therapeutics in future, including for tuberculosis, dengue, foot and mouth disease, Zika and Nipah viruses, etc. This platform provides the unprecedented opportunity to tweak the vaccines in the shortest possible time, allowing them to respond to changes in the pathogen. Though mRNA-based Covid-19 vaccines had not been used in India as by the time Indian-made mRNA vaccines for Covid-19 had been licensed in India, the majority of the population had already been vaccinated. However, indigenous vaccine production capacity gives the opportunity for further research for other vaccines.

The second major news has been the WHO recommendation for a malaria vaccine. It is significant as malaria is a major challenge in most low- and middle-income countries. In Africa, it is among the leading causes of mortality in children. Yet, till 2021, no safe and effective malaria vaccine was available. In late 2021, the first-ever malaria vaccine RTS S/as01 was approved, which has now become available for children in three countries in Africa. However, the currently available vaccine has a production capacity of around 18 million doses per year, far lower than the demand. Around 28 countries in Africa intend to use the malaria vaccine, but there is not enough supply. With the approval of the second malaria vaccine, which has an annual production capacity of around five to 10 times the existing vaccine -- 100 to 200 million a year -- it is likely that vaccines would be available for more countries. This newly-licensed vaccine will be manufactured by Indian manufacturers, which brings an Indian connection, and also ensures that the malaria vaccine would be available at lower price than other vaccines.

These two developments are a reminder that the world needs more vaccines and also to use the available vaccines more effectively. The vaccines have power to prevent the diseases with a few shots and prevent mortality. This is also a reminder that to prepare for epidemics and pandemics, countries and governments need to invest in vaccine research and development. The research investment of today produces results a few decades later. It is a reminder that countries like India and Indian manufacturers have the capacity to make vaccines available and affordable for the rest of the world.

The benefits of already proven and available vaccines are not reaching the target beneficiaries. Children of this generation are less at risk of many diseases than the children of four decades ago. India has made immense strides in the number of vaccines offered through the universal immunisation programme in this country. Till early 2007, only six antigens were part of the national immunisation programme. In 2023, WHO recommended that vaccines will be offered to children in India through government programmes. Vaccine research is catching up and more vaccines will become available in the near future. That will lead to the improved survival of our children.

However, the benefits of these vaccines are not reaching everyone. A few days ago, there were media reports of a measles outbreak in some areas of Delhi. This is a reflection of the variable and incomplete reach of the measles vaccines, specially of those most vulnerable and marginalised children. Similarly, a number of already licensed vaccines -- other than the Covid-19 vaccines -- can benefit adolescent and adult populations. Yet, it is a lack of knowledge and awareness that the benefits of vaccines do not reach adult populations. People have misconceptions and many people fear vaccines. The vaccines are safe and effective and protect from future illnesses. So, there is nothing to worry about vaccines. Increasing adult vaccination coverage is an area that should get attention in India.

In future more vaccines will become available and will be administered to both children and adults. This is indeed good news. In fact, vaccine research is an area where there should be competition between countries to produce more and affordable vaccines. We hope soon there will be a new vaccine against tuberculosis, which can help India to eliminate the tuberculosis disease. What vaccines achieve in preventing illnesses for a long period, no other intervention does. The vaccines are a modern-day wonder. We should celebrate the Nobel Prize for the vaccines.