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The most effective malaria vaccine yet discovered
- chmod600 6y agoAre any of the mosquito extinction approaches being seriously tried? Genetic engineering, etc.?
- Darmody 6y agohttps://www.bbc.com/news/world-us-canada-53856776 https://www.bbc.com/news/world-us-canada-53856776
- FredPret 6y agoI, for one, have been going at them one at a time for years now
- ska 6y agoSeriously tried, yes. Seriously effective, no (at least so far). At least that was the state of things last I looked a few years ago.
- bolangi 6y agoWidespread supply of mosquito nets treated with an insecticide is one of the more successful measures.
- User23 6y agoThe most successful measure was carpet bombing the USA with DDT for years[1]. Most people don't know this now, but malaria used to be endemic in the USA as far north as the border with Canada. DDT's environmental persistence is obviously a double-edged sword, but it made the eradication possible. [1] https://www.cdc.gov/malaria/about/history/elimination_us.html https://www.cdc.gov/malaria/about/history/elimination_us.htm...
- stuff4ben 6y agoI don't mean to be crass, but why wouldn't that have worked in Africa? Yes DDT is scary bad, but we seem to be doing ok in the US.
- elric 6y agoThe US is pretty small compared to the parts of Africa that have to deal with malaria. The sheer size of the continent might make it difficult.
- Vrondi 6y agoWeird as this seems, at the time, you had to be in a country that could _afford_ DDT. It wasn't free.
- jfk13 6y agoThe environmental impact of widespread DDT use is pretty devastating. http://www.rachelcarson.org/SilentSpring.aspx http://www.rachelcarson.org/SilentSpring.aspx
- User23 6y agoSilent Spring isn’t a scientific work[1] and has some serious factual problems. If you want to support banning DDT in an evidence based way you need to look elsewhere. It is on the other hand observably a rhetorical masterwork. [1] https://www.nytimes.com/2007/06/05/health/05iht-sntier.1.6003787.html https://www.nytimes.com/2007/06/05/health/05iht-sntier.1.600...
- jfk13 6y agoIt wasn't written to be simply and solely a scientific work; and it's hardly surprising that over the intervening 60 years, things haven't followed exactly all the scenarios it suggested. That doesn't alter the fact that it was a seminal work that helped open many people's eyes to some very real issues; and the devastation of many ecosystems over the past half-century or more surely confirms the importance of its message.
- icandoit 6y agoThis group Oxitec released some in Florida: https://www.oxitec.com/en/news/florida-keys-mosquito-control-district-and-oxitec-announce-site-participation-for-florida-keys-pilot-project-to-combat-disease-transmitting-mosquito https://www.oxitec.com/en/news/florida-keys-mosquito-control... They previously released some in Brazil: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003864 https://journals.plos.org/plosntds/article?id=10.1371/journa... those results?: ...in the Brazilian city of Indaiatuba found that Oxitec’s mosquito suppressed disease-carrying Aedes aegypti by up to 95%* in urban, dengue-prone environments following just 13 weeks of treatment, as compared to untreated control sites in the same city. *95% was the high 2-week rolling average and the individual weekly high was 98%; the highest 4-week rolling average was 92%.
- UncleOxidant 6y agoWould mosquito extinction even be a good idea? There would be substantial impacts to ecosystems if mosquitos were completely eliminated.
- abfan1127 6y agoyes. mosquitos do quite a bit of pollination.
- stjohnswarts 6y agonot the species spreading malaria. Efforts to genetically engineer a fix are welcomed by most people I think to stop malaria. There are ongoing trials with mixed results.
- chmod600 6y agoMy understanding is that only a couple species go after humans, and they don't have any important ecological niche.
- Fomite 6y agoVector control is the primary way that epidemiology and disease ecology have been exploring reducing the burden of malaria (and Dengue, and a number of other diseases). Genetically engineered, effectively sterile mosquito breeds are part of that effort. But that is hard to do - ecological systems are hard to push off stable equilibria.
- eloff 6y agoWhat blows me away is in a study group of 734 infants, which benefited from maternal antibodies against malaria, 717 were infected by malaria in the first year of their life. That's nearly 100%, in the first year since birth. That's devastating. The vaccine is showing 77% efficacy in trials in Burkina Faso. That's an ongoing pandemic that makes covid-19 look like a case of the sniffles. Malaria deaths peaked around 930,000 a year in 2004, and is around 600,000 a year now. I believe covid-19 death toll stands around 3 million deaths, most above the age of 70. Malaria is over 100 million, most under the age of 5. Source: https://ourworldindata.org/malaria https://ourworldindata.org/malaria
- vanderZwan 6y agoAlthough I am Dutch, I was born in Ghana. My parents worked in a local hospital as doctors. If you can expect anyone to be extremely cautious and in the position to be able to act on it, it would be them. Still got malaria before I turned one.
- stephenhuey 6y agoI lived in Nigeria from the ages of 9-18 and while we did not use mosquito nets, I’d generally assume that even people who use mosquito nets would be likely to get bitten by a carrier mosquito at some other time of day. Hearing of people getting malaria felt like a very commonplace occurrence, and I had it several times.
- Exmoor 6y ago> Malaria deaths peaked around 930,000 a year in 2004, and is around 600,000 a year now Your link does a good job showing this, but for those who don't click and scroll down it's probably worth mentioning that the vast majority of those deaths are in central Africa. So it's not just a lot of deaths, but it's a really significant portion of the population and, as you said, mostly children.
- eloff 6y agoI think it's common knowledge that malaria primarily affects Africa, but you're right that it's particularly devastating to a couple dozen mostly very poor countries.
- _Microft 6y agoFor comparison, the mentioned "RTS,S" vaccine has an efficacy "from 26 to 50% in infants and young children", see https://en.wikipedia.org/wiki/RTS,S https://en.wikipedia.org/wiki/RTS,S
- warrenm 6y ago25% efficacy sounds HORRIBLE ... but when you stand it next to 100s of 1000s dying every year - knocking it down by a few 10s of 1000s would be wonderful!
- grecy 6y agoHaving personally had Malaria twice, I am elated at this news. It was fascinating to experience it from "the inside" in Africa, and attempt to understand how essentially everyone gets it, every single year. It's simply a part of life there.
- Fomite 6y agoOne of my Kenyan colleagues casually talked about every time she visited her grandmother, they came down with malaria.
- robbmorganf 6y agoIn this trial, shots were given in May-August to children a minimum of 5 months old. Assuming children that have not reached 5 months by August (or say October) can't be vaccinated in time for the seasonal peak of Malaria, should we recommend the safest time to have a child is roughly Dec-May? Therefore, couples should be trying for a child Mar-Aug if they want to reduce mortality risk to malaria.
- hintymad 6y agoIsn't Malaria caused by parasites? So vaccine is not just for virus?
- rossdavidh 6y agoThe parasites are single-celled microorganisms. Generally speaking, anything your immune system can fight, you might theoretically be able to make a vaccine for. Emphasis on "might", of course.
- andi999 6y agoWhat is the difference to bacteria? (or is it a bacterium?)
- JonathonW 6y agoThey're not bacteria. The malaria parasite is considered a protist, which is a broad category comprised of organisms whose cells contain a cell nucleus but aren't otherwise classified as plants, animals, or fungi. This group includes some multi-celled and single-celled organisms (that aren't necessarily related beyond the fact that they have a nucleus); the single-celled species in the group distingush themselves from bacteria because bacteria do not have a nucleus, and are generally simpler overall.
- baybal2 6y agoThere used to be a weird theory that malaria parasite has descended from algae.
- stephenhuey 6y agoMalaria is caused by protists which are spread by Anopheles mosquitoes. So it’s not a virus.
- smaddox 6y agoI somehow had never seen/heard the word protist before (biology is obviously not my specialization). Thank you for that.
- anonymous4759 6y agoIt's interesting how everyone in this thread (rightly) views this as a promising development, yet whenever articles are posted discussing longevity research, you see ghastly comments like this: https://news.ycombinator.com/item?id=26211722 https://news.ycombinator.com/item?id=26211722 Isn't that hypocritical?
- dang 6y agoHN is not a person - it can't have human qualities like being hypocritical about something. That would be like calling a room hypocritical because people in it disagree. The community is a statistical cloud of people whose views are all over the place. While I have you: could you please stop creating accounts for every few comments you post? We ban accounts that do that. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html. You needn't use your real name, of course, but for HN to be a community, users need some identity for other users to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comment&storyText=false&prefix&page=0&query=community%20identity%20by:dang https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
- anonymous4759 6y agoI've used throwaway accounts here for a decade, since I post infrequently and don't care about karma, and it's never been a problem. Further, my comment wasn't flamebait (or anything otherwise objectionable) and shouldn't have been flagged. While I have you, dang: the flagging on this site is out of control. Why do you allow users to so easily hide from others comments they dislike? The downvoting, I don't care about. But flagging should be reserved for things like spam, racial slurs, and other stuff that obviously doesn't need to be seen.
- dang 6y agoAlthough I turned off the flags on your comment, I don't agree that it wasn't flamebait. It was off-topic, generic, and provocative. It was even name-calling too ("ghastly"). That's a flamebait cocktail. Creating accounts for every few comments you post is a problem for the reason I just explained. Doing it for a decade doesn't make it ok. It makes it worse! In a way, this is a freeloader problem. The richness of the community here comes from people interacting and relating with each other over time. On HN people are welcome to do that anonymously (pseudonymously, for those who speak pedantic), but still need some identity for others to relate to. If you don't contribute that, you're freeloading in the sense that you're benefiting from what other people are giving, without giving anything comparable of yourself. That undermines the community. If everyone did it, we would have no community. Throwaway accounts are ok on occasion when there's some sensitive relevant information that shouldn't be linked to the main identity—but note that I said on occasion. Using them as a matter of course is abusive. That's also in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
- tgb 6y agoIs it possible to get herd immunity to malaria? Does the parasite have non-human reservoirs (for the non-mosquito part of its lifecycle)?
- lisper 6y agoYes and yes: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-018-2328-z https://malariajournal.biomedcentral.com/articles/10.1186/s1... https://pubmed.ncbi.nlm.nih.gov/22215999/ https://pubmed.ncbi.nlm.nih.gov/22215999/
- tgb 6y agoThanks. I can't actually see where the second paper says that there are reservoirs, at least not of P. falciparum, which is the most relevant. It doesn't directly state it but seems to suggest that there's little in the way of human infections that arise from another species.
- yyyk 6y agoThe first link just says people would accept the vaccine. It doesn't get at all to the heart of OP's concern (that the parasite will hide in non-human reservoirs).
- Fomite 6y agoThe parasite has non-human reservoirs, which is one of many reasons that eradicating malaria is extremely difficult. That being said, a protective vaccine even absent herd immunity would be a huge thing.
- walidwalid 6y agoCurious to know how much money they spent on this vaccine while there is already a treatment for malaria - it's called Artemisia Annua. Ans big pharma is doing everything it can to dismiss that almost free solution to the problem.
- robbrown451 6y agoThere is a problem with the parasite resistance to Artemisinin (https://en.wikipedia.org/wiki/Artemisinin#Resistance https://en.wikipedia.org/wiki/Artemisinin#Resistance) Regardless, malaria still kills millions... and you are complaining about them spending money on it?
- mabbo 6y agoWhy bother with a treatment when you can prevent even catching the illness in the first place?
- Fomite 6y ago"Big Pharma" has been providing antimalarials pretty much at cost through negotiations with the WHO and other international funders for quite some time now. But cheap drugs - especially since Artemisinin needs to be used as part of a combination therapy - aren't an easy solution to the malaria belt's woes.
- abeppu 6y agoI vaguely recall people talking about human/malaria co-evolution. And I was of the impression that the malaria parasite was supposed to be good at evading our immune system, and that was part of why vaccines had limited efficacy. If anyone here is educated in this area ... would it be reasonable to expect that the 77% efficacy would decline if such a vaccine were put into widespread use? Like, I know we observe a pattern where antibiotics become less effective if they are deployed widely. Or are protists slower / less able to evolve in response to this kind of intervention?
- asdfasgasdgasdg 6y agoIt depends on a lot of things. First is how easy it is to evolve a way around a particular defense. For example, it will be easier to achieve an vaccine escape when only one gene is required to mutate compared to ten thousand. If you have a vaccine that disrupts something fundamental about a pathogen's lifecycle, it's better than one that targets something superficial. Another question is what fraction of the population is exposed to the selective pressure, and to what extent the selective pressure confers a benefit or cost to all other members of the population. If responding to the pressure makes the population more fit in other hosts, then we should expect it to become widespread eventually. On the other hand, if it causes the disease to become less efficient in other hosts, you would not expect the mutation to become widespread. For example, imagine if there were a monster that lived in a small part of Alaska that tended to eat humans with small fingers, we would probably just not go to that part of Alaska. On the other hand, if such monsters were present throughout the world, you'd probably see humans with longer fingers over the generations. Does that make any sense? It's a strained metaphor but I hope it gets the point across. Another thing that can happen is speciation, but we'll leave that for another day.
- bullfightonmars 6y agoThere is a key sentence of this article that speaks to this: > This new vaccine (R21) uses a circumsporozoite protein (CSP) antigen – that’s a highly conserved protein of the parasite, involved in several functions as the parasite makes the move from mosquito to human and into different human tissues such as the salivary glands. Circumsporozoite protein is a highly conserved protein meaning that it is a genetic sequence that is very unlikely to change regardless of adaptive/evolutionary pressure.
- perardi 6y agoThe crux of the vaccine technology: This new vaccine (R21) uses a circumsporozoite protein (CSP) antigen – that’s a highly conserved protein of the parasite, involved in several functions as the parasite makes the move from mosquito to human and into different human tissues such as the salivary glands. This has been a vaccine ingredient before, such as in the RTS,S vaccine (the first one ever licensed), but R21 has a much higher proportion of CSP assembled into a virus-like particle. It also uses the exact same adjuvant from Novavax (Matrix-M) that they are using in their coronavirus vaccine – you can’t keep a good adjuvant down, and this Chilean-soapbark-based one seems to really kick the immune system up under all circumstances. Great to see we are managing to develop new vaccine platforms.
- pradn 6y ago"Chilean-soapbark"! Happy to see an ingredient such as this. One more reason to conserve biodiversity is for useful ingredients like this one.
- interestica 6y agoI had the same reaction: https://www.theatlantic.com/science/archive/2020/10/single-tree-species-may-hold-key-coronavirus-vaccine/616792/ https://www.theatlantic.com/science/archive/2020/10/single-t...
- DoreenMichele 6y agoI'm guessing this is likely a large part of why the efficacy is so high. From what I gather, parasitic infections are hard to vaccinate against at least in part because at least some of them routinely change their protein markers, so it's hard to identify them. It sounds to me like this counters that.
- interestica 6y ago> adjuvant > Chilean-soapbark More on this: https://www.theatlantic.com/science/archive/2020/10/single-tree-species-may-hold-key-coronavirus-vaccine/616792/ https://www.theatlantic.com/science/archive/2020/10/single-t...
- yyyk 6y agoThis is great news which will save many lives. We will need to do more though. There are species of Plasmodium which survive on non-human hosts which means the disease will always be waiting - and this vaccination regimen is very demanding, so interruption or underinvestment will make Malaria come back. IMHO to finish off malaria we'll need some other approaches to complement it, and my suggestion is to get rid of the specific mosquito species that carries the disease. That's what happened in all developed countries long before a vaccine ever existed, and that's a good solution for poor countries (this time, we can use more discriminate methods).
- 0-_-0 6y agoGene drives might be able to get rid of entire species: https://en.wikipedia.org/wiki/Gene_drive https://en.wikipedia.org/wiki/Gene_drive
- Fomite 6y agoThere's a lot of debate in the field as to whether or not it's actually possible to eradicate malaria. Partially because mosquito eradication programs failed in the core "malaria belt" even with substantial international investment. There is work on this though, primarily around introducing genetically modified mosquitos.
- rossdavidh 6y agoWell, the attempt in Brazil did not go as planned: https://www.dw.com/en/genetically-modified-mosquitoes-breed-in-brazil/a-50414340 https://www.dw.com/en/genetically-modified-mosquitoes-breed-... "The hope of the Ministry of Health was to reduce mosquito populations by 90 percent. And this worked well during the field trial. About 18 months after the end of the experiment, the mosquito population returned to what it had been before."
- Fomite 6y agoIndeed. Ecological systems are complicated and remarkably resilient.
- pinipedman 6y agoThis is not the most effective malaria vaccine. Three doses of intravenous PfSPZ-CVac is more effective. https://www.nature.com/articles/nature21060 https://www.nature.com/articles/nature21060
- ArgyleSound 6y ago9 people? I don’t think you can really say it’s more effective based on this data.
- Vecr 6y agoIntravenous is pretty nasty as well, people will find a way of spreading viral/viroid hepatitis and HIV if it was ever deployed outside of well-staffed hospitals.
- hanniabu 6y agoWould this be a one and done vaccine or is it something that needs a booster every few years like tetanus?
- warrenm 6y agoPretty sure the 100s of 1000s dying every year wouldn't mind an extra jab every couple years
- ncmncm 6y agoIt strikes me as extremely odd to call this a "discovery". The vaccine was very specifically designed to work in exactly its unique mode to be effective against one species of pathogen. We might equally well talk about SpaceX Starship being "discovered". To me, it is invented, constructed, engineered, or created. What has been discovered?
- namenotrequired 6y agoThis is an interesting question. I'm honestly curious if anyone knows - why do we talk about, say, machines being invented but drugs and vaccines being discovered? (I get that you invent the drug, and then you discover whether it works. But the same is true for machines.)
- ncmncm 6y agoIt makes sense to talk about discovering a bioactive compound, such as from an herbal remedy, or by testing a family of related compounds. An engineered vaccine is a wholly different animal. The only other time we say "discover" about something manufactured is when somebody else did it. We can discover a meth lab, a Ponzi scheme, or (in principle) an alien civilization.
- aledalgrande 6y agoFrom wiki: > Malaria strains found on the Cambodia–Thailand border are resistant to combination therapies that include artemisinins, and may, therefore, be untreatable. Having a vaccine as effective as this new one would save many lives.
- sabujp 6y agowhy aren't we releasing hordes of mosquitoes into these areas that will render the next generation incapable of breeding? https://www.cdc.gov/mosquitoes/mosquito-control/community/sit/wolbachia.html https://www.cdc.gov/mosquitoes/mosquito-control/community/si...
- yboris 6y agoI'd like to urge everyone to consider contributing to cost-effective charities that work on alleviating the scourge of malaria. GiveWell, a charity evaluator recommends Malaria Consortium and Against Malaria Foundation as cost-effective ways to directly reduce instances of malaria. https://www.givewell.org/charities/top-charities https://www.givewell.org/charities/top-charities
- deleted 6y ago[deleted]
- frankus 6y agoNot an epidemiologist but a bit of googling suggests that humans are the sole reservoir for the varieties of parasites that can cause malaria in humans. I wonder if how much closer a 77% effective vaccine could bring is to eradicating the parasite worldwide.
- stjohnswarts 6y agoUnlikely, it would probably take something more like 95% since the spreaders are not human they're mosquitos, you would have to cut the population of mosquitos down to the 77%+ number to get started via that mechanism for herd immunity.
- alexedward 6y agoI think that was a good initiative taken to save people from death as already lot of people died due to Covid-19
- sleepydog 6y agoI know mosquitos are a major carrier of malaria, but does modern malaria come from other humans? If a population got 100% vaccinated, would the next generation need the vaccine as well or would malaria be eradicated within that population?
- Gatsky 6y agoThe long and arduous task of dealing with malaria does give one pause when considering that there have been two new globally significant infectious diseases in the last 50 years. We aren’t getting rid of HIV or SARS-CoV-2 any time soon. To me there is little doubt we should deploy massive resources to detect new infectious agents early and prevent their spread. We have the technology. There is no better gift we can leave to our future civilisation.
- stjohnswarts 6y agoWell one good way might be to try to quit eating everything that walks, crawls or hops and switch over to veganism.
- pietroglyph 6y agoYep. Animals are the most common way that diseases are introduced to humans, and industrial animal agriculture brings these animals into close proximity with themselves and us. Removing animal products from our diets not only mitigates this huge disease reservoir but also removes a huge source of greenhouse emissions, land use, pesticide use (for feed), and animal and labor exploitation (the meatpacking industry is extremely exploitative in the United States.)
- greazy 6y agoInfluenza cries. Influenza has been constantly assaulting humans for the last ~100 years: Spanish flu (1918–1920) Asian flu (1957–1958) Hong Kong flu (1968–1969) Russian flu (1977–1979) H1N1/09 flu pandemic (2009–2010) and imo there's another coming in the next decade. Hopefully it won't be any of the H7/H9/H5 viruses because that's going to hurt
- pezo1919 6y agoFun fact: potent anti-malarial drugs like HCQ and IVM do work well against covid19. They are being censored, but you can see some data on www.c19early.com Me being censored now here, 3, 2, 1...