The most effective malaria vaccine yet discovered | Hacker News Reader

The most effective malaria vaccine yet discovered

blogs.sciencemag.org

763 pointshprotagonist277 comments

What 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

> 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.

I grew up in Africa. We weren't as scared of Ebola, as we were, of good old Malaria.

It's also the gift that keeps on giving. Once you get it, it does a reunion tour, every now and then, for the rest of your life.

At the dinner table, we (expats) used to have a bowl of quinine tablets, set out like a condiment.

I really hope this works out, because, thanks to climate change, the lower 48 may get a chance to find something in common with our neighbors to the south.

Agreed with the other responses. The main reason there are lots of malaria deaths is often due to the lack of access to medication but for folks that do, it is similar to the flu stateside.

I was born and raised in Uganda and I'm shocked by this. Ebola was 100x more scary than malaria growing. At least way back before this recent vaccine. Get Ebola you are basically screwed, get malaria have a pill

To be fair on your part, as an 'expat' (I have a lot of qualms with this word, see https://www.theguardian.com/global-development-professionals... as a starter), its harder as your immune system didn't grow up with it and so when you get it, its much worse. Quinine in my head is a hard core malaria drug for the tough cases (well atleast in was 10-20 years back). But for folks born and raised it really was like the flu. When I go back these days though, I'm in the same boat and actually start a dosage of anti malarials a week before I arrive

Quinine is better as a prophylaxis rather than a treatment - i.e. for preventative or early-stage use, not once it's developed into a bad case. Low doses early (like in the tonic water of the late 1800s) could help prevent one from catching malaria while avoiding the nasty side effects of larger quinine doses needed for treating an advanced case.

Ah I see. I was only familiar with the latter advanced case usage

That's interesting and I hadn't thought about the difference in terms and how they were used before, thanks for the article to chew on.

Expat typically means emigrant, not immigrant.

Japanese working abroad are expats wherever they are.

And Russians are immigrants. It doesn't go by race, it's Haves vs Have Nots - the only two classes that really exist.

It's definitely more nuanced for sure. Factors that can play into it can include but aren't limited to race, social standing and class, country that you are living into etc. I agree there's a have vs have nots at play at times but I don't think you can discount race at play either.

As an example, I always found it interesting that when I moved to the US, I found the words use suddenly disappears despite there being lots of people that could fit that mold. Has anyone experienced otherwise? I'd be curious to know

> it's Haves vs Have Nots - the only two classes

Then what do you call it when the Haves trend light in skin tone and the Have Nots trend dark in skin tone?

I call it "fighting over bread crumbs when 0.01% take away the whole cake".

3/4 of Europe are have-nots in the expat:immigrant debate...

I might be confused. Is your argument that 3/4 of Europe being Have Nots negates racial inequity?

Malaria used to be common in the US until the 1950s or so. It was eradicated through extensive mosquito control and engineering efforts. Rich countries can cope; it's the developing world that's thoroughly boned, at least until industrial capabilities catch up.

I can't help being annoyed by how the West first exterminated malaria at home, and then, once they were safe, started worrying about the ecological consequences of doing the same in Africa.

I think it's a bit more complicated than that looking at the wiki article. It seems to have been very successful to begin with, but then the mosquitos became resistant to DDT and western countries have a climate advantage. Notably, they did try it in poorer countries too.

And a ton of kerosene. Spray it on all bodies of water and the larva can't breathe.

Malaria is why the first attempt at the Panama canal failed. Kerosene is partly why it became successful.

DDT was also used incorrectly. It was supposed to be sprayed on walls, so it was made to be persistent. Naturally farmers crop-dusted it on their fields, and that made it an environmental problem.

During cabin decompression, you put your oxygen mask on first, then help others.

I think the right analogy for the GP post is putting your oxygen mask on and then telling your seatmate they shouldn’t be flying due to climate change.

If all kids in your neighborhood get sick, including yours.

Do you first try to heal your kid or everyone at the same time?

> Malaria used to be common in the US until the 1950s or so.

I had no idea of that, as I suspect many given the time past if you wasn't around then. Did a little digging and nicely covered here: https://www.cdc.gov/malaria/about/history/index.html

Which makes me wonder - what the cost of malaria drugs are and how much would it cost to eradicate it. Equally have the true environmental and ecological aspects of eradication methods been analysed. I wasn't aware that mosquito's were pollinators until a while back, not that anything usurps Bee's, but many insects are pollinators and in some area's they may even be crucial as a species.

After all the 1950's approach was basic killing of the mosquito's and whilst that may of been a solution for one area like the US, I'm not sure that approach would be taken as much today and for Africa, certainly as I mentioned, the whole pollinator aspect of mosquito's may make for a more fragile ecosystem that removal of a species would be more impaction than the gains.

I always found it fascinating that malaria has been around so long that a genetic mutation evolved in some that makes them immune to it.

Afaik mosquitoes don’t really contribute ecologically. They are just nuisance.

I recall a town in Texas decided to wipe out the local bat population due to fear of rabies. The next year they had a major scourge of mosquitoes. Turns out bats mostly eat mosquitoes. They let the bats resettle the area.

Bats eat tons of mosquitoes. Some outfits encourage and help people set up bat friendly enclosures to deal with local mosquito problems.

There's IIRC a single-digit number of mosquito species carrying malaria and a slightly higher number of mosquito species targeting humans - as compared to hundreds of species of mosquito. Kill the carriers off and they just get replaced by some other specie of mosquito.

Lets face it, if the same Malaria mortality rate happened in the West, we wouldn't (and historically didn't) wait for vaccines - we'd pave over an entire ecosystem if we had to. We'd do the same even if we had the same death rate as the group that got vaccinated.

Well bats certainly haven’t caused us any major global health problems recently...

While the bat origin of Covid 19 is plausible, it hasn't been conclusively demonstrated. The gain of function lab leak is just as plausible, and equally unproven -- due to the Chinese dictatorship's suspicious lack of transparency and cooperation.

Lab escape is still bat origin, just potentially with a human assist (or human mistake with an unaltered virus.)

Sure, and they’re a large viral reservoir, but I’d hope we don’t think that’s a good reason to eradicate them. They don’t typically come into our homes the way mosquitos do; we go to theirs.

They are the food for birds. Not sure how big that chunk is. Also mosquito's larvae is a water predator, might be an important ecological niche in water reservoirs.

Malaria has killed so many people I don't really care if wiping them out starts a trophic cascade, it would probably still kill fewer people than malaria. If we had to give up condors and bees, I'd still think it a fair trade.

With the bees will go lots of foods that depend on them for pollination. Bees are very essential for agriculture.

Actually very few of our foods, and none of our staple crops rely significantly on insects for pollination. Grapes for instance, can use insects but don't have significant problems in their absence.

Bees are just another legacy producer ripe for disruption. With recent Progress in AI and Drone technology the question isn’t if Bees get replaced by autonomous Nanobots but when.

I remember when I was a kid the EMP trucks went around to keep the nano swarms down, but most of us got bot-lung anyway.

Even rogue nanoswarms are less worrisome than mosquitos as a vector.

It used to be common in southern Europe as well and was an absolute scourge in SEA until the 20th century.

Not just Southern Europe. Oliver Cromwell (English ruler in 1600s) died of malaria.

Malaria in North America and England is covered pretty well in Mann’s 1493. There are a couple kinds of malaria, one more resistant to cold than the other.

No doubt the indigenous Americans had it bad, to put it mildly, but reading the accounts of early colonization efforts in that book, I mean, damn. Wave after wave of colonists, each losing 50+% in the first year (and it’s not like the survivors stopped dying then). For years on end, across multiple colonies. Mostly to disease.

That's awesome trivia!

> Once you get it, it does a reunion tour, every now and then, for the rest of your life.

Maybe only certain strains of malaria do that? I had malaria many years ago. It was a very unpleasant experience, but I recovered in a couple of weeks with no lingering effects.

Growing up in India, malaria was common. But I don't recall anyone living in terror of it. Mosquito nets, mosquito repellent incense, repellent cream, turning the ceiling fan on to full speed were common countermeasures we employed at bedtime.

From my understanding, the vivax variety can bury into the liver and come back out in the future, whereas the falciparum type, which seems to have faster and deadlier results if untreated, once it is treated, is no longer in the body.

Or at least I hope so. I lived in Tanzania for a few years and I got malaria (I think falciparum) a few times. The first time it was the worst headache I've ever experienced. By the third or fourth time, I barely noticed that I had it and yet it was at maybe 5x or more the concentration it was when I first contracted it.

I have had both falciparum and vivax (different years), confirmed by lab tests. The treatment was exactly the same in both cases. While one of them was quite debilitating, the other felt like an ordinary flu. I forgot which is which. In both cases, I was prescribed a month's worth of medication to get rid of the plasmodium from the liver.

I don't live in a malaria-prone locality anymore, but when I did, the people did not consider it a deadly disease. I think access to medical facilities and good nutrition are the key factors why some populations consider it a deadly disease, and other populations don't.

That's my experience as well - I had it 17 years ago, was very ill for weeks, but recovered and haven't had any problems since (but am no longer exposed to risk of new infections). However, it used to be that in the US you could donate blood if you had seen a doctor and been symptom-free for 3 years. It's now a lifetime ban. So perhaps there's new evidence it's not so simple?

Edit: Or there just aren't many donors who have had malaria, so they err on the side of safety.

That's my understanding as well; there are multiple malaria (plasmodium) species, and their effects vary. Some are a one-time infection, and some come back periodically.

I never got it, so I don't know.

The way it was explained to me, is that it's a parasitic disease, and the parasites would embed eggs in tissues, with the possibility of the eggs (or whatever they are -spores?) being re-released in the future.

I grow up in Africa too, Sudan to be specific. During my early childhood years, I contracted malaria more than 5 times. It was really a very regular disease -- that an typhoid. It was only during college have I learned how devastating and seriously dangerous those diseases are: just to put things in perspective, a doctor once told my friend, after he checked his lab results (and be mused of it), they either have malaria or typhoid.

I'm interested to read more about the possibilities that in africa we contracted so many diseases that explains the rather shocking covid mortality rate. It could be because of mean age too.

I dont know what part of Africa you grew up in, but growing up in Nigeria, no one was scared of Malaria.

It is treated pretty much the same way Americans treat getting the Flu

I was born in Nigeria. I barely remember it, but what I can remember, is being constantly told how bad it was. It's entirely possible that my parents had an unreasoning fear of it. When we are kids, they are our source of Truth.

I also remember my sister getting caught in one of those 'squito swarms, near the Delta. That was freaking awful.

Uganda was a bit worse; but we also had other things to be scared of.

I should also mention that Ebola wasn't actually around (that we knew of), when I was a kid, but we hasd some fun diseases. The parasitic ones (like Elephantitis and Belhartzia) were pretty difficult to look at.

Well then, nice to meet a fellow Nigerian :) Ebola is a recent thing AFAIK, so it would make sense that no one was freaking out about it when you were a kid.

To be fair, it does sound like you were in rural Nigeria, so my Malaria experience is likely different from yours

Someone pointed out that us Europeans were probably a lot more sensitive to this than others, who had been around it, all their lives. Also, my mother was the prime vector for my information, and she might have been a bit freaked out by all the fun ways Africa has to kill people.

But I'm still here. I seem to have survived.

My African friends would run around barefoot over the most God-awful crap, and were some of the healthiest people I've ever known.

200000 kids under 5 don't die of the flu every year.

Malaria is a massive drain on the lives, well being and economies of central Africa. An effective malaria vaccine would be huge.

And from the perspective of most africans a lot more relevant than the Corona vaccine.

I wish the rest of the world would realize that Africa first and foremost benefits from this new Malaria vaccine.

I 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.

The fact that malaria is so common in those areas is almost certainly a significant contributing factor to the intractable poverty in those areas.

It's hard to be productive when you are sick all the time and/or caring for someone sick.

I think the point was mostly that comparing the case/fatality numbers of covid19 - a truly global pandemic - with those of malaria has to factor in the size of the population being exposed.

Sure, Malaria is unlikely to spread like covid or it would have done so a long time ago, but the absolute numbers don't tell the whole story about how bad each disease is.

Actually malaria used to be in much larger areas of the world, including the United States. But the population was much smaller at that time.

It's a good point about absolute numbers versus population relative numbers.

Siberia used to be a giant malaria hotspot, and then it was suddenly gone at the onset of 20th century, and first semblances of effective treatment.

Some say climate change killed it, some say the extinction of a mosquito species carrying it, some better nutrition, some say quinine.

That's just an astounding incidence rate. That kind of selective pressure makes the reason for the sickle cell mutation in hemoglobin more obvious.

https://www.cdc.gov/malaria/about/biology/index.html

> Inheritance of this mutated gene from both parents leads to sickle cell disease and people with this disease have shorter life expectancy. On the contrary, individuals who are carriers for the sickle cell disease (with one sickle gene and one normal hemoglobin gene, also known as sickle cell trait) have some protective advantage against malaria. As a result, the frequencies of sickle cell carriers are high in malaria-endemic areas.

> . . .It was found that that the sickle cell trait provides 60% protection against overall mortality.

Very strong selective pressure.

Sickle cell has separately arisen in at least four populations in Africa and some in South East Asia.

Although 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.

I 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.

Although some posts suggest that the USA may experience malaria at some point in the future because of global warming; in actuality, the USA has already experienced malaria.

In 1882, the range of malaria in the USA extended from the Canadian border on the north to southern border with Mexico on the south. The only states of the current 48 contiguous states unaffected were Nevada, Utah, Arizona, Idaho, Main, Vermont, and New Hampshire. Something like 41 states had malaria cases (the maps are a bit hard to read).

Approximately 375 cases acquired in the USA per 100,0000 population were reported in 1920.

Eradication efforts continued until the 1950s when the USA essentially became free of malaria. See [1].

[1] https://www.cdc.gov/malaria/about/history/elimination_us.htm...

The eradication efforts in the US included lots and lots of DDT.

The Little House on the Prairie family caught malaria, and was so sick they almost died of dehydration because they couldn’t get down to the river to drink.

https://littlehouseontheprairie.com/dr-george-a-tann-pioneer...

This is something that has confused me for a long time. America definitely has mosquitoes (I’m from Washington, DC). How are there mosquitoes but no malaria?

It's bizarrely hard to find good explanations of this! The National Malaria Eradication Program, between 1947 and 1951, cut down on malaria transmission enough that the parasite was driven locally extinct. They drained wetlands where mosquitoes bred, sprayed house interiors and mosquito-heavy areas with DDT on a very large scale, and generally engineered a very specific ecological disaster, depriving the parasite of the human hosts needed for part of their reproductive lifecycle. Without enough infected humans, the parasites died out.

Crucially, they didn't need to get rid of all the mosquitoes to do this: they just needed to drive mosquito-to-human transmission low enough for long enough.

https://en.wikipedia.org/wiki/National_Malaria_Eradication_P...

If this were the complete story then just a single person coming back to the USA infected would lead to mass infection...

Clearly that hasn't happened.

We do still have mosquito abatement programs too.

I know here in Louisiana the local abatement program has trucks that spray synthetic pyrethroid chemicals (resmethrin, sumithrin and prallethrin) at night and uses an organophosphate (naled) from planes.

And residents are routinely urged to be aware of and eliminate standing water on their property.

We just don't use DDT anymore -- we almost wiped out our state bird with it.

Edit: I have to wonder how much housing changes also mattered. With modern air conditioning and well sealed homes it's fairly rare to have mosquitoes in the home at night.

Malaria does not spread from human to human, you need infected mosquitos in the mix. So you would need to get a breeding population of infected mosquitos biting humans for it to start spreading.

The answer is malaria eradication efforts never stopped neither in US nor in Europe. It's just as routine as renewing asphalt roads or maintaining sewers

Only explanation I can think of is that the malaria from elsewhere is different somehow, worse adapted to US conditions.

The Anopheles mosquitos [1] which spread human malaria are present at some level across about half of the US, but are just not especially abundant here compared to other mosquitos that do not spread malaria.

In fact, of the ~200 mosquito species which occur in the United States, only 12 are known spread any sort of human disease [2].

[1] https://en.wikipedia.org/wiki/Anopheles

[2] https://www.cdc.gov/mosquitoes/about/mosquitoes-in-the-us.ht...

It's only a few (4?) species of mosquito that carry malaria, out of hundreds of species in total.

There's a reason the CDC is in Atlanta.

Yea but I’m an Atlanta native and never hear of malaria. Plenty of mosquitos around here.

That's because they did their job well.

https://upload.wikimedia.org/wikipedia/commons/b/b3/MalariaM...

I grew up in Alabama, and remember a few times a summer seeing the "mosquito truck" drive by, spraying pesticide as I played in the yard. I guess it works!

We had those growing up in suburban Chicago too -- in my case in the 70s. The trucks would only appear at dusk. We dumb kids thought the fog was a hoot so we would jump on our bikes and chase behind the truck hooting at the novelty, breathing in who knows what chemicals. I can still remember the smell.

It was probably malathion, which is an organophosphate pesticide that is considered low toxicity, although it may be a carcinogen.

> breathing in who knows what chemicals

Probably DDT. Not thwebest of ideas!

In the 1970s? No, almost all use of DDT in the US ended in 1972.

I seem to recall this in the Midwest as recently as the 90s

My dad told me similar stories from midcentury New York.

In FL, we still have the mosquito truck end up coming by at least every other week.

I don't think we do it for malaria these days, just to reduce mosquito stings? Thinking about like mosquito sprays in Chicago...

AFAIK it's more about West Nile and EEE, maybe Zika and even others.

Though, incidentally, if you reduce/eliminate mosquitos carrying West Nile, Zika, etc ... you also reduce/eliminate the ones carrying Malaria :)

Covid-19 is a baby bike with training wheels. And we fail disastrously at that. It is far from the worse scenario epidemiologists train for, but it could easily become one: a variant with high lethality can always appear suddenly.

And yes, malaria is not discussed enough. I remember Bill Gates releasing mosquitos in a room before a speech to get the public attention "these could carry a deadly disease we have no cure for"

You know, that's complicated...

A more deadly virus, as we saw with SARS, was that it was actually easier to control because the high death rate made it very easy to contact trace and identify infected.

In many ways covid19 is a challenge exactly because it doesnt kill too many people.

Unfourtuantly, this correlation is not always the case.

HIV is extremely deadly without treatment, but has an asymptomatic stage that can last over a decade despite still being infectious during that time.

The silver lining with HIV is that its modality of transmission is primarily sex and blood, which greatly limits the number of contacts an infected individual will have.

An airborne disease with the lethality, incubation length of infectivity, and vaccine resistance of HIV would be a slow moving disaster of an unimaginable magnitude.

I am not aware of any theoretical reason such a disease cannot exist.

It wasn't the death rate of SARS that made it easy to control, it was the lack of an infectious period pre-symptoms.

In addition to the real and massive reduction in human suffering a 77% efficacy vaccine could bring, the opportunity for renewed investment and growth for the economic development of Central Africa cannot be overstated.

"... somewhere in the region of 150 million to 300 million people have died from the effects of malaria during the past 100 years. If it is taken that around 6,000 million people have died during this period, malaria may be reckoned to have been a factor in between 2 and 5% of all deaths across the planet in the 20th century." [0]

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC126857/

Except for the age difference of the victims, those numbers actually make covid seem pretty bad. Covid has hardly been around for a year and is killing 7x as many people a year.

Also, while covid is not done yet, it's probably going to kill in total much less than 100M.

COVID is bad, but in some ways we got lucky because there could have been way worse pandemics that acted more like smallpox or measles.

Covid is an acute infection, you get infected, you beat the infection or you die. Some may have life-long side effects from the disease, but they are free from the disease itself.

Malaria, like HIV or Herpes, is a chronic disease. Once you're infected, you're affected by it until you die. The debilitating effects of malaria also have disastrous economic impacts.

Malaria affects far smaller population size.

Those are the numbers for a single country. Malaria kills 1-3 million people per year globally.

Unless I'm misreading the link, those numbers (~600k/yr) are global. Still, staggeringly high, and concentrated in a region.

Yes, the number is "global" - but the actual part of the "globe" that's affected is remarkably small ..making its rate far worse than it otherwise appears

And the worst thing is: malaria is easily curable, as malaron is not only preventive, but fully kill the plasmodium in the liver cells. Despite that, we don't provide the drug to them.

It would cost a fraction of what we spend on research for a vaccine, but no cigar.

Of course, there is the argument that we risk developing resistant bugs. But the truth is, if suddenly all mosquitoes were moved magically to the US, you would see the drug massively used for everybody without a second though.

Not sure why you were downvoted down much but here’s my 2 cents.

I first started taking anti-malarial medicine as a child. My entire life I’ve been hearing of resistance to one drug and then another drug, and then another. Also, whenever we took chloroquine or any other drugs on a regular basis, we were well aware that having the medicine in our body would not prevent malaria—-we took it just to help reduce the severity of malaria when we’d become infected. Looks like there are already strains resistant to your drug of choice:

https://malariajournal.biomedcentral.com/articles/10.1186/14...

So preventing and even treating malaria has never been a sure thing with ANY drug that I’ve ever known.

May be worth mentioning that the article documenting malarone-resistant malaria is virtually 20 years old already. As far as I'm aware, the problem of drug-resistant malaria hasn't been getting better...

Thats a weird argument. "Lets not give the medicine that might help as that might also encourage mutations." --> basically you are saying let's deny it to the many dying today in order to ensure the few (that can afford it) can still use it in the future. A deeply immoral and selfish perspective if spelled out this way.

The only solution then is rapid and large-scale intervention. Massive use of the most effective/least side-effect variety of drug for all at risk populations for 3(?) months, then bring in the alternatives and quickly and widely ensure their use in those areas where resistant strains still spread.

I am not saying don’t treat people. The anti-malarial medicines we used growing up were very affordable, so access was not the problem. I’m saying the vaccine is more encouraging because the medicines have not been able to put much of a dent into the problem of malaria.

>That's an ongoing pandemic that makes covid-19 look like a case of the sniffles

How? There are literally 3 times more deaths in the last year than peak Malaria, and that's only deaths that were actually counted.

Yes, but over the course of history, there's no comparison. Which was my point.

Covid-19 is hopefully going to be short-lived thanks to the vaccines, but even if it weren't for that it would likely become more virulent but less deadly over time like the other Coronaviruses that are endemic in humans.

There is a also a big difference in lives lost at the end of life versus at the beginning.

>Covid-19 is hopefully going to be short-lived thanks to the vaccines, but even if it weren't for that it would likely become more virulent but less deadly over time like the other Coronaviruses that are endemic in humans.

Over the last year it's be come more virulent and more deadly.

We have no idea how well the vaccines are going to work. We have a situation right now where a country(india) with 100 million people vaccinated is getting 350,000 cases a day, and it's doubling every 10 days. That's a scenario where the evolution around the protection a vaccine offers becomes a very real and distinct possibility.

> Over the last year it's be come more virulent and more deadly.

Evolution is a somewhat random process at its heart, but I stand by what I said as the likely outcome, because that's the path new diseases normally take. It's early days yet.

> We have no idea how well the vaccines are going to work

I think we have a petty good idea by now actually. A bigger question is how much will it be hampered by people afraid or unwilling to be vaccinated? I have never in my life seen such widespread and illogical fear of vaccines.

We may have to just accept that there will be an ongoing toll in the unvaccinated population that keeps the virus circulating in quantity and keeps the hospitals busy. Until sufficiently many develop natural antibodies through infection.

> We have a situation right now where a country(india) with 100 million people vaccinated is getting 350,000 cases a day, and it's doubling every 10 days. That's a scenario where the evolution around the protection a vaccine offers becomes a very real and distinct possibility.

Yes, that's a tail risk that's real and terrifying. I think the risk is small given such a mutation would possibly render the virus much less virulent. The vaccines tend to target the spike protein, without which it can't even infect humans. But nature finds a way. We can and will also adapt the vaccines in that case though. The money, motivation, and technical expertise are all there. But nobody knows how likely a risk that is.

>Evolution is a somewhat random process at its heart, but I stand by what I said as the likely outcome, because that's the path new diseases normally take. It's early days yet.

So that's why malaria is less deadly now? I've seen this said many times with zero backing, and it just really doesn't correlate with the history of disease. The reason we don't deal with the majority of deadly diseases is vaccines, not because they've evolved to become less deadly.

>I think we have a petty good idea by now actually

We have an idea of how well they work on the original covid-19 strain that we saw last year. We don't know how well they will work on actually eradicating the virus.

>I think the risk is small given such a mutation would possibly render the virus much less virulent

Based on what? It's already evolved to evade antibodies produced by infections from the first wave (P1 strain in Manaus specifically is a good example). Those have been mutations in the spike protein, and have made the virus more virulent and deadlier.

> not because they've evolved to become less deadly.

Apparently our DNA is literally encoded with lots of viruses, as they've evolved to become utterly harmless to people. Our bodies are loaded with various bacteria and viruses that have evolved a symbiotic relationship to the point where we'd die without them, and they can't live without us.

I seriously doubt they started out that way.

Smallpox (around since about 500 BC or earlier near as we can tel), still had a 35% lethality rate until it was eradicated in the 70’s though an extensive vaccination campaign.

Diseases can be severely lethal far longer than you or human memory can survive.

> I have never in my life seen such widespread and illogical fear of vaccines.

It's interesting, in the UK we had ridiculous reaction to the MMR jab after a fraudulent claim, fired up by the media - from the ever populist Daily Mail to Private Eye [0], which led to a collapse in MMR takeup and a resurgence in measles.

But we haven't seen that with covid, perhaps because the printed press is (mostly) on the side of the current government (flag waving populists), and the vaccine rollout has been branded aprt of the generational "battle" between the UK, standing alone against Europe (many in the UK don't realise WW2 ended 76 years ago).

I wonder if we'd had a Corbyn or Starmer led coalition in charge if things would be different.

Or imagine if the lib dems had held on to 20-30 seats that the tories gained in 2015 -- likely another coalition, with a 5 year fixed term, no brexit referendum, and then the GE having to be delayed (it would have been set for May 2020)

[0] https://behavioralscientist.org/how-fraud-and-a-broken-publi...

>Over the last year it's be come more virulent and more deadly

Source?

https://www.bmj.com/content/372/bmj.n579

Covid's victims are mostly in their 70s and above.

Malaria's victims are mostly under 5 years of age. In terms of life-years lost, Malaria is far far worse.

The average age of death from the coronavirus appears to be in the 80s for many countries. In Norway it's 84, in the UK it's 82.4.

You also have to take into account the health of those involved. Saving a life only for that person to live a few low quality years in poor health is worth less than saving the life of a healthy young child.

The resulting measure is the QALY, the quality adjusted life year.

Unfortunately there has not been nearly enough research or discussion about QALYs and their applicability to the coronavirus. There are a few studies out there, though, here's one: https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4208

TLDR: the mean discounted QALYs lost by someone dying of the coronavirus in the US is 4.3.

Yes, and, imagine you're 40 years old, and your 75 years old parents die, or your two 5 years old kids

That's peak malaria deaths in a single country

Globally, malaria kills 1-3 million people annually despite many people having some natural resistance to it and there being many effective treatments for it and it already having been eradicated in many areas. Covid killed the same amount in a much larger population that had no pre-existing defenses or treatments.

Because malaria has been killing people consistently for thousands of years? You can easily add Tuberculosis to the makes-covid-look-like-sniffles list as well. Over the last 200 years 1 billion people have died of TB.

https://www.nature.com/articles/502S2a

It's incorrect to say it looks like sniffles in comparison. This is basically severity / priority in software. If we left sars-covid-19 without mitigation for a century, it would catch up rapidly. You compare things over relevant intervals.

There are far more influenza deaths over the last 3 decades than ebola, but ebola is far more severe and greater concern.

> If we left sars-covid-19 without mitigation for a century, it would catch up rapidly.

I think that's probably wrong? The most likely outcome would be that after the initial pandemic subsided (with lots of deaths), most people would catch it when they were reasonably young and then be mostly protected.

This is different from malaria, which is much more deadly.

Yes. Also evolution tends to favor making diseases better adapted to their hosts and note virulent, but less deadly.

We have a number of Coronaviruses endemic to humans that cause the common cold (among other viruses.) That's probably how covid19 would turn out, left to its own devices.

That's not correct. The virus doesn't care whether you die or heal. It cares how long you are contagious, so generally the time until death after infection tends to stretch, not general deadliness.

I think the most likely outcome is that it will become like the flu: not that deadly in Western society, but mutating too rapidly for protection to last long, and still killing many elderly and people with chronic health conditions each year (according to https://en.wikipedia.org/wiki/Influenza, Influenza kills over half a million people each year)

(Both are RNA viruses. https://en.wikipedia.org/wiki/Orthornavirae)

That's a pretty fair amount of speculation about the future evolution of sars-covid-19, but you might be right. I hope you are. To be direct with you - I disliked the framing altogether, neither of them are sniffles, and it's unhelpful and barely meaningful to compare an acute respiratory transmitted virus with a mosquito borne parasite over such wildly different timeframes. This is wonderful news about the vaccine for the terrible disease malaria. Covid is also a terrible disease.

It is as yet unclear how long effective immunity lasts after catching the disease, but pessimistic estimates put it at less than six months. While the pessimistic estimates are likely wrong (hence the term "pessimistic"), there certainly isn't confidence in the sort of lifelong immunity that one gets to some other contagions.

Part of what's so exciting about the vaccines is that the antibodies seem to decay at a slower rate, meaning that it could result in longer immunity (though we obviously don't know for sure yet).

> pessimistic estimates put it at less than six months

If that were the case we would see large amounts of re-infection, since the pandemic started over a year ago

>I think that's probably wrong? The most likely outcome would be that after the initial pandemic subsided (with lots of deaths), most people would catch it when they were reasonably young and then be mostly protected.

Then why hasn't that happened with malaria?

Malaria is a very different sort of disease? Among other things, covid is something that (a) doesn't seem to badly affect children and (b) seems to give some kind of immunity. Malaria does not have (a).

Malaria also doesn't [seem] to have (b)

Getting malaria doesn't inherently make you less likely to get it again (if anything, it's the other way around)

So somehow it being around longer makes the more lethal disease the sniffles? That doesn't make sense.

Yes. Add HIV to that list as well. Polio, which is almost gone now. It's a long list.

You're comparing the worldwide Covid-19 numbers with the malaria numbers of a small region.

Comparing the deaths side by side misses an important aspect: most malaria deaths are children, whereas Covid mostly affects older age groups.

Because old people are worth less than children?

Yes but not in the way you're implying.

A child dying robs them and the world of 60+ years of human life. An 80 year old dying of COVID-19 was not going to live much longer anyway, so the loss is less severe. Old people have already had the opportunity to live a "full" life.

Imagine two societies – one where a disease kills 50% of < 10s every year, and another that kills 50% of > 70s every year. Which society would do better? Which society would you rather live in?

In the US, more people in the 55-74 age range have died than the 85+. Those are people who are taking care of grand children, or are still working. These are people that society has spent decades making fully functioning parts of society. A child has had none of that investment.

A society of just children wouldn't work, just as a society without wouldn't work.

Is your goal to just be as misleading as possible in this conversation?

Yes, of course more 55-74s have died – there are far, far more of them than there are >85s. Normalized, COVID is far more lethal (8x more lethal) for >85s than for your range. Here's the mortality rates:

55-74: 0.28%

85+: 2.5%

https://www.statista.com/statistics/241488/population-of-the...

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

How in any way is that misleading?

The actual numbers are more representative than lethality percentages when we're talking about contribution to society.

What's more representative is "life years lost", and malaria wins there (we've lost many more years to it).

How do you calculate that in an area of the world with the highest rate of child mortality?

Same as in any other area, assume malaria isn't killing babies and do the math. Your question sounds rhetorical but is too simple to answer, so I'm confused.

My anecdotal observation is that is a position that a majority of old people themselves take, at least nominally.

Frankly, yes. It sounds cold hearted but many of the COVID deaths were people who were going to die in the next 24 months anyway.

> The average years of life lost per death is 16 years.

https://www.nature.com/articles/s41598-021-83040-3

And, dismissing the death of someone by saying "they were going to die soon anyway, so what" is disgusting.

>And, dismissing the death of someone by saying "they were going to die soon anyway, so what" is disgusting.

It may be "disgusting" - but it's also statistics

It was sad when my grandfather died a couple years ago at 87 - but not exactly "unexpected"

Compare that to friends who lost their 18-year-old daughter before she graduated high school

Which one is shocking? Which one "hurts more"?

Deaths rates follow a bathtub curve - ultimately leading to a 100% mortality rate (ie, everyone dies eventually)

If you have to choose between saving a 5-year-old and an 85-year-old, the "smart money" says "save the kid"

If you don't have to choose, then by all means - save both

But that's not how economics works: choices must be made

In a QALY sense, yeah. The most valuable to society are the workforce but children are almost as valuable.

My parents are 60+ yr old surgeons. They work during the pandemic not because they have to. It's because you run the QALYs and the morality is clear. You participate or make way.

Also worldwide incidence of dengue has risen 30-fold in the past 30 years, and more countries are reporting their first outbreaks of the disease due to re-emergence of mosquito vector viruses.

Yet there seems to be no better alternative for simple mosquito nets when it comes to safe, efficient way of protecting ourselves from mosquitoes.

P.S. I've been tracking mosquito control strategies, it's the very first problem I posted on my problem validation platform - https://needgap.com/problems/6-safe-affordable-and-efficient...

Covid 19 affects rich powerful people (rich old people in the west who can't buy their way out of it)

Malaria affects poor people with no power (young children in poor countries with limited access to medicine)

There is an extremely effective treatment.

Millions have perished from being denied it.

https://www.wsj.com/articles/SB113236412756302115

The Stockholm Convention on Organic Pollutants contains an explicit exemption for DDT used for disease vector control. ( http://chm.pops.int/Portals/0/Repository/convention_text/UNE... page 28.) Your "millions have perished from being denied it" is incorrect. I don't know whether that's the Wall Street Journal's fault, because I won't pay them to find out whether they're wrong.

https://www.latimes.com/archives/la-xpm-2006-may-29-fg-ddt29...

Been awhile since I researched the topic, but it was clear Africa counties got a lot heat each time they tried to use DDT.

So I will stick by millions dead.

Absolutely. Malaria is the reason why mosquitos are considered the species most dangerous for humans.

Btw, I don't think it's a pandemic since it doesn't affect the entire globe. It's an epidemic, isn't it?

Malaria is an endemic disease in parts of Africa (constant occurrence in a population). An epidemic is a disease rapidly spreading in a population (sudden outbreak). Pandemic is a worldwide outbreak.

These are somewhat fuzzy terms, because pandemic or epidemic both imply unexpected numbers of cases, not just "lots" of cases.

For the most part, malaria is considered an endemic disease with a high incidence rate.

Infants can also be infected before their first year of life, via vertical transmission: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259075/

malaria vector is mosquitoes, which are particularly devastating in tropical areas with rainy seasons that end up with numerous stillwater deposits.

Stillwater deposits (i.e. no fish) are the perfect breeding grounds for mosquitoes. If you have a very wide area with poor transportation infrastructure, or if you don't have funds to fumigate for mosquitoes...you are toast.

The incidence rate should not be surprising for anyone that has lived in a tropical country with a rainy season.

You can't run and you can't hide. Mosquitos come out when you sleep, and use body heat and breathing to find their victims. You will be bit by mosquitoes. Many times. Sometimes multiple times a day. The question is whether you get enough bites that chance will deliver a malaria bite.

Mosquitos use CO2 to find victims*

Technically, they recorded 717 incidents of malaria in 734 infants, which may have affected less than 717 infants if some of them were infected multiple times. Regardless, it's an awful situation.

The wealthy nations don't care about malaria because it happens only in poor countries. Maybe global warming will make them finally take notice.

I get what you mean: Malaria vaccines never got a sudden rush of Manhattan-Project-esque funding like COVID-19 vaccines. But according to the study, funding for this research was provided by "The European & Developing Countries Clinical Trials Partnership (EDCTP), The Wellcome Trust and the NIHR Oxford Biomedical Research Centre".

The EDCTP is funded by the European Union as well as the individual member countries. The Wellcome Trust and Oxford are both British.

Perhaps wealthy nations could/should be doing more, but it seems like wealthy countries are responsible for this breakthrough.

Malaria eradication did get a massive Manhattan Project-esq push. It just failed.

As an infectious disease epidemiologist, after HIV, malaria is probably the next most closely studied and well-funded infectious disease we look into. It's also been a WHO priority for basically the entire existence of the WHO.

Malaria used to happen in USA and Europe, it was eradicated there less than hundred years ago.

Ah, that's why GiveWell rates mosquito netting so high. To think I could save a child with a thousand dollars.

Not to be too nit-picky, but a thousand dollars would help or save many children, not just one. $20 will get you a mosquito net on Amazon.

Ah but not each child will die. GiveWell estimates that one grand roughly to spend enough netting to transform one dead child into a live child.

I'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

This 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).

> There are species of Plasmodium which survive on non-human hosts which means the disease will always be waiting

A small correction, the species you're referring to don't 'survive' in non-human hosts, but actually the other way around. There are probably thousands of plasmodium species that infect everything from lizards to birds to monkeys. In monkeys (eg simian) there are a large number of pasmodium species that have undergone zoonotic transfer thereby infecting humans. It's believed the 'last man standing' in defeating malaria will be P. Knowlesi, or monkey malaria. It can infect humans, and seems to be quiet common in Borneo Island. But it hasn't to my knowledge, started transmitting human to human. But without a doubt we will continually see spill-over events of not only Malaria but other parasites.

There'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.

Well, the attempt in Brazil did not go as planned: 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."

It's was not unexpected that levels bounced back eventually - we'd expect them to, after a small trial lasting only 27 weeks. Arguably if this approach (or the gene drive one) was sustained and combined with the standard treatments we'll get rid of these things or at least malaria.

Indeed. Ecological systems are complicated and remarkably resilient.

Gene drives might be able to get rid of entire species:

https://en.wikipedia.org/wiki/Gene_drive

The 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.

> adjuvant > Chilean-soapbark

More on this:

https://www.theatlantic.com/science/archive/2020/10/single-t...

A fantastic article. Thanks for sharing this.

"Chilean-soapbark"! Happy to see an ingredient such as this. One more reason to conserve biodiversity is for useful ingredients like this one.

I had the same reaction:

https://www.theatlantic.com/science/archive/2020/10/single-t...

I'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.

Having 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.

One of my Kenyan colleagues casually talked about every time she visited her grandmother, they came down with malaria.

The 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.

Influenza 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

I 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?

There 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.

I see. So the 23% does not suggest that, e.g. there's some minority of parasites that are "immune" already.

Not necessarily - vaccine effectiveness also relies on the person's immune system actually developing the needed antibodies. Some fraction of people simply won't. This is also why vaccine effectiveness goes up with multiple doses - sometimes the first one doesn't take but the second one does.

It 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.

Are any of the mosquito extinction approaches being seriously tried? Genetic engineering, etc.?

This group Oxitec released some in Florida:

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/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%.

I, for one, have been going at them one at a time for years now

Widespread supply of mosquito nets treated with an insecticide is one of the more successful measures.

The 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.htm...

I 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.

We tried it in Africa. A lot. DDT is great - it's cheap, it's persistent, and there was a heady note of optimism that we might be able to drive malaria to extinction via vector control.

Then DDT-resistance developed in the mosquitos.

Combined with the health and ecological concerns around it, its use was largely halted. It's been reinvigorated recently as malaria incidence has rose, but it's a trade-off that it would be nice to minimize with other approaches.

Isn’t DDT resistance a result of so-called “responsible” usage like DDT coated netting instead of overwhelming application such as in the USA? It’s the same principle as antibiotic resistance: under-dosing selects for resistance.

DDT resistance arose during a time when it was extremely intensively used to try to wipe out malaria-carrying mosquito populations. It's certainly sustained by the more moderate uses of it, but at this point, that ship has sort of sailed.

It's been reintroduced in some countries as well - it's effective, and it's an important tool, but it's not nearly enough. And indoor residual spraying with DDT for malaria control remains fairly controversial - I fall in the camp of "It's probably worth it, but anything we can do to minimize it is a thing worth pursuing."

Weird as this seems, at the time, you had to be in a country that could _afford_ DDT. It wasn't free.

DDT has worked perfectly well in some areas of Africa, but you have to do it right. You have to carpet-bomb the place with the stuff properly for years without any let-up. The tradeoff is higher cancer et al rates for those years, in exchange for no more malaria.

The WHO campaign of the late 50s and early 60s very nearly did eradicate malaria globally. Unfortunately, for people living today in those parts of the world where it has resurged, a miss is as good as a mile.

The environmental impact of widespread DDT use is pretty devastating.

http://www.rachelcarson.org/SilentSpring.aspx

Silent 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.1.600...

It 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.

If you ignore the reality of a situation in favor of rhetorical tricks to land a heavier impact - it still doesn’t make it actually true. Even if the heavier impact has some positives.

I had forgotten about that piece of tripe until you mentioned it

The 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.

Also worth point out that DDT is not blankety banned in the US. It's just not allowed as a pesticide. You can still use it to kill mosquitos.

> Although Carson never directly called for an outright ban on the use of DDT, its publication was a seminal event for the environmental movement and resulted in a large public outcry that eventually led, in 1972, to a ban on DDT's agricultural use in the United States. https://en.wikipedia.org/wiki/DDT

Well I have my doubts about that because it would have come right back after the DDT bombing stopped. Mosquitos can breed exponentially with zero issues, so I think that puts a huge hole in your theory.

Seriously tried, yes. Seriously effective, no (at least so far). At least that was the state of things last I looked a few years ago.

Vector 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.

https://www.bbc.com/news/world-us-canada-53856776

Would mosquito extinction even be a good idea? There would be substantial impacts to ecosystems if mosquitos were completely eliminated.

My understanding is that only a couple species go after humans, and they don't have any important ecological niche.

So some people claim. Our understanding of ecosystems is so superficial that this looks like a pretty big gamble to take.

Or a big gamble not to take, if you are vulnerable in a malaria zone.

yes. mosquitos do quite a bit of pollination.

not 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.

For 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

25% 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!

In 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.

It 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?

This 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.)

It 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.

Is it possible to get herd immunity to malaria? Does the parasite have non-human reservoirs (for the non-mosquito part of its lifecycle)?

Yes and yes:

https://malariajournal.biomedcentral.com/articles/10.1186/s1...

https://pubmed.ncbi.nlm.nih.gov/22215999/

Thanks. 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.

The 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).

The 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.

Would this be a one and done vaccine or is it something that needs a booster every few years like tetanus?

Pretty sure the 100s of 1000s dying every year wouldn't mind an extra jab every couple years

Not 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.

Unlikely, 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.

This is not the most effective malaria vaccine. Three doses of intravenous PfSPZ-CVac is more effective.

https://www.nature.com/articles/nature21060

9 people? I don’t think you can really say it’s more effective based on this data.

Intravenous 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.

I 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?

From 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.

Isn't Malaria caused by parasites? So vaccine is not just for virus?

The 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.

What is the difference to bacteria? (or is it a bacterium?)

They'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.

There used to be a weird theory that malaria parasite has descended from algae.

Malaria is caused by protists which are spread by Anopheles mosquitoes. So it’s not a virus.

I somehow had never seen/heard the word protist before (biology is obviously not my specialization). Thank you for that.

why 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/si...

I think that was a good initiative taken to save people from death as already lot of people died due to Covid-19

It'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

Isn't that hypocritical?

HN 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. 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=comme...

I'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.

Although 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.

>ghastly

That's a perfectly apt description of someone who desires the death of others, especially the death (by extension) of their own parents and grandparents in the name of some vague notion of "progress." And many of these same people then laud a vaccine that will increase the life expectancy and reduce the suffering of millions of people, oblivious to the contradiction.

>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.

Dang, as far as I'm concerned, I'm the one who's contributed and asked for nothing in return. I never asked for points (karma), or the ability to censor (flag) others' posts I dislike, or the ability to de-emphasize those posts (downvote). Meanwhile, I routinely see "uberusers" here get leeway, not just from you, but from the flag- and downvote-happy users, that anonymous users like me do not get.

Most people who break the guideline against calling names feel that they are "apt descriptions". It's still against HN's rules, so please don't. You can make your substantive points without that.

I'm one of the people who agrees with both sentiments. I think decreasing child mortality is great and that humanity needs people to eventually die.

Dying in itself is not an issue. Early mortality is an issue. Give everyone the chance to live a full life.

Curious 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.

There is a problem with the parasite resistance to Artemisinin (https://en.wikipedia.org/wiki/Artemisinin#Resistance)

Regardless, malaria still kills millions... and you are complaining about them spending money on it?

"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.

Why bother with a treatment when you can prevent even catching the illness in the first place?

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