Malaria vaccine gets 'green light' | Hacker News Reader

Malaria vaccine gets 'green light'

bbc.co.uk

78 pointssjcsjc33 comments

Progress, perhaps. I really, really hope this doesn't end up having the unintended consequence of people coming to believe (consciously or unconsciously) that bed nets are no longer required. Maybe we should wait until we have something more effective. Does anyone know: are malaria vaccines not interesting for drug companies because there's no money in them?

I don't understand your question, it was developed by a drug company. I would think that if their promise to not to make profit off its sale would put a damper on similar development. Over thirty years to reach this point, that too would be a barrier to others trying to solve the same issue. So that is at least two easily identifiable issues.

Simply put, if government is not going to develop or contract the development of a drug why should a company bend to pressure to produce and sell it at cost? However in this case this drug had support of the Bill and Melinda Gates foundation so not looking to profit off of it makes sense and may also be part of an agreement for funding.

I didn't mean to imply that drug companies have an obligation to produce products that aren't commercially viable. I understand that's just not the way the world works at the moment. I was just curious whether anyone knew whether lack of commercial viability was the reason we haven't seen a malaria vaccine yet.

Thirty years to reach this point isn't necessarily representative of the actual effort expended on finding a malaria vaccine. I wouldn't be surprised to discover that the same number of working hours goes towards treatments for male pattern baldness each year as has gone into a malaria vaccine over thirty years.

In most areas that malaria is a risk, there are also other diseases being carried by mosqitoes: Dengue and Chikungunya come to mind. I live in a country where malaria is a risk, and most people from the countryside don't know any specifics, other than "mosquitoes make you sick". When you go to a poor village and ask the elders what they need, they almost always say "mosquito nets" since there are always some poor families that cannot afford them.

I wouldn't consider it a risk, unless doctors and government officials would explicitly start teaching that the nets are no longer required, which I don't expect happening any time soon.

You make a good point about other mosquito-borne diseases. I suspect that at the margins some degree of risk homeostasis will occur nonetheless, but that seems like it will quite likely be mitigated by this point.

You're also very much correct about this being a public health issue. As much as possible, care will need to be taken to ensure education is administered with any vaccinations.

> are malaria vaccines not interesting for drug companies because there's no money in them

Considering the nature of market economies and how the wealth is distributed in the world, it is not particularly surprising that most most medical research is aiming to cure ailments that affect white western men.

This is why the huge commitment from the Bill and Melinda Gates Foundation is such a huge boon. We see progress in the fight against malaria in the developing world for the first time in many decades.

In other news, "malaria mortality rates have fallen by more than 25% globally since 2000, and by 33% in the WHO African Region"

http://www.who.int/mediacentre/news/releases/2011/malaria_re...

I wish people would quit making shit up.

As for the observation that companies only spend billions in research for markets where they can find can paying customers, I would say that others are free to raise money and start companies to cure other diseases. Even in the developed world, there are literally thousands of other diseases for which a handful of people that don't have large markets either. The WSJ ran a large article on this a year or so ago.

I agree with melling's comment here, and I wanted to add that malaria has been a difficult disease. Attempts to create a vaccine for it have been going on for decades. It is a disease caused by a parasite, not a virus nor a bacteria. No other parasitic disease has ever had a successful vaccine created for it.

Malaria lingers in infected people for their entire lives with periodic disabling relapses. The malaria antigens, that trigger the antibody response, are extremely variable and allow the malaria parasites to evade the body's immune system. It is surprising to me that any vaccine can be developed which is effective against it.

I was researching stuff for another post I was going to make (didn't end up making it), but I think it's worth adding an caveat to your point re parasitic vaccines, namely that we do have anti-parasitic vaccines for livestock [0]. This is not an attempt to down play the general difficulty of anti-parasitic vaccines in general, or of malaria especially. My understanding is that malaria is sufficiently nasty that even repeated childhood exposure typically only grants partial immunity - as opposed to say some other nasty like smallpox or measles which grants much fuller acquired immunity.

[0] http://www.oie.int/doc/ged/d4014.pdf

Oh, you're right. Thanks for the correction.

Im not an expert but I think that bed nets reduce infection in infancy. Where malaria is endemic (and eventual infection is highly likely regardless of preventatives) a vaccine is a good extra proection.

"A bed net is more effective than this vaccine, but nonetheless it is a very significant scientific achievement. I see it as a building block towards much more effective malaria vaccines in years to come."

"Does anyone know: are malaria vaccines not interesting for drug companies because there's no money in them?"

This drug was developed by GSK...

In a general sense, no. Malaria is just a very hard target for vaccine development. Not the hardest, but the limiting factor for vaccines is not just 'interest'. Otherwise, we'd have one for HIV.

I was excited then read this:

"A bed net is more effective than this vaccine, but nonetheless it is a very significant scientific achievement... "

Seems like like I will still be taking that damned medicine when I visit materia regions.

Twist: you are actually visiting the region and you're currently dreaming vividly.

(for those who do not get it, a side effect of many Malaria medications are extremely vivid and realistic dreams)

Why not sales to travelers? Is there no extra productive capacity or is it because the not for profit statement?

I can't say any of this for certain, and I have no qualifications to back it up, but I would assume that any or all of the following may apply:

1) Cost - if a you only visit an area with a risk of malaria for two weeks every year (which is far more often than most holiday makers), then taking a short course of pills that cost pennies a dose will be cheaper than receiving a vaccine that requires three doses and a booster.

2) Malaria strains - if you've been to multiple places in the world with malaria risk, you may have been given different medication. The first time I went to Cambodia/Vietnam I was given Larium, but the most recent time I took Doxycycline because the NHS no longer recommends Larium for the region. For Iran they recommended Cloroquine, which was significantly cheaper. This vaccine may only fight one strain, leaving you to have to take pills for other destinations anyway.

3) Effectiveness in adults - The article suggests that the vaccine was most effective in children within a given age range, so it may be the case that it simple doesn't work on adults. I have no idea if this is likely or even possible, but it certainly seems plausible to me.

I don't know anything about fighting malaria, but it looks to me like they are giving these vaccines to children to get them through the time when they are most vulnerable, rather than giving them lifelong protection.

I don't think (1) really applies. It sounds like the vaccine is very cheap ($20) and you simply don't take the boosters if you're not returning. At that price, the significant side-effects of most antimalarials are more important considerations.

I think you make a valid point, although I was able to acquire a course of Chloroquine to cover me for a couple of months at one week's notice, for <£10, whereas the vaccine would need two months for the three initial doses. So maybe it's a practicality argument that I'm making, rather than a financial one.

Travelers aren't at high risk for malaria. They visit cities and areas where malaria isn't usually endemic.

Eradication of malaria has been a failure because we can't reach the more remote areas where humans live with it. Because there is an animal host (mosquitoes), treating a village with anti-malarials is often a temporary reprieve. There will always be mosquitos and recurrent infections to re-infect the locals after the doctors are gone.

Is this true of, say, Chinese mining engineers?

If you are in a rural area of southern china, drink your gin and tonics daily.

If you are in a city, particularly a northern city, I wouldn't worry about it.

I mean foreign mining engineers in Africa

Sounds awesome. Malaria seems like it has the capacity to really ruin someone's life.

Do you reckon?

http://www.who.int/gho/malaria/epidemic/deaths/en/

> Malaria seems like it has the capacity to really ruin someone's life.

I contracted a unknown variant of malaria when I was a kid. It really wasn't a pleasant experience. There's sickness; then on a completely different level there's malaria.

It won't ruin your life - if you survive you'll be left as healthy as you were before. However, that's IF you survive.

It can leave you slightly more stupid, though: http://journals.plos.org/plosone/article?id=10.1371/journal...., http://www.malariajournal.com/content/9/1/366, http://www.sciencedirect.com/science/article/pii/S0167629612...

> It can leave you slightly more stupid, though

That explains a lot ;)

> as healthy as you were before.

Except that anytime you are otherwise sick or generally run down in the future it could return and make you very ill again (or kill you). I hope that this does not happen to you. Good luck!

While it's widely believed that once contracted you can't get rid of malaria, you actually can(though not in all cases, and it might be hard to prove you are malaria free).

http://www.cdc.gov/malaria/about/faqs.html#treatment

Good knowledge! I wouldn't bet my life on it though.

"Malaria kills around 584,000 people a year worldwide..."

Consider that's more per year than the number of people the United States lost during all of World War II.

"...most of them children under five in sub-Saharan Africa."

Ugh, that's a gut punch.

I have this image of young children storming the beaches of Normandy and how we celebrate as a country when the madness was finally over & our children were no longer being slaughtered.

Science is truly awesome.

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