Abstract
Malaria remains a major health burden especially for the developing countries. Despite concerted efforts at using the current control tools, such as bed nets, anti malarial drugs and vector control measures, the disease is accountable for close to a million deaths annually. Vaccines have been proposed as a necessary addition to the armamentarium that could work towards elimination and eventual eradication of malaria in view of their historical significance in combating infectious diseases. However, because malaria vaccines would work differently depending on the targeted parasite stage, this review addresses the potential impact various malaria vaccine types could have on transmission. Further, because of the wide variation in the epidemiology of malaria across the endemic regions, this paper proposes that the ideal approach to malaria control ought to be tailor-made depending on the specific context. Finally, it suggests that although it is highly desirable to anticipate and aim for malaria elimination and eventual eradication, many affected regions should prioritize reduction of mortality and morbidity before aspiring for elimination.
Highlights
Malaria transmission is falling in some parts of Africa as anti-malarials, bed nets and other vector control measures become more widely available [1,2,3,4]
More efforts on combined and multi-stage vaccines with potent adjuvants will be necessary ingredients for the malaria elimination agenda [51]. This call for malaria elimination should be extended to all stakeholders from funders of malaria vaccine work through endemic country governments, research institutions, control programmes and down to the individual family faced with the daily challenge of malaria sickness
The global community working towards malaria control and eventual elimination is faced with many difficult challenges which cannot be fixed by a magic bullet
Summary
Malaria transmission is falling in some parts of Africa as anti-malarials, bed nets and other vector control measures become more widely available [1,2,3,4]. The leading malaria vaccine candidate in development RTS,S, which is currently undergoing phase III field evaluation in African children, has progressed based on demonstrated efficacy against clinical malaria recently reported to be around 50% in the field [11] This good news of a possible vaccine against malaria in the foreseeable future has revived the possibility of enhanced malaria control and perhaps incited the call for malaria elimination and eventual eradication. Based on the possible transmission dynamic factors in the Macdonald formula, this review looks at the potential impact of vaccines targeting the various malaria parasite stages would have on the basic case reproduction rates. The most advanced candidate vaccine RTS,S recently showed an adjusted efficacy against clinical episodes of malaria at 53% (95% CI 28-69; P
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