Just over $600M a year goes to malaria R&D. Can COVID-19 change that?

MANILA — The accelerated phase of vaccine development for the novel coronavirus has experts hopeful that it could have knock-on effects for other diseases, such as malaria. On average, malaria research and development have seen just over $600 million in investment annually from 2007 to 2018.

“For a biologically complex parasite transmitted by a mosquito, [these are] really very small numbers,” said Dr. Pedro Alonso, director of the World Health Organization Global Malaria Programme, during a press briefing for this week’s launch of the “World Malaria Report.”

Total malaria R&D investment from 2007 to 2018 was over $7 billion, according to data from Policy Cures Research in the report. Of that total, about $1.8 billion went to vaccine R&D. In comparison, U.S. investments in vaccine R&D for COVID-19 this year through the Biomedical Advanced Research and Development Authority have exceeded $11 billion.

The minimal investments have an impact on vaccine development. The world’s first malaria vaccine, GlaxoSmithKline’s RTS,S vaccine, which started undergoing pilots in three African countries in 2019, was 30 years in the making.

The RTS,S vaccine has modest levels of efficacy, and immunity against malaria wears off a few years after the final shot. It is likely that the malaria vaccines to emerge in the next five to 10 years will have characteristics similar to the RTS,S vaccine in terms of efficacy and levels of protection, said Ashley Birkett, who leads PATH’s Malaria Vaccine Initiative.

“That major breakthrough in terms of a vaccine that could provide very high level protection — the 80, 90% protection — and then provide protection for many, many years after immunization, I think we're still a very long way from that goal, because we've still got a lot of knowledge to gain on the parasite and how to target it effectively. It’s just a very difficult biological challenge, and one that we’re still grappling with,” he told Devex.

There has been some “exciting” research in the past few years that is informing malaria vaccine development, such as new approaches to target the blood-stage malaria parasites that cause clinical disease. There have also been promising advancements in vaccine approaches that block parasite transmission between humans and mosquitoes.

Both of these vaccine approaches have shown evidence for biological activity against the parasite in human volunteers over the past three to four years, which confirms further investment is appropriate, Birkett said.

Most malaria vaccines in clinical trials today, however, target the malaria parasite Plasmodium falciparum, which accounts for the majority of malaria cases and deaths worldwide, and very few target Plasmodium vivax. P. vivax remains the most common cause of malaria outside Africa, and more investment in vaccines targeting this parasite is needed.

But again, investments in moving promising research into clinical trials will be critical, as well as in implementation.

“You often think that once you've developed a vaccine, tested in phase three … all the heavy lifting is done and most of the investment is made. But what we're learning from the RTS,S program … [is] that you often need many hundreds of millions of dollars after you've completed the traditional development to do these additional what we call ‘research for implementation’ studies to generate ... more safety data in larger numbers of people, as well as to figure out how to best use the intervention in the field,” Birkett said.

But Birkett said the rapid development of COVID-19 vaccines has challenged those working on malaria and other diseases.

“I think it's challenged everybody to say: ‘Look at what we can do ... when we're faced with a pandemic. Look at what's actually possible,’” he said.