Now, a Malaria Vaccine

As the Covid-19 vaccines compete with new variants and sometimes fierce political resistance around the world, researchers in Africa have been testing another breakthrough vaccine, for malaria. The parasite that causes malaria has been with us for tens of thousands of years and remains endemic in nearly 100 countries near the equator in Africa, Asia, and Latin America. Transmitted from person to person by a single type of mosquito, the disease is estimated to have killed billions over the course of human history—and continues to kill nearly half a million people every year, most of them children under the age of five in sub-Saharan Africa. The new vaccine, approved by the World Health Organization in October, is the first successfully devised not only for malaria but for any parasitic disease. Known as Mosquirix, the vaccine has only demonstrated about 50 percent effectiveness in large trials, and children have to get it when they’re five months old, with three booster shots over the following three years—a tough proposition in the relatively remote, poor areas where malaria is most common. Given these complications, what difference will the new drug make?

Pascaline Dupas is the Kleinheinz Family Professor of International Studies and faculty director of the King Center on Global Development at Stanford University. According to Dupas, the vaccine could mean a major turning point in the developing world, particularly sub-Saharan Africa. Beyond saving lives, significantly reducing malaria, as the vaccine has the potential to do, will lead to improved human and economic development. Combined with existing insecticide-treated bed nets, malaria treatments, and efforts to control mosquitos, Mosquirix could even spur a movement to eradicate the disease for good. To Dupas, the only thing now lacking for an adequate distribution of the vaccine—and the attendant push to wipe out malaria altogether—is money.

Michael Bluhm: How important is this new medicine?

Pascaline Dupas: It’s super-important, because malaria is a huge problem. It’s long been one of the most pressing issues of our time. I’ve been very frustrated that it’s felt as though people have given up on eradicating malaria. I never quite understood why, because it kills so many kids, and it makes people unproductive. Imagine getting the flu over and over and over again—as a child, it’s a deadly thing.

A vaccine is a great tool, even if it’s not fully effective. Now, it’s for kids, and it would be about 50-percent effective at reducing incidence—it’s still a huge deal. Imagine that a year ago there was a vaccine for Covid that was 50-percent effective—everybody would have jumped on it if that’s the best we had.

Bluhm: If the vaccine alone won’t eliminate malaria, what difference will it make on a human level?

Dupas: For the people who aren’t going to die thanks to the vaccine, it’s a matter of life and death. For their parents, you can imagine what it means to feel that there’s a Sword of Damocles over your infant’s bed through the first five years of their life. It’s crippling, it’s terrible. If there’s a vaccine that reduces the likelihood that your child has a deadly infection, that changes your well-being as a parent, your mental bandwidth, and your ability to have aspirations, see the future, and not always be worried.

There’s not just lower mortality—there’s also lower incidence, fewer visits to the hospital, and less cash spent on treatment, which frees up parents’ resources.

For those who don’t get sick when they’re kids—and especially for those who don’t get cerebral malaria, which is very bad for cognitive development—their potential can be realized to a much greater extent. It’s been shown that if you have malaria early in childhood or throughout childhood, it cripples your ability to develop cognitively and to pay attention in class.

These aspects of human capital are interrelated. Your health matters for how much education or knowledge you can acquire. If you improve the health of very young children, you allow them to realize their potential.

Bluhm: Malaria and other diseases have long been among the top public-health problems in the developing world. What are the implications of the new vaccine for other diseases and public health generally?

Dupas: Imagine that it’s implemented at scale, and most kids in malaria-endemic areas get it. That would reduce the burden on the healthcare system. That could free up resources to better take care of other things.

If your system isn’t weakened because of malaria, then you’re less susceptible to other illnesses. There could be positive effects on other aspects of the health system from being able to reduce malaria.

There’s a question of how you implement the vaccine and make sure kids get it. That may require some changes to the system before the full benefits can be reaped.

Your health matters for how much education or knowledge you can acquire. If you improve the health of very young children, you allow them to realize their potential.

Bluhm: You and other economists have argued for many years that malaria, and disease more broadly, have had an enormous—and under-appreciated—effect in slowing growth in sub-Saharan Africa and other developing areas. How does malaria stunt economic development?

Dupas: You’re right that it’s been much more debated than I believe it should be. The disease burden is a brake on development, and malaria is one of the biggest diseases, especially in sub-Saharan Africa.