S1-Episode 2: Historic Malaria Vaccine Breakthrough

Episode intro

Josephine: This is the Africa Renewal podcast, I am Josephine Karianjahi.

Melissa: I am Melissa Mbugua.

Josephine: In this episode…

Dr. Ogutu: This was a vaccine that was developed targeting the African continent and is incumbent on the managers of the health sector in Africa to ensure that this vaccine is deployed as soon as possible.

Episode background

Melissa: 

Today we are discussing an African expert on the timely topic, which is the the recent endorsement by the World Health Organization of RTS, S Malaria vaccine,

Today’s guest is Dr. Bernhards who has worked extensively in public interest Research and Development in delivering medical innovations urgently needed to achieve universal health coverage and the sustainable development goals. He believes the Malaria vaccine is a game changer in Malaria control and possibly a way towards its elimination.

Dr Ogutu is the Chief Research Officer with the Kenya Medical Research Institute and the founding President of the East African Chapter of the Association of the Clinical Research Professionals (ACRP). He is also the Senior Clinical Trialist with the Malaria

Clinical Alliance of the INDEPTH Network, and he is also the Director for the Center for Research in Therapeutic Sciences at Strathmore University in Kenya.

He holds a Ph.D. A Master of Medicine (MMed) and a Bachelor of Medicine and Bachelor of Surgery degree programme (MBChB) all from the University of Nairobi and he is a certified Medical Practitioner, Pediatrician and Clinical Pharmacologist.

Dr. Ogutu and his colleagues in Kenya worked with other researchers and experts from different African countries, Europe and America in the search for the Malaria vaccine.

Josephine:

For Africa, malaria is deadly, and for centuries malaria has been known around the world, it has caused so much suffering and it has lost so many precious people. The pandemic made it worse. You see malaria needs access to health services for treatment and to be able to control the spread in any area, but with the pandemic taking over precious scarce resources across Africa, this didn't happen and unfortunately Africa has been hit harder by malaria deaths than many other areas in the world. We are so lucky that when we were preparing for this episode, and preparing for it, the WHO released the 2021 Malaria report. One of the things that really struck me about this report is that 10 of the worlds 11 highest burden countries for malaria are in Africa.

There were an estimated 241 million malaria cases and 627,00 malaria deaths worldwide in 2020. Of all the people who die of malaria each year, about 80% of deaths in Sub-Saharan Africa are among children under 5 years of age, and this information shared by Dr. Abdi Noor who is the head of the strategic information for response unit of the WHO global malaria program hit me even harder. This tool, this vaccine is actually such a critical strategic choice for the WHO, as an innovation for us to really accelerate progress as a world, where we can reduce the number of cases of malaria and get back on track towards reducing the impact of malaria on the population as well as the number of deaths attributed to malaria.

This RTS,S vaccine is the first vaccine ever to be recommended by the WHO against a human parasite.

We’re so privileged today to be able to talk to somebody who has been working in clinical trial development and the work to bring the malaria vaccine to the population that need it the most and specifically to offer hope across Africa.

Melissa: Congratulations on this very exciting milestone with developing a malaria vaccine. Malaria has been a very well known and very big problem, a number one killer in Africa so we are very curious to know, and for the audience as well, I'm sure, they're very curious to know, how did this global group of researchers come up with RTS,S malaria vaccine and what was different this time compared to all the decades before, during which this malaria vaccine research has been happening?

Dr Ogutu: Thank you very much and it's a pleasure to discuss this. It's not that this happened in this decade, these actually part of work that has been going on, and there have been several trials and failures and learnings. Most of the thing people call failures are basically learning experiences because the first time the RTS,S was actually tested in people and possibly found to have some potential of being a vaccine was around 1985/86. The work was published in 1987 by the US military.

This work that has been going on from those years, from the 80s till 2015, when it was actually approved that now it is a vaccine that can be produced and marketed and used by the public.

Melissa: Mm-hmm, wow. Can you take us through the journey? How many countries have been involved in the development over the two decades that you've talked about?

Dr Ogutu: Yeah because most of this work starts up from the bench, we have somebody who's doing the basic science. The first thing that happens that somebody describe the parasite and somebody identified that this the stage that we need to target. And this is because this vaccine targets the early stage when it enters the body, which is basically the stage in the liver. The main thing is that if you can target the parasite at that liver stage then you're not going to get into the blood stage, which gives you the

symptoms. That's why this becomes a primary target. The basic science is identified, okay, this is the code of the parasite at this stage and the vaccine is based on the coat, or the wall of the liver stage of the parasite. I think then the next people looked at how, if we get these studied and then we can synthesize it and possibly that these are studied, and then we can synthesize it, and possibly add a few things. Then maybe it can become more provocative to the immune system so that it can help the body develop antibodies, or prime the body immune cells to react and possibly kill the parasites when it comes to you, you're admitting attacking the parasite the next time.

And this is what was done. Actually, this vaccine contains components of that wall of the liver-stage of the parasite, which is also fused with components of Hepatitis B virus. And then with a few other excipient that make it more immunogenic. So actually, apart from this, the only thing that we don't talk about is that this is also a very potent Hepatitis B vaccine, this combined with the Malaria vaccine.

Some of the tweaking around that was basically done by the group at DSK and may end up becoming a more immunogenic molecule.

So with that, then a number of the initial studies like I've said, was done in the US military lab in Maryland. And that's when they had the first time of that. Then when DSK picked it up, then this work that had been done in Kenya started being part of development fairly early in the 90s, when we are still doing some of the studies in adults, just to see how well the adults respond to it before we move down to children.

After that, then that's when we got the expansion to seven countries that was Ghana, Burkina Faso, then we had Gabon, then we had Tanzania. Then we have Malawi. Then we had Mozambique as part of the team that were involved with that. And they were involved at different stages, and also in the final stage. And now, what has been happening since the 2017 was basically pilot deployment, which now this was going on basically in the three countries, Kenya, Malawi, and Ghana.

So it can be rolled out in large scale in those countries that need to roll it out.

Josephine: Thank you for saying that, Dr. Ogutu. So when you talk about the 90s and the beginning of this particular malaria vaccine need for Kenya and researchers, I can imagine like many other medical personnel across the continent, and even across Kenya, you worked quite hard on this process, even as malaria has been so devastating and prematurely ending lives of many of Africa's best and brightest. And I must ask, did you ever lose hope? What kept you going?

Dr Ogutu: I think some of these things, especially when you're in research, there's lots that go on. And when you are working on something, this was not the only malaria vaccine of worked on. The other malaria vaccine candidates that I worked on, that didn't perform. And for everyone that you worked on, there are lessons you learn. And even after the RTSS, the other potential second generation vaccines that we have looked at, which have also fallen by the wayside. And we were looking at the whole sporozoite, which is basically looking at the entire parasite, the entire stage of that parasite, and just killing it and using it whole as a vaccine.

We got this information that there's a new vaccine that was found to be more with a higher efficacy from Burkina Faso, with the University of Oxford group. It is actually a different version of the RTS, S. Being given in lower doses.

And I think some of the things that have also happened, which is what are going to change the landscape of how this is going to be done is that for a long time, for academic reasons, the scientific committee was very hesitant on using genetically based vaccines like the RNA and the DNA vaccines, but because of the desperation around COVID, we have realized that these technologies are as safe as we never thought they are. And now we might start seeing more vaccines, even some of the new vaccines for malaria, using the same similar platforms. And this might totally change the landscape and possibly the way the vaccine development is going to continue in the next several years So the main thing around this is that, as new technologies come up, it gives people hope that if you apply them well, then you're likely to succeed where you didn't succeed in the early stages of development.

And I think that’s what we’re going to see and people are be becoming more aggressive. We might be starting to look at more parasites, because the malaria vaccine is the first anti parasitic vaccine ever to be developed for human beings.

Melissa: This is evidently quite a milestone moment in the history of humankind. And also very hopeful, because as you mentioned, out of the last year, out of the pandemic, COVID 19 pandemic has come this new perspective on looking at vaccines and how to develop them.

I'm sure everybody who's listening to this episode is curious to know from you, how this vaccine will help fight the number one killer disease in Africa? We've been hearing so much about the dangers, and the loss brought on by malaria. So what's the new story we can hope for now that this vaccine is out?

Dr Ogutu: The main thing is that if we know that if we apply the vaccine at the right time, in good enough number of children that are affected. this was a vaccine that was developed targeting the African population because that's where the problem is. And it is incumbent on the managers of the health sector in Africa to ensure that this vaccine is deployed as soon as possible. Countries like Kenya, Malawi, and Ghana are lucky that they are part of the pilot deployment. So their systems are more or less ready. Because every year lost, we are talking of tens of thousands of children that have been lost, possibly some that you can prevent. So if you have something that can help you mitigate these deaths, the sooner you apply it so that you can reduce your losses, that's the most important thing. And the other thing that is going to change possibly in the landscape the way we're going to use the vaccine, and the drugs, and other interventions to see how well we can make them triple their efficacy. Because we realize that even the Saharian region, when they are used, the RTSS vaccine in combination with seasonal chemoprophylaxis for malaria, the impact was much bigger.

Josephine: Thank you for mentioning the idea of prevention. Because in the past we read a quote that you've mentioned in the past that you said that we to get out of the mode of waiting for a sick patient. How does the vaccine move us into the mode of being more proactive, even as, for example, across Africa? The capacity of many medical settings is not as robust as it could be. So how does a vaccine support those medical professionals across the continent to be able to create impactful prevention strategies for the children who are eligible now, and hopefully soon the adults in the future?

Dr Ogutu: I think this... We have a tool that is primarily for prevention unlike the drugs that we have had for quite a while and we tended to use them purely for treatment.

Which we can say was basically dealing with the tip of the iceberg. So you ask yourself, do you want to preserve the drugs and let people continue dying? Or can you use them and possibly clear the disease even if we are going to possibly lose the drugs, but we stalled the whole thing once and for all.

So these are basically serious decisions that we need to make. But we have not made them because the Africans leaders have not owned malaria as their problem.

Melissa: Mm, thank you for that. Very straightforward. This was very clear statement about what's needed. As an African yourself who has invested so much of your life and your time, your career, essentially, to developing healthcare solutions and the malaria vaccine. I want to take you back if you'll allow me to the day when the World Health Organization announced about the malaria vaccine, how did you feel? And did you ever feel, did you ever think that you would be part of such a historic moment for our world, Africa in the world when you began your career?

Dr Ogutu: Well, I think some of the things that you look at is what can you contribute? And what I would want to say is that if you're given work to do, do it as if you will not have a chance to do another one, but plan as if what you are doing is not the end and you are looking for what next. The thing that possibly one needs to know is that basically you are like the chef working in the kitchen and you don't expect the customers to tell you the food is great because you always remain in that background. And for us is to make sure that those who are seeing the patient, the frontline healthcare workers, have the tools and have the proper way to use those tools, to make sure that the patients all the human health is maintained at all costs.

Josephine: That is so true. So what are now the next steps that are needed to make sure everyone who needs this vaccine can get it against a backdrop of the times we are living in now?

Dr. Ogutu: It is upon the African countries to put their house in order, look at what they require, how they're going to deploy these vaccines so that they can present their case to WHO and GVIRF early enough so that the manufacturers can start doing the jobs because even the manufacturer I need to know if I'm manufacturing the vaccine, how much do I need to manufacture? Who needs it? And what is the outlay for the next 10 or so years?

Josephine: For sure. And also one of the questions that we have when we think about Africa's young adults who are the majority of the population, many of them are asking, when are we likely to have a malaria vaccine for adults? What can you say to this question?

Dr. Ogutu: Some of the things that are being looked at is expanding the age bracket where you can use this, especially for those who have not been exposed to malaria. So this work that is in progress. And everybody would be happy that we get a vaccine that will possibly cut across the age bands.

The malaria vaccine discovery has not stopped. It has actually been ignited. And I think there's more resilience now to possibly look at what are the next antigens that would more or less can give us a better result. And I think there's work going on around this, around the clock.

People have not stopped working. Is only that you not hear much about them because you don't want to talk on some of these things so early. Because with the nature of research of product development, we say that even if you're developing a drug, when you start with 10,000 compounds, if you're lucky two might make it to the shelf. That's how our attrition rate is in discovery for new products. That's why things will remain quite until you are very certain that you are getting into the touchline for possibly getting something to the market.

Josephine: One of the things that we always want to know from our guests is what haven't we asked about the ITSS malaria vaccine that you'd like to comment on?

Dr Ogutu: What I can possibly say that is getting involved and being part and parcel of this development is getting African scientific community to the stage where we need to start investing heavily on research and development, so that these things can happen within the continuum from stage one to the last stage.

Until the day we tune ourselves that that's how we are going to act and consolidate the resources, both human and physical, that we look at ourselves as a group. Because the US does that, the Europeans are doing that and the EU. And that's how they are able to run bigger programs.

There is no way a small country with a small economy in Africa is going to face this alone. We have to start moving. And this is where the African union needs to start looking at itself in the face and say, "How do we move together?" Some might lag, but we need to carry one other along to ensure that we can bring scientific independence to Africa.

Melissa: Very well said. Thank you so much, Dr. Ogutu, for taking your time, for your very clear and spot on, to the point guidance on the malaria vaccine. And also on hope, a picture of how we can get to the Africa that we want. I'm sure to everybody listening, you feel inspired, informed. And now, you know the right questions to ask about the malaria vaccine and getting yourself involved and protecting yourself and your community. Thank you so much, Dr. Ogutu.

Dr Ogutu: My pleasure too. You are the future and you are the leaders. As we are on the back banner, you guys drive this to the next level.

Episode outro

Josephine: This episode of the Africa Renewal podcast was produced by the United Nations department of global communications and Africa Podfest.