The Vaccine That Took 40 Years to Make – The Journal. – WSJ Podcasts


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Kate Linebaugh: Paul Kofi Awuffor is a public health officer in Ghana, and he thinks a lot about malaria.

Paul Kofi Awuffor: It is so common, everybody knows malaria in Ghana and in my community.

Kate Linebaugh: For one thing, Paul’s had malaria several times.

Paul Kofi Awuffor: I’ve had malaria, even this year, I think I’ve had malaria.

Kate Linebaugh: What did it feel like to have it?

Paul Kofi Awuffor: Very painful. You have severe headache. You have chills, you have general body weakness, you have loss of appetite, and it is very painful, very painful.

Kate Linebaugh: Malaria, which is transmitted by mosquitoes, kills more than 400,000 people a year. Two thirds of them are children in Africa under the age of five. Just a few years back, Paul’s four year old son got malaria. He came down with symptoms in the middle of the night, and Paul had to rush him to the hospital.

Paul Kofi Awuffor: He was there for three days but he was given some infusions. He was very, very weak with high temperature, high temperature, the body was very hot to touch, not even warm, very hot to touch.

Kate Linebaugh: Were you scared?

Paul Kofi Awuffor: Very scared. I was so scared. So scared.

Kate Linebaugh: Paul’s son recovered. But as a public health worker, Paul continues to deal with malaria every day. And he says the disease affects more than just physical health.

Paul Kofi Awuffor: Malaria affects the life of people who get it, economically. Economically, when someone gets malaria, it takes you no less than a week before you are fully recovered. And if you are admitted to the hospital, it means that you won’t be able to go about your normal day to day business. And if a child, the parents, or the parent is also not able to go to work because the child is being admitted to the hospital. And when it comes to health, as I said, it is very devastating, it can lead to death.

Kate Linebaugh: But Paul has a new reason to be hopeful. Last week, the World Health Organization announced the rollout of the first ever vaccine for malaria, one of the deadliest diseases in history. Welcome to The Journal, our show about money, business and power. I’m Kate Linebaugh. It’s Friday, October 15th. Coming up on the show, the long held dream of a malaria vaccine and how it became a reality. A lot of people have followed the development of COVID vaccines, which took less than a year to develop, the fastest vaccines ever. But the story of the malaria vaccine is a very different one. Our colleague, Denise Roland has been covering its development, which has taken about 40 years.

Denise Roland: It’s a story that caps off a very, very long tail. The length of it is, I think the most extraordinary thing about it.

Kate Linebaugh: So why has a malaria vaccine not existed up until this point?

Denise Roland: So I think a lot of it comes down to just how hard this thing is to vaccinate against. Malaria is a really, really complicated parasite. It’s got about 5,000 genes in its genome, that means it makes 5,000 proteins. Those are all possible targets for a vaccine. COVID only has about 13 genes and it has a really big obvious spike protein on its surface.

Kate Linebaugh: But it’s not just the science that makes the malaria vaccine different from COVID vaccines. It’s also the funding. Malaria hasn’t gotten nearly the amount of money or political attention that COVID has.

Denise Roland: Even with all the funding in the world. It would’ve taken longer to develop a malaria vaccine than a COVID vaccine, but funding can speed up clinical trials. It can speed up the initial science because you put more scientists into the lab and get stuff on more quickly. Funding will always accelerate a process.

Kate Linebaugh: In the absence of a vaccine, doctors and public health workers have figured out other ways to fight malaria.

Denise Roland: And that was through a combination of insecticide treated bed nets, insecticide in general using these antimalarial preventative medicines. So you can get these pills that can prevent to taking hold in you in the first place. And also just improvements and access to treatment for malaria. So some progress has been made, but that progress has been stalling over the last few years. They seem to have maxed out where you can get to with those kind of interventions.

Kate Linebaugh: Before they stalled out, those interventions were very successful. Between 2000 and 2019, deaths from malaria fell about 44%, but to fully get malaria under control, a vaccine is a key tool, which is why scientists have spent decades working to find one.

Denise Roland: The scientific breakthrough that laid the foundation for this vaccine happened out of NYU in 1979. It was by this team of scientists led by a married couple, Ruth and Victor Nussenzweig. And the key discovery from them was they honed in on this one protein that they thought had potential. So they were the ones that identified what’s known as the antigen that would form the basis of the vaccine. A few years later, that was taken up by the company that would become GlaxoSmithKline.

Kate Linebaugh: GlaxoSmithKline or GSK is a British drug company. In the 1980s, when it was called SmithKline, the company tried to take that antigen discovered at NYU and turn it into a vaccine. At the time, it was the only major pharmaceutical company trying to make a Malaria vaccine. And that’s partially because there’s not a lot of money in it.

Denise Roland: Problems that mostly affect poorer countries do just attract less money. They rely more heavily on donor money. It’s not the same as, I guess, governments throwing all they’ve got at a problem. And when it’s a really hard and like eradicating malaria, it kind of plots along, but nobody’s deciding to throw everything at it.

Kate Linebaugh: Feels like it would be prestigious though, to find a vaccine for one of the oldest human ailments.

Denise Roland: Right. Yeah. I mean, I think there’s an element of just sort of scientific pride in having done it, even if they’re not going to get commercial payback.

Kate Linebaugh: Did GSK ever think about giving up?

Denise Roland: Yeah. Well, there was a moment in 1999 where they’ve done a bunch of the early science and laid down some foundations, but they were wavering about whether to keep it going. At that moment, the unit of GSK that was working on it actually went and applied for funding from the Gates Foundation. And that’s what kept the program going.

Kate Linebaugh: GSK says it spent more than 350 million dollars of its own money developing its malaria vaccine. And on top of that, it got another 200 million dollars from donors. All that funding helped GSK try different things over the years to improve the vaccine. It tried things like adding another protein from the parasite into the mix to see if that would cause a stronger immune response. It also experimented with different substances that you can add to a vaccine to try to kick up the immune response. And years after GSK almost gave up, it landed on a malaria vaccine that it was ready to test on a large scale. That’s after the break.
In 2009, GSK had been working on a malaria vaccine for 20 years and it was finally ready to take the vaccine to a late stage clinical trial. The vaccine was given to 15,000 babies in Sub-Saharan Africa in two age groups, one to four months and five to 17 months.

Denise Roland: They tracked these kids for a few years. And the big final result was that about 36% of the older age group were protected against malaria four years on. And it was about 26% of the little babies who were protected. I think three years on in that case. The protection was a bit lower against severe malaria in both groups. In fact, in tiny babies, there was no protection from severe malaria three years on.

Kate Linebaugh: These results came out in 2015. They averaged out to about a 30% efficacy rate, which was…


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