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Published online 27 February 2008 | Nature 451, 1042-1046 (2008) | doi:10.1038/4511042a
News Feature
Malaria: The end of the beginning
After decades of work, a pioneering malaria vaccine may soon reach the final phase of clinical trials. In the first of two features on efforts against malaria, Brendan Maher reports on a vaccine that is far from perfect - but which may provide new direction and save thousands of lives.
In 1987 Rip Ballou taped an ice-cream carton to his arm. The young US Army doctor was doing his bit for science; inside the carton five hungry mosquitoes set about doing theirs.
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I was shocked to find that no mention was made to the work of Manuel E. Patarroyo (Nature. 1987; v328: p629) misrepresenting the history of the creation of the malaria vaccine. It seems that the absence of credit stems from the triumph of commercialization (6th paragraph already brings up the massive monetary gain to be had) than the welfare of mankind. Dr. Patarroyo (CMAJ. 1995 Nov; 153(9):1319-1321) developed the first malaria vaccine, SPF66, documented it in 1987 and donated the patent to WHO for no financial benefit. It was disappointing to see that this article failed to convey the whole picture.
Richard Foster raises a useful point. Indeed many of my sources on this story were involved in trials of spf66 as developed by Manuel Pattaroyo, and they spoke with reverence of its role in pioneering malaria vaccine field studies in endemic areas. Spf66 contains antigens both from the sporozoite and from the blood stage parasite and had been deemed promising from the immunogenicity that it elicited in human studies. But alas, it’s my understanding that the vaccine failed to offer any protection in African field trials and that the indications of protection seen at one point in South America disappeared with more robust studies. Many of the people I spoke with in reporting this story pointed to the important role these studies had in the design and roll out of clinical trials with RTS,S. So, it is another facet of this multilayered story. Certainly if every contribution to the development of RTS,S -- be it blind alley, success story, or failed attempt -- had been mentioned, it would have filled the pages of this magazine. That said, this comments board is certainly a good place to fill in more details of the vaccine’s past and future, and I welcome more comments of this nature. I’ll add that you’re not alone in having concerns about the high profile of RTS,S’s development and I hope that such concerns were made clear in this story. It’s a vaccine with an uncertain future and a very rich history.
As the only surviving member of the group that did the work noted in this article as "The work culminated in a landmark 1973 paper describing long-lasting protective immunity in humans inoculated with irradiated sporozoites2", I have more than a little interest in this issue. This report by Brendan Maher is the most informed and best balanced of any of the news articles that I have seen on malaria vaccines. However, I do agree with Adrian Hill's comments that it is unwise to depend only upon one approach. I believe that it is both presumptious and dangerous to place all of the bets on one horse. Many people have contributed to these advances over the years and continue to do so. More basic research continues to be needed together with the vaccine development work that this article focusses upon. However, the door seems to have largely been shut on this.