Ozempic continues to win the year-end list highest honor For achievements in science. But in this new golden age of medicine, one of the most spectacular advances was in the less glamorous field of public health.
In late October, the World Health Organization conducted a large-scale trial rollout of the malaria vaccine RTS,S in parts of Africa. was shown Science magazine reported a 13 percent reduction in infant mortality over four years. It is so surprising that a reduction in mortality in one disease can change the outlook for all child deaths, and the epidemiologist who led the program said that when this news was announced, the audience He said he expected it to be breathtaking.
As a result, RTS,S sounded like a miracle drug. But it immediately seemed like a missed opportunity. Important advances were made more than 30 years before his death, and the vaccine's safety and effectiveness were shown in clinical trials that began in his 1998, but some questions remained about side effects. WHO did not recommend the use of RTS,S. October 2021. Since then, fewer than 2 million children have been vaccinated and only 18 million doses have been administered. 4.5 million childrenIn the quarter century since vaccine trials began in 1998, more than 18 million people have died from malaria, most of them young children.
In the meantime, a new, and perhaps even better, vaccine has arrived. The drug, called R21, has been shown to reduce symptomatic cases of malaria. 75% increase Within 12 months after completing 3 doses. But the rollout of new vaccines has been slow and partially hampered, the Financial Times reported. reportDue to the WHO's lack of urgency, finally added It will be added to the list of pre-qualified vaccines in December.
120 million doses of R21, enough to save lives Over 200,000 According to public health advocacy group 1Day Africa, infants could be born as early as 2024. But even with pre-qualification, far fewer doses are expected than would be expected to be administered immediately. In the December situation report, 1Day was suggested Tens of millions of vaccine doses could go unused this year.
These vaccines are not perfect, and even a global rollout will not eradicate malaria. His 2015 RTS,S clinical trial reported the vaccine's efficacy against clinical disease to be 36.3 percent, but R21 looks more promising. But for a disease of this magnitude, even a limited effect could save a huge number of lives. More than 600,000 people die from malaria each year.More than half of them are children Under 5 years old.
From the promontory of the developed world, it is easy to think that scientific advances and the discovery of new drugs will almost instantly usher in a new era of medicine, and that diseases of poor countries like malaria will be a permanent feature of the world's current state. But malaria kills more than 1,000 children every day, many of whom could be saved at surprisingly little cost with the effective vaccines we already produce. R21's global rollout could cost him just $1 billion in a day calculate, the average cost to save a child's life can be just $4,000.Other quotes even lower.
This may sound like effective altruism, an argument that even small-scale philanthropists can fund truly transformative medical interventions in developing countries. But producing and deploying vaccines is more complex than distributing bed nets. For me, the real lesson is not about finding public health workarounds, but how much can be achieved through strong national action.
In an admirably comprehensive history of the 141-year history of malaria vaccines. published Saloni Dattani, Rachel Glennerster, and Siddhartha Haria laid out a different roadmap in September's Works in Progress. By promising to pay for a vaccine before it is developed, known as an advance market commitment, governments could rapidly accelerate the rollout of medicines.
Clinical trials and pilot studies of the RTS,S vaccine took so long, researchers say, largely because there was no expectation of substantial benefit and related research required philanthropic funding. points out. “Why are you allowing children to die without distributing vaccines?” Asked Adrian Hill is one of the scientists at the University of Oxford who developed the R21 vaccine. Ripley Ballou, who spearheaded the development of RTS and S, Gave It's like an answer to last May's Undark. “Mainly, this is the problem you run into when you're trying to develop a vaccine that no one wants to pay for.” But the solution may be relatively simple, the authors of Works in Progress suggest. Masu. It's about finding a way to pay for it in advance. As they point out, the $1.5 billion pre-market commitment made by five countries and the Gates Foundation in 2009 for a pneumococcal vaccine saved 700,000 lives just 12 years later.
But this is not just a cautionary tale for developing countries, or a morality tale about the indifference of well-funded countries to public health. In the United States, Operation Warp Speed has come to be seen as a similarly moving and groundbreaking milestone, at least for those who still believe in and are willing to celebrate the achievements of COVID-19 vaccines. It is a reminder of how much we have accomplished. If we put our minds to it, even in the wealthy world, we might be able to do something for public health.
In some quarters, the success of Operation Warp Speed has been described as a triumph for entrepreneurs. Businessman Jared Kushner assembled the brightest innovators from biotech and Silicon Valley to run a ruthless, red tape operation. to start. However, the federal government's advance market commitments Key drivers of program success: Sufficient funding was guaranteed upfront not only for mass vaccination but also for the cost of conducting expensive clinical trials.
This is not the usual strategy for drug development, either domestically or globally. But maybe you should consider working on it a little more often.
