Reuters looks at cost-effectiveness of pursuing malaria vaccine, eradication

Dec 15 2010

Reuters examines the effort to create an effective malaria vaccine and asks: "[I]s the vaccine - and the global health community's aim of completely eradicating a disease that kills a child every 45 seconds - really worth the money?"

"It may seem an absurd thing to ask. Malaria threatens half the people on the planet and kills around 800,000 people a year, many of them too young to have even learned to walk. The death rate has come down in the last decade, but full-scale eradication will cost billions and drag funds away from other equally, or possibly even more urgent health efforts," the news service writes. "As governments in poor countries and donors from wealthy ones weigh up where to put their money, experts have begun a quiet but fundamental debate about whether wiping out malaria is realistic or even makes economic sense," according to Reuters.

The article highlights GlaxoSmithKline's RTS,S vaccine candidate, noting that its cost could be a concern. "GSK has promised it will be cheap, with a profit margin of 5 percent over the cost of making it to be reinvested in new vaccines for malaria and other neglected diseases. ... But the company has yet to give an exact figure to enable direct comparison with, say, the cost of insecticide-treated mosquito nets - currently available for around $5 each. [GSK CEO Andrew] Witty points out that mosquito nets typically last around 20 washes, or three to four years, while a vaccine may last a lot longer," the news service writes. 

"The cost-benefit analysis that donors must make when they work out where to spend their money is sure to be a lot more complex with this vaccine than with those targeting other diseases such as polio and smallpox. For those diseases, vaccines virtually guarantee (or guaranteed, in the case of smallpox, which was eradicated in 1979) people won't get sick. With malaria, the picture is more complex, given its transmission cycle via mosquitoes and the practical steps that can already be taken to reduce the risk of infection," Reuters continues.

The article also notes other experimental malaria vaccines under development at the PATH Malaria Vaccine Initiative (MVI), Sanaria and others. "These are promising leads for the future, but some experts fear the race for smart technology may risk sidelining the effective tools that already exist," the article writes. Chris Whitty of London School of Hygiene and Tropical Medicine said, "The fact is our biggest problem with malaria at the moment is that we are not getting the technologies we know work and are already there to the people who need them."

The role of the GAVI Alliance is noted and its success with other diseases are listed. "If it wants to beat malaria, the GAVI Alliance will have to up its game even further. It is already $3.7 billion short on donor money to fund its work through 2015, and that's before any new malaria vaccine," according to Reuters. Nina Schwalbe, GAVI's managing director for policy and performance, acknowledged that a malaria vaccine cannot come at any price. "In order to be taken on it has to be cost effective," she said. "What that means is clearly defined by the World Bank: interventions are considered cost-effective if they save a year of healthy life for less than a country's average gross domestic product per head," Reuters adds.

Experts differ on whether to focus on finding an effective vaccine and malaria eradication. Oliver Sabot of the Clinton Health Access Initiative "and others say countries could focus instead on achieving 'controlled low-endemic malaria,' where the disease still infects and might still kill, but no longer ranks as a major health concern."

On the other hand, PATH MVI Director Christian Loucq believes finding a vaccine "is a price worth paying and draws a comparison with smallpox. ... 'For the detection of the last cases, when people were running all over the globe chasing those last few - the costs of that were enormous - but they still did it,'" Loucq said.

Several other experts are quoted in the article, including: David Brandling-Bennett of the Bill & Melinda Gates Foundation; Roma Chilengi, a doctor working on the RTS,S trial in Africa; biologist Joe Cohen; and Richard Feachem, a malaria specialist and director of the Global Health Group at the University of California, San Francisco (Kelland/Hirschler, 12/14).