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Old 13th October 2023, 07:47 PM   #1
Roboramma
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The Case For Rapid Malaria Vaccination

The WHO has approved a malaria vaccine for use in children. This is amazing news. Medical interventions that can cheaply treat the worst diseases, particularly those still affecting millions of people in the developing world, are probably the highest leverage acts for doing good in the world.

One criticism, from economist Alex Tabarrok, though, that I strongly agree with:
Quote:
The WHO, however, is planning on rolling out the vaccine next year.
https://marginalrevolution.com/margi...ccination.html

Quote:
The WHO just approved a malaria vaccine for use in children, the R21/Matrix-M vaccine. Great! There are still some 247 million malaria cases globally every year causing 619,000 deaths including 476 thousand deaths of children under the age of 5. That’s not 1000 deaths a month but more than 1000 deaths of children every day. The WHO, however, is planning on rolling out the vaccine next year.

Adrian Hill, one of the key scientists behind the vaccine is dismayed by the lack of urgency:
Quote:
“Why would you allow children to die instead of distributing the vaccine? There’s no sensible answer to that — of course you wouldn’t,” Hill told the Financial Times. The SII said it “already” had capacity to produce 100mn doses annually.

…“There’s plenty of vaccine, let’s get it out there this year. We’ve done our best to answer huge amounts of questions, none of which a mother with a child at risk of malaria would be interested in.”
Hill is correct: the case for urgency is strong. More than a thousand children are dying daily and the Serum Institute already has 20 million doses on ice and is capable of producing 100 million doses a year. Why not treat this as an emergency?!
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Old 13th October 2023, 08:34 PM   #2
Orphia Nay
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Is that attitude one of privilege?

Remember how long it took for the COVID-19 vaccines to reach many African countries compared to the US and UK, for example.

Is it actually physically (and/or economically) possible to get vaccines distributed there soon?

I would really hope they can distribute them ASAP, but I have doubts and think it's probably easier said than done.
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Old 13th October 2023, 09:15 PM   #3
Roboramma
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Originally Posted by Orphia Nay View Post
Is that attitude one of privilege?

Remember how long it took for the COVID-19 vaccines to reach many African countries compared to the US and UK, for example.

Is it actually physically (and/or economically) possible to get vaccines distributed there soon?

I would really hope they can distribute them ASAP, but I have doubts and think it's probably easier said than done.
I have two issues here. The first is simply that yes, the logistics of distributing vaccines in Africa are difficult and we should certainly expect the process to experience more delays than in the US for example. That's not an argument for not starting that process, though.

The second is simply that while the logistics may be more difficult than in developed countries, that doesn't mean that these problems can't be solved with urgency. I found this from the comments in the post referenced in the OP to be reasonable:

Quote:
Responding to your concerns about African capacity for the handling and administration of the vaccine- here are a few off the cuff points.
1. Because of the high disease burden in Africa, we have very functional capacities for vaccinations. Think about the several routine immunizations that are carried out on the continent.
2. The cold chain requirement you mentioned is not an ultra cold chain. We have been using cold storage for many other vaccines in use in Africa including those for BCG, Tetanus, Rabies etc.
3. Healthcare workers are available and they as I mentioned earlier posses the skills from the numerous immunization campaigns.
4. On the security point, I am now thinking that your understanding of African healthcare delivery systems or public health is not in tandem with the reality on the ground. Africa doesn’t have a functional black market for vaccines- the population is very mistrusting towards medical products in general. There is a reason why even for Covid-19, there had been vaccine hesitancy.
5. You claim that distribution of the malaria vaccine is a massive and complex one. Yes it sounds massive but there actually exists already established networks of distribution for other malaria countermeasures such as insecticide treated bed nets, the door to door IRS program which reaches even the remotest and rural most parts. The Global Fund, Gates Foundation and Against Malaria Foundation are some key players that have contributed to ensuring delivery networks are resilient and effective.

My last point on this matter is this. We can not normalize the loss of lives on account of slow bureaucratic systems. In a world where 1000 children are dying of malaria every day, getting those vaccines to them even 1 day sooner is the difference between life and death.
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Old 13th October 2023, 09:22 PM   #4
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I like point 5, about established delivery networks.

I'm not arguing delaying starting the process. I agree, start now.

I'm just not sure what the WHO think they have to do between now and next year in order to start then. Produce the vaccines? Why not start with what they've got, and keep going?
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Old 15th October 2023, 07:49 AM   #5
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Very interesting. I would hope that this gets implemented as soon as possible.

Some more info here, including effectiveness:

https://www.who.int/news/item/02-10-...n-immunization

Quote:
  • High efficacy when given just before the high transmission season: In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to 4 or 5 months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75% during the 12 months following a 3-dose series. A fourth dose given a year after the third maintained efficacy. This high efficacy is similar to the efficacy demonstrated when RTS,S is given seasonally. 
  • Good efficacy when given in an age-based schedule: The vaccine showed good efficacy (66%) during the 12 months following the first 3 doses. A fourth dose a year after the third maintained efficacy.
So, three doses initially followed by I assume yearly booster doses.
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Old 15th October 2023, 08:17 AM   #6
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I hope they'll be able to design a vaccine against schistosomiasis, too.
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Old 15th October 2023, 09:49 AM   #7
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Originally Posted by Roboramma View Post
The WHO has approved a malaria vaccine for use in children. This is amazing news. Medical interventions that can cheaply treat the worst diseases, particularly those still affecting millions of people in the developing world, are probably the highest leverage acts for doing good in the world.

One criticism, from economist Alex Tabarrok, though, that I strongly agree with:


https://marginalrevolution.com/margi...ccination.html
So... What's the hypothesis? The leadership at the WHO is too lazy to get started sooner? Too stupid? The leadership wants to start right away, but they've only just now discovered that their operations staff are too lazy or too stupid to get started right away, and they need a year of lead time to make the necessary attitude corrections further down the org chart?
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Old 15th October 2023, 06:48 PM   #8
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Originally Posted by theprestige View Post
So... What's the hypothesis? The leadership at the WHO is too lazy to get started sooner? Too stupid? The leadership wants to start right away, but they've only just now discovered that their operations staff are too lazy or too stupid to get started right away, and they need a year of lead time to make the necessary attitude corrections further down the org chart?
I expect that they have systems for doing things that make sense in situations of less urgency. First you form a committee that makes a plan for how to begin the rollout of the vaccines, then that goes through some review process, etc. This probably makes sense in the general case. But in a situation of urgency where hundreds of thousands of lives are at stake and every day counts, those processes should be sped up and the process should be begun while at the same time beginning distribution.

This shouldn't be taken as a criticism of the WHO in general. It's amazing that we even have an organization that can facilitate the international distribution of this vaccine at all, and they should be applauded for their work. I'm only suggesting that Tabarrok is correct that this should be treated as an emergency situation, and as such distribution should be given extreme urgency.
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Old 15th October 2023, 10:23 PM   #9
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Sorry, but only skimmed this thread and want to know what the reason is for not distributing faster. Maybe there is a reason but the person talking about it is merely stating that there is no reason they are aware of. That is not the same thing.

If we knew then it may be easier to either accept or to remedy the problem.
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Old 15th October 2023, 10:33 PM   #10
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The WHO contradicts the OP writer.

It's already being done.

Quote:
Since 2019, Ghana, Kenya and Malawi have been delivering the malaria vaccine through the Malaria Vaccine Implementation Programme (MVIP), coordinated by WHO and funded by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid. The RTS,S/AS01 vaccine has been administered to more than 1.7 million children in Ghana, Kenya and Malawi since 2019 and has been shown to be safe and effective, resulting in both a substantial reduction in severe malaria and a fall in child deaths. At least 28 African countries have expressed interest in receiving the malaria vaccine.

In addition to Ghana, Kenya and Malawi, the initial 18 million dose allocation will enable nine more countries, including Benin, Burkina Faso, Burundi, Cameroon, the Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, to introduce the vaccine into their routine immunization programmes for the first time. This allocation round makes use of the supply of vaccine doses available to Gavi, Vaccine Alliance via UNICEF. The first doses of the vaccine are expected to arrive in countries during the last quarter of 2023, with countries starting to roll them out by early 2024.
https://www.who.int/news/item/05-07-...who-and-unicef
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Old 15th October 2023, 10:45 PM   #11
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Vaccinators aren't welcomed in many places:
Quote:
In conservative Pakistani rural areas, hardline religious groups have long opposed and viewed polio inoculation campaigns as a ploy to leave Muslim children infertile. Anti-state militants operating in Baluchistan and elsewhere in the country view polio vaccinators as government spies.
The propaganda against the vaccine and the deadly militant attacks have set back Pakistan’s efforts to eradicate the crippling disease.
Gunmen Kill 2 Pakistani Policemen Guarding Polio Vaccinators (VOA News, Aug 1, 2023)

This no doubt contributed to making people think of "vaccinators as government spies":
Quote:
The CIA organised a fake vaccination programme in the town where it believed Osama bin Laden was hiding in an elaborate attempt to obtain DNA from the fugitive al-Qaida leader's family, a Guardian investigation has found.
As part of extensive preparations for the raid that killed Bin Laden in May, CIA agents recruited a senior Pakistani doctor to organise the vaccine drive in Abbottabad, even starting the "project" in a poorer part of town to make it look more authentic, according to Pakistani and US officials and local residents.
CIA organised fake vaccination drive to get Osama bin Laden's family DNA (TheGuardian, July 11, 2011)
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Old 16th October 2023, 03:02 AM   #12
Roboramma
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Originally Posted by Orphia Nay View Post
The WHO contradicts the OP writer.

It's already being done.



https://www.who.int/news/item/05-07-...who-and-unicef
Thanks! That does seem to contradict what was claimed by Tabarrok, and seems like good news.

ETA: Though your link still says that they won't actually be administered until early 2024, which is in line with Tabarrok's criticism. Is that really the best that we can do? Would it not be possible for an organization that treats this as an emergency to get the vaccines delivered sooner?
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Last edited by Roboramma; 16th October 2023 at 03:06 AM.
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Old 16th October 2023, 09:55 PM   #13
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Originally Posted by Orphia Nay View Post
The WHO contradicts the OP writer.

It's already being done.

https://www.who.int/news/item/05-07-...who-and-unicef
Originally Posted by Roboramma View Post
Thanks! That does seem to contradict what was claimed by Tabarrok, and seems like good news.

ETA: Though your link still says that they won't actually be administered until early 2024, which is in line with Tabarrok's criticism. Is that really the best that we can do? Would it not be possible for an organization that treats this as an emergency to get the vaccines delivered sooner?
They are talking about different vaccines.

The last paragraph:
Quote:
In addition to the RTS,S/AS01 vaccine, developed and produced by GSK, and in the future supplied by Bharat Biotech, it is expected that a second vaccine, R21/Matrix-M, developed by Oxford University and manufactured by Serum Institute of India (SII), could also be prequalified by WHO soon. Gavi has recently outlined its roadmap to support increasing supply to meet demand.


The RTS,S/AS01 vaccine has been distributed since 2019, but only 1.7 million doses have been administered so far, in 3 countries. The second vaccine, R21/Matrix-M (which is what Tabarrok was talking about) will be distributed starting next year. Also "next year" is less than 3 months away. The goal is to increase production to 40-60 million doses by 2026, increasing to 80-100 million doses by 2030. But, the FT story claims that Serum Institute of India (SII) says that they can already produce 100 million doses annually. If you take that at face value, then the bottleneck is no longer on the production side but on the distribution side. Presumably someone also needs to pay for them, although I read a figure of $2-$4 per dose. If so, it shouldn't be too hard to pay for that. At less than $1 billion for 100 million doses, compared to $12 billion and 1.3% slower GDP growth, which is one estimate of the economic burden of malaria in Africa alone.
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