It kills hundreds of thousands a year and infects many millions more across the globe, but no place bears the brunt of malaria like Africa. According to the World Health Organization (WHO), 90 percent of 2015's malaria cases occurred in Africa, as did 92 percent of malaria deaths. It is here that WHO has chosen to pilot the world's first malaria vaccine next year, with Ghana, Kenya and Malawi to be the first recipients.
Scientists have explored some very creative approaches to controlling the spread of malaria through the years, including reducing mosquito populations, altering their sense of smell and making ourselves less tasty.
Meanwhile, the development of a malaria vaccine has ramped up with a number of exciting candidates emerging of late, including one that can be delivering through the skin with a microneedle patch and another that injects live malaria parasites into the human body. The latter was shown to be 100 percent effective in providing long-term protection in early clinical trials.
But the furthest along of these vaccines is RTS,S/AS01, which was the first malaria vaccine to reach large-scale clinical testing. The injectable vaccine was developed specifically to tackle malaria caused by the plasmodium falciparum parasite in young people in sub-Saharan Africa, a group that accounts for most malaria deaths in the region.
Following the successful phase III trials, which were carried out in Africa between 2009 and 2014, RTS,S/AS01 will now be introduced as part of a WHO-coordinated pilot program in Ghana, Kenya and Malawi next year. It will be administered through intramuscular injections via those nations' immunization and malaria programs, and the regions with high malaria burdens will be prioritized.
The pilot program is designed to assess whether the success of the vaccine in children aged five to 17 months, which was exhibited in the trials, can be replicated in real life. This means assessing whether the four required doses can realistically be delivered, how the vaccine can play a role in preventing childhood death, and how safe it is when used routinely.
WHO has not announced plans to introduce RTS,S/AS01 in other regions at this stage, but does say the knowledge gathered through the pilot program will help their decision-making as they consider a potential wider use of the vaccine.
"The prospect of a malaria vaccine is great news," said Dr Matshidiso Moeti, WHO Regional Director for Africa. "Information gathered in the pilot will help us make decisions on the wider use of this vaccine. Combined with existing malaria interventions, such a vaccine would have the potential to save tens of thousands of lives in Africa."