First malaria vaccine reduces early childhood mortality

https://www.science.org/content/article/first-malaria-vaccine-slashes-early-childhood-deaths

by rbanffy • 3 years ago

365 99 3 years ago

yieldcrv• 3 years ago

interesting article, many things left me skeptical throughout but I’m glad they’re doing it

it seems like a nice stride is occurring in the cheap malaria vaccine market

the actual malaria part seems to have limited efficacy - which is what was studied initially - while simply having preventative healthcare at all is improving everything, with this vaccine being a useful component on its own in boosting the immune system

shipscode• 3 years ago

13% over 4 years sounds pretty weak.

djoldman• 3 years ago

It's presumably all-cause mortality. So deaths solely attributed to malaria might have seen a far larger drop.

Someone• 3 years ago

FTA: “the first vaccine approved to fight malaria cut deaths among young children by 13% over nearly 4 years”

I read that as 13% of all young children deaths.

https://www.sciencedirect.com/science/article/pii/S240584402...:

“Malaria was the fourth highest cause of mortality in Sub-Saharan Africa, accounting for 10% of children's deaths”

“In 2013, malaria in Malawi was the leading cause of hospital admissions and death in children under five years of age and pregnant women. The disease accounted for 20% of all deaths of children under five”

⇒ I guesstimate this decreased mortality by malaria in those regions by 50-ish percent.

Teever• 3 years ago

What numbers would your layman mind cosider acceptable?

dang• 3 years ago

Thanks—we've s/slash/reduc/'d the title above to make this point clearer.

Fomite4• 3 years ago

13% over 4 years for a novel vaccine against a disease we have been trying and failing to eradicate for the better part of several centuries sounds like a pretty significant step forward to me.

linuxftw• 3 years ago

To calculate mortality in the three countries, where death registry statistics are unreliable, the researchers employed tens of thousands of community reporters—more than 14,000 of them in Kenya alone—to conduct household surveys of childhood deaths in 79 areas where the RTS,S vaccine was administered and 79 comparator areas where it was not available.

That doesn't sound remotely close to reliable.

The mortality benefit was documented even in the areas with the lowest RTS,S coverage

The report doesn't provide any actual data, so it's impossible to make sense of this statement.

CurtisWright• 3 years ago

Randomised placebo controlled trials are the only way to determine the reliability of a product.

The manufacturers know this. When they are doing something different it is not a good sign.

SubiculumCode• 3 years ago

13% is a large effect size, you'd have to presuppose a systematic bias in the unreliability between the comparator districts. Also, this is the case where research needs to be conducted but reality makes it hard but you can't just +not+ do the research. Field tests are always messy, and I'd posit that community reporting is probably more reliable thn politically motivated reporting from some governments.

timr7• 3 years ago

13% is a large effect size,

You can't just say that. Depends on what you're measuring, how you measure it, and how big the denominator is.

The fact that they saw the same effect size in groups that didn't get the vaccine is a reason to doubt the results, regardless of effect size. It was weird/credulous that they called it out as some kind of mysterious woo-woo advantage ("maybe it helps their immune system somehow!"). When you see stuff like that in a paper, it makes you scrutinize the results. When you hear it in a conference talk, it makes you reserve judgment until you see the paper.

lopis2• 3 years ago

Weirdly, there's only a link to the old paper [0] that initially reported only on severe malaria cases and the complications. I can't find the source of the reduction in deaths.

But regardless, I found "slashing" to be a bit exaggerated when the fatality reduction was 13% in a small pilot program. Very promising, but sensationalistic. I guess when you're up against anti-vax fear mongering, you need to fight fire with fire.

[0] https://pubmed.ncbi.nlm.nih.gov/25913272/

swader9992• 3 years ago

I would expect that approach fuels it.

bluSCALE42• 3 years ago

What would fight it is honesty, not rushing to markets with sensationalism.

mlyle3• 3 years ago

A 13% reduction in all-cause mortality is huge. There are other methodological/reliability concerns, but malaria isn't near 100% of death, even among children.

vmilner• 3 years ago

I hadn’t grasped the all-cause aspect from a skim read.

lettergram3• 3 years ago

That’s not all that huge when there’s such a small number of deaths in the given group over that time. This is part of the reason a lot of drugs later prove to be useless…

I also don’t see a citation for the 13% reduction in all cause mortality. To be honest, that’s an insanely weird metric to review for a malaria vaccine. Why not malaria related deaths?

Total in 2015 study [1]:

8922 children and 6537 young infants were included in the modified intention-to-treat analyses.

Total deaths: …? Are we talking 8 deaths in the control group and 7 in those injected?

This isn’t clear at all to me

[1] https://pubmed.ncbi.nlm.nih.gov/25913272/

On page 20 of the 2021 report we see 1443 deaths in comparison group and 1421 in implementing group [2]. With a pretty wide margin of error I might add. Is that what they’re reporting…?

[2] https://www.nitag-resource.org/sites/default/files/2022-05/M...

BurningFrog4• 3 years ago

One way to describe Africa's development in this era is that they're economically 100 years behind the rich world, but catching up 3 years per year.

In that environment, you'd expect child mortality to go down year by year, regardless of this vaccine.

Maybe the study corrects for that, but the complete absence of details in this report isn't promising.

skybrian• 3 years ago

The significance seems to be that it shows real-world results from a malaria vaccine that’s only moderately effective:

In clinical trial results published in 2015, RTS,S showed 36.3% efficacy against clinical malaria a median of 4 years after toddlers were vaccinated.

Some possible side-effects seem to be ruled out:

Giving RTS,S to 5-month-olds to 24-month-olds did not hurt the uptake of other childhood vaccines, which had been a concern. And it didn’t cause a decline in bed net use due to a false sense of security.

eigenket• 3 years ago

Here is the relevant text from the article

The comparison, covering 46 months, revealed the 13% decline in mortality—excluding accidental deaths—attributed to RTS,S.

Thats a 13% decline in all cause morality, excluding accidental deaths. The 13% number isn't just in deaths from malaria, its in deaths including all diseases.

lopis2• 3 years ago

From the article, yes. Where's the report?

dgacmu• 3 years ago

13% of all toddler deaths by any (non-accident) cause. That's very substantial.

saalweachter• 3 years ago

Quick googling says that there are around 3.4 million child (<5 years) deaths in the region; 450k malaria deaths would be about 13% of that.

timr7• 3 years ago

I guess when you're up against anti-vax fear mongering, you need to fight fire with fire.

That's completely unfair, in this case. The vaccine in question was associated with an increase in deaths in some subgroups (vs control), and overall low effectiveness in the phase 3 clinical trials.

A 13% decrease in mortality in this study is actually quite good given what was expected, but it is in no way "fear mongering" to question the safety/efficacy balance, even now. For example, you'd likely never administer this vaccine outside of high-risk populations. The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself.

Where is this line? Hard to say, but just for the sake of argument: anyone suggesting that we add this to mandatory vaccination schedules in the US would be a total lunatic. Should it be widely used outside of the worst parts of Africa, where malnutrition and preventable childhood illness are rampant? Again, hard to say.

Vaccines are not automatically good, and it isn't "anti-vax fear mongering" to question a particular vaccine. We have to test them, and see if the rewards are greater than the risks in the populations where we intend to use them.

aredox• 3 years ago

"The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself" - or just the fact that sometimes, a study can give the wrong signal, the same way it can happen you land a coin three times heads in a row and yet the coin isn't biased...

rhuru• 3 years ago

I think a lot of people simply ignore the basic fact that vaccines aren't safe by nature, they have to be proven to be safe through very very rigorous processes. Anti-vaxxers might come across as a lunatic but their extreme behaviour does not make opposite is true by default.

asynchronous• 3 years ago

An astoundingly level-headed take for HN. We need more science in the science community.

chmod600• 3 years ago

"I guess when you're up against anti-vax fear mongering, you need to fight fire with fire."

That's seems like a dubious strategy likely to backfire. I hope you're not serious.

VoodooJuJu• 3 years ago

I guess when you're up against anti-vax fear mongering, you need to fight fire with fire.

Comment was great until this. Rent-free. Don't start fires and you won't have to fight them.

Slava_Propanei• 3 years ago

People are opposed to being forced into injections of experimental mRNA.

Very few people were ever opposed to the standard-type vaccines we have been using for 100 years.

That is why the vast majority of people are happy to vaccinate themselves against polio and tetanus, but only 2% of people were interested in the latest Pfizer booooster experiment.

I would suggest against making up imaginary enemies.

smileysteve2• 3 years ago

Seems inaccurate where vaccines were correlated to autism in a 2016 GOP debate. (And the doctor on stage said nothing to rebut, and turned out to be anti mRNA as well)

lost_tourist• 3 years ago

The problem with your assessment is that you aren't being injected with experimental mRNA, it is well tested and proven on billions of people. It's fine to not want to be a part of that, but saying it is experimental is misinformation.

Lordarminius• 3 years ago

I guess when you're up against anti-vax fear mongering, you need to fight fire with fire.

You do know the vax is associated with a myriad of side effects including clots, strokes, reduced fertility and increase in turbo cancers, contains dna contaminants and was not properly tested don't you ?

TimPC2• 3 years ago

The article doesn't say but my understanding is this was a 13% reduction in all-cause mortality as in they measured the number of children who died during the time period and that went down by 13%. Not that 87% of malaria related deaths still occurred. A 13% reduction in all-cause mortality is quite large. To know how effective the vaccine is at stopping malaria related deaths you'd need to know what % of those who were dying were dying to malaria. If it was 14% then the vaccine is performing insanely well if it was 50% more work needs to be done.

vehementi• 3 years ago

Wow I thought there already was a Malaria vaccine and that that was what the Gates foundation had been deploying to eradicate the disease, but they've only so far been able to (go to great lengths to) mess with mosquitos, protect people from symptoms, remove people from conditions, etc. to otherwise prevent it by conventional means. A vaccine is huge!

crossroadsguy• 3 years ago

It is indeed huge. It might be coming as a shock that there was no vaccine for this, but it would make sense if you look at the demographics and geography that gets affected by malaria, dengue. And that truly makes it huge. Hope this is accessible as well. Now I hope my country gets an approved dengue vaccine. I had it once, won’t wish to my enemies. I’d rather take covid any day.

Fomite4• 3 years ago

Beyond demographics and geography, malaria is just hard. It's not a virus with fairly stable antigenic targets - it's a parasite that readily develops resistance to things.

This is indeed huge, even if the effect is only modest on a per-person basis, because we're still talking about a tremendous number of the world's population being protected.

lettergram3• 3 years ago

Would love to see independent research, not the company presenting their own.

It’s insane to me that we let people with massive financial incentives run their own trials.

dbdmxjxnx• 3 years ago

Who'd pay to run a trial if they didn't have an interest in the outcome?

A company running their own trial doesn't preclude other trials later on. Would you feel better if the African Union nations bucked up for a trial? Because they have a massive financial incentive too, though it's based on efficacy rather than sales.

lettergram3• 3 years ago

Imo most trials should have two parts (1) do a blind bid so competitors can conduct trial (2) fund trial yourself as well. Hide names of both people conducting trial.

Keep results hidden and send both results to FDA for review. Publish both results after review. Only attach names of entities who conducted the trial at the end.

This enables for a full replication and evaluation without anyone knowing who did anything. And at the very least reduces risk of corruption.

Ensorceled5• 3 years ago

It’s insane to me that we let people with massive financial incentives run their own trials.

The alternative is for some other organization to be on the hook for the HUGE costs a large scale trial. And then the incentives to not run useless expensive trials goes away.

anoxor3• 3 years ago

Consider your argument and opioids, where nearly 1000 people a week overdosed on at the peak?

Also consider "a scientist is as easy to buy as a politician".

Cigarette were considered to not cause cancer backed by science.

On top of that, the replication crisis in even chemistry and physics is seeing 30% of results can't be replicated.

The system is far more busted than people think.

refurb• 3 years ago

They don't run their own trial. Hundreds of doctors and clinics sign up to run trials on the companies behalf.

epups• 3 years ago

I find these results extremely promising. If I understand the numbers correctly, about 450,000 children die of malaria alone every year. That means a 13% reduction in deaths would save over 50,000 children per year. This is a lower bound estimate as well, as there are other sources of child mortality and the 13% figure is for all deaths.

I think some of the other commenters were expecting higher numbers. It has been very difficult to produce a malaria vaccine in the past, and we already knew this particular one was not very effective. If you had this as a prior, you should be able to see this as the breakthrough it ultimately is.

freeone30002• 3 years ago

13% is the reduction in all-cause mortality — ie, if every death this prevented was a death from malaria, this reduced deaths from malaria by over 99%.

saberdancer• 3 years ago

This would mean that a lot of malaria related deaths are unaccounted for or that the vaccine is helping in another way.

ryle_1• 3 years ago

BS , all there problems are becauseof Bill Gays needles ,there life style is natural and healthy they don't need any help , just leave them alone and stop using them like lab mice

First malaria vaccine reduces early childhood mortality

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