World’s first malaria vaccine can save thousands of children lives

One of the world's deadliest diseases, malaria takes the life of a child every two minutes.

  • Malaria, one of the world's deadliest diseases, kills 435,000 people a year, most of them children in Sub-Saharan Africa.
  • Three African countries are set to receive the world's first malaria vaccine this week as part of a WHO pilot program.
  • The vaccine has the potential to save the lives of hundreds of thousands of children worldwide.

The 20th century has seen some truly profound advances in human medicine. We now produce clean water and uncontaminated food at unprecedented levels. We've eradicated smallpox and rinderpest — the former having been one of history's deadliest diseases, the latter having caused widespread, depopulating famine — and we're close to eradicating deadly, debilitating diseases such as polio, yaws, and rabies.

But some medical leaps have been more elusive. One of the most devastating has been our inability to find a cure for malaria.

Malaria is among the world's deadliest diseases. It kills 435,000 people worldwide every year, the vast majority in Sub-Saharan Africa. Ninety percent of all malaria-related deaths occur in Africa, and children under the age of five are its most likely victims. In fact, every tenth child death in 2016 was the result of malaria.

But that tragic paradigm may be changing soon. The World Health Organization has launched a pilot program for the world's first malaria vaccine, a change that's been three decades in the making.

Countering the malaria epidemic

Image source: CDC / Wikimedia Commons

The malaria vaccine pilot program will launch in Malawi this week. In 2016, the country suffered 45 malaria-related deaths per 100,000 people. In the coming weeks, Ghana and Kenya will introduce the vaccine as well. In 2016, these countries suffered 69 and 11 deaths per 100,000 respectively.

The vaccine, called RTS,S, will be administered in a regimen of four doses. The first three will be given to children between five and nine months of age. The final dose will be provided around the children's second birthday. The program aims to vaccinate around 360,000 children per year across the three countries. It will focus on areas with moderate-to-high malaria transmission rates in the hopes of maximizing the impact.

"Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death," Dr Matshidiso Moeti, WHO Regional Director for Africa, said in a statement. "We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes."

WHO's press statement notes that the pilot program is a global partnership. It has brought together a range of in-country and international partners to coordinate with the ministries of health in the three pilot countries. GSK, the vaccine's developer and manufacturer, will donate 10 million doses.

"This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination," Moeti added.

Difficulties in eradicating malaria

However, the vaccine is not a silver bullet aimed at ending the malaria epidemic. RTS,S does not have a 100 percent success rate, offering only partial protection. In clinical trials, it prevented approximately 4 in 10 malaria cases (3 in 10 for life-threatening malaria).

As such, WHO is presenting the vaccine as a "complementary malaria control tool." The vaccine paired and supported by other preventative measures, including bed nets, indoor insecticides, and antimalarial treatments.

"It's a difficult disease to deal with. The tools we have are modestly effective but drugs and insecticides wear out — after 10, 20 years mosquitoes become resistant. There's a real concern that in 2020s, [cases] are going to jump back up again," said Adrian Hill, a professor of human genetics and director of the Jenner Institute at the University of Oxford, told CNN.

Malaria has proven difficult to eradicate because of its nature. The disease is caused by a parasite of the genus Plasmodium. Its life cycle is split between a sexual stage in its mosquito hosts and an asexual stage in human hosts. When a mosquito bites an infected human, it contracts the disease from that person's red blood cells.

When it bites another person, the mosquito transmits the disease to a new host. The infected patient develops a fever, chills, headaches, and other flu-like symptoms. If untreated, it can develop into severe malaria, where the symptoms can manifest into anemia, organ failure, and neurological abnormalities. Any mosquito that bites this person has the chance to then pass on the disease further.

The difficulty in preventing mosquito bites, the insect's growing resistance to insecticides, and changes the parasite undergoes during its life cycle, all contribute the difficulties on controlling and containing malaria in the world's poorest countries.

Developing sustainable change

Graph showing the percentage of global malaria deaths per world region. Africa accounts for 90 percent of deaths resulting from the disease. (Source: Our World in Data)

WHO's Sustainable Development Goals are 17 directives comprising 169 targets. The ultimate aim is to advance peace and prosperity for all people.

The program's third directive is to ensure health and well-being for all people of all ages. Among its targets are the end of the AIDS, tuberculosis, and malaria epidemics by 2030 and the reduction of mortality for children under 5 to as few as 25 per 1,000 live births worldwide.

Despite the difficulties still ahead, any substantial reduction in malaria deaths is a welcome change and a significant step in achieving this goal.

Thanks to this vaccine, hundreds of thousands of children will likely avoid a crippling, painful death. Communities in some of the world's poorest regions will be given a chance to better stabilize and grow. And the pilot may help scientist develop better strategies for future endeavors.

The vaccine's development came at an auspicious moment, too. Malaria cases began to rise in 2017, after nearly two decades of decline.

"The malaria vaccine is an exciting innovation that complements the global health community's efforts to end the malaria epidemic," Lelio Marmora, executive director of Unitaid, said. "It is also a shining example of the kind of inter-agency coordination that we need. We look forward to learning how the vaccine can be integrated for greatest impact into our work."

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Want to forge stronger social bonds? Bring beer.

New research shows that a healthy supply of locally-sourced beer helped maintain Wari civilization for 500 years.

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  • A new analysis of an ancient Wari brewery suggests chicha helped maintain the civilization's social capital for hundreds of years.
  • Civilizations throughout the ancient world used alcoholic drinks to signify kinship, hospitality, and social cohesion.
  • The researchers hope their findings will remind us of the importance in reaffirming social institutions and sharing cultural practices — even if over coffee or tea.

Beer is history's happiest accident. Though the discovery probably happened much earlier, our earliest evidence for beer dates back roughly 13,000 years ago. Around this time, the people of the Fertile Crescent had begun to gather grains as a food source and learned that if they moistened them, they could release their sweetness to create a gruel much tastier than the grains themselves.

One day a curious — or perhaps tightfisted — hunter-gatherer hid his gruel away for a safekeeping. When he returned, he found the bowl giving off a tangy odor. Not one to waste a meal, he ate it anyway and enjoyed an unexpected, though not unpleasant, sensation of ease. By pure happenstance, this ancestor stumbled upon brewing.

That's one possible origin story, but we know that our ancestors learned to control the process, and beer took a central role in Fertile Crescent civilizations — so central that Professor Patrick McGovern, a biomolecular archaeologist at the University of Pennsylvania, argues that beer, not bread, incentivized hunter-gatherers to relinquish their nomadic ways.

Beer may also be proof of a God who wants us to be happy (Dionysus?), because the beverage* would be independently rediscovered by peoples across the ancient world, including those in China and South America.

One such peoples, the pre-Inca Wari Civilization, made beer, specifically chicha de molle, a critical component in their religious and cultural ceremonies. In fact, a study published in Sustainability in April argues that the role was so important that beer helped keep Wari civilization intact for 500 years.

Brewing social capital

Twenty years ago, a team of archaeologists with the Field Museum of Natural History, Chicago, discovered a brewery in Cerro Baúl, a mesa in southern Peru that served as an ancient Wari outpost. The brewery contained original equipment, clay storage vessels, and compartments for milling, boiling, and fermentation.

The team recently analyzed these on-site vessels to uncover the secrets of the Wari brewing process. Removing tiny amounts of material found in the spaces between the clay, they were able to reconstruct the molecules of the thousand-year-old drink. They then worked alongside Peruvian brewers to recreate the original brewing process.**

Their molecular analysis revealed several key features of the beer: The clay used to make the vessels came from a nearby site; many of the beer's ingredients, such as molle berries, are drought resistant; and though alcoholic, the beer only kept for about a week.

These details suggest that Cerro Baúl maintained a steady supply of chicha, limited by neither trade nor fair weather, and became a central hub for anyone wishing to partake. The Wari would likely make such trips during times of festivals and religious ceremonies. Social elites would consume chicha in vessels shaped like Wari gods and leaders as part of rituals attesting to social norms and a shared cultural mythology and heritage.

"People would have come into this site, in these festive moments, in order to recreate and reaffirm their affiliation with these Wari lords and maybe bring tribute and pledge loyalty to the Wari state," Ryan Williams, lead author and head of anthropology at the Field Museum, said in a release. "We think these institutions of brewing and then serving the beer really formed a unity among these populations. It kept people together."

The Wari civilization was spread over a vast area of rain forests and highlands. In a time when news traveled at the speed of a llama, such distinct and distant geography could easily have fractured the Wari civilization into competing locales.

Instead, the researchers argue, these festive gatherings (aided by the promise of beer) strengthened social capital enough to maintain a healthy national unity. This helped the Wari civilization last from 600 to 1100 CE, an impressive run for a historic civilization.

Bringing people together (since 10,000 BCE)

A Mesopotamian cylinder seal shows people drinking beer through long reed straws. Image source: Metropolitan Museum of Art.

Of course, the Wari weren't the first civilization to use beer to reaffirm bonds and maintain their social fabric. Returning to the Fertile Crescent, Sumerians regarded beer as a hallmark of their civilization.

The Sumerian Epic of Gilgamesh tells of the adventures of the titular hero and his friend Enkidu. Enkidu beings as a savage living in the wilderness, but a young woman introduces him to the ways of civilization. That orientation begins with food and beer:

"They placed food in front of him,
They placed beer in front of him,
Enkidu knew nothing about eating bread for food,
And of drinking beer he had not been taught.
The young woman spoke Enkidu, saying:
"Eat the food, Enkidu, it is the way one lives.
Drink the beer, as is the custom of the land."
Enkidu ate the food until he was sated,
He drank the beer — seven jugs! — and became expansive
and sang with joy.
He was elated and his face glowed.
He splashed his shaggy body with water
and rubbed himself with oil, and turned into a human
."

Tom Standage, who recounts this scene in his History of the World in 6 Glasses, writes: "The Mesopotamians regarded the consumption of bread and beer as one of the things that distinguished them from savages and made them fully human." Such civilized staples not only demarcated their orderly life from that of hunter-gatherers, they also served a key role in their culture's unifying mythology.

Furthermore, Standage notes, Sumerian iconography often shows two people sipping from waist-high jars through reed straws. The earliest beers were consumed in a similar fashion because technological limitations prevented baking individual cups or filtering the beverage. But the Sumerians had the pottery skills to make such cups and filter the dregs. That they kept the tradition suggests that they valued the camaraderie brought by the experience, a sign of communal hospitality and kinship.

The ancient Greek's similarly used alcohol as a means of maintaining social and political relationships — though their drink of choice was wine.

During symposiums, upper-class Greek men would gather for a night of drinking, entertainment, and social bonding. In Alcohol: A history, Rod Phillips notes that symposiums were serious affairs where art, politics, and philosophy were discussed throughout the night and could serve as rites of passage for young men. (Though, music, drinking games, and sex with prostitutes may also be found on the itinerary.)

Of course, we can amass social capital without resorting to alcohol, which has been known to damage social relationships as much as improve them.

In the 17th century, London's coffeehouses stimulated the minds of thinkers with their caffeine-laden drinks, but also served as social hubs. Unlike the examples we've explored already, these coffeehouses brought together people of different backgrounds and expertise, unifying them in their pursuit of ideas and truths. Thus, coffeehouses can be seen as the nurseries of the Enlightenment.

Relearning ancient lessons

The Field Museum archaeologists hope their research can help remind us the importance social institutions and cultural practices have in creating our common bonds, whether such institutions are BYOB or not.

"This research is important because it helps us understand how institutions create the binds that tie together people from very diverse constituencies and very different backgrounds," Williams said. "Without them, large political entities begin to fragment and break up into much smaller things. Brexit is an example of this fragmentation in the European Union today. We need to understand the social constructs that underpin these unifying features if we want to be able to maintain political unity in society."

So, grab a beer or coffee or tea, spend some time together, and raise a glass. Just try not focus too much on whether your friend ordered Budweiser's swill or an overpriced, virtue-signaling microbrew IPA.

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