Page 63 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

Introduction
Compared to the rapid development of COVID-19 vaccines, the development

of malaria vaccines has been a disappointingly sluggish and ultimately neglected field.
COVID-19 vaccines were registered within a year of the discovery of the pathogen and
a year later hundreds of millions of vaccine doses had been rolled out (WHO, 2023;
Mathieu et al, 2023; New York Times, 2023). Malaria has been a constant threat for

approximately 3.3 billion people globally and has already killed many more people
than COVID-19 ever will, but it took more than 100 years from the discovery of
the parasite for the first vaccine to be registered. Aside from the complicated malaria
parasite organism and immunity, the generally impoverished characteristics of the

population at risk for malaria may explain the low priority and delayed development
of a malaria vaccine.

Rational, evidence-based malaria vaccine development started approximately
60 years ago with Ian McGregor and co-workers demonstrating in The Gambia that
the passive acquisition of antibodies can protect against malaria (Cohen et al, 1961).

Since then, a long list of malaria vaccine candidates has perished in various stages
of development. The first serious malaria vaccine candidate, RTS,S was conceived
by investigators at the Walter Reed Army Institute of Research (WRAIR) and was
developed in a collaborative effort between WRAIR and the pharmaceutical company

GlaxoSmithKline (GSK) (Gordon et al, 1995). RTS,S was found to be safe and afforded
statistically significant protection compared to earlier malaria vaccine candidates.
Yet the collaboration between WRAIR and GSK was not a partnership between equals.
WRAIR brought intellectual property and GSK brought capital and production

facilities into the collaboration. As so often when dealing with the pharmaceutical
industry, the return on investment in the shortest possible time plays an all-
encompassing role while public health priorities play at best a minor role. Malaria
endemic populations are not a promising market for high returns irrespective of

potential donor investments. Consequently, the clinical development of RTS,S made
limited progress until the American billionaire Bill Gates was persuaded by advisors
that RTS,S held great promise. From Gate’s perspective a vaccine was the ideal tool to
eradicate malaria, a technological solution for a complex problem (Gates W, 2011).

The Bill and Melinda Gates Foundation (BMGF) invested upwards of a billion US
dollars in the development of RTS,S in the first and second decade of the 21st century.
This funding support came to a

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