Science Friday - Global Vaccination, Malaria Vaccine, Zombie Wildfires. May 21, 2021, Part 1

Episode Date: May 21, 2021

How Do You Solve a Problem Like World Vaccination? Here in the U.S., it feels as if we’ve turned a corner in the COVID-19 pandemic. Most of the population can be vaccinated, and restrictions for masks and distancing are loosening. But we won’t be able to get a handle on the pandemic until the rest of the world has access to a vaccine. If you thought distributing shots to rural areas here in the U.S. was hard, imagine distributing them to every corner of the globe. President Joe Biden this week pledged to send an additional 20 million vaccine doses abroad, bringing the total promised to 80 million. But the U.S. is hardly the only country that plans to share doses. So where does the world vaccination effort stand? One international effort, led by organizations including the World Health Organization and UNICEF, is called COVAX, or COVID-19 Vaccines Global Access. Joining Ira to discuss this effort is implementation team member Dr. Bruce Aylward, senior advisor to the Director-General at the World Health Organization. Ira also speaks to medical supply chain expert Prashant Yadav, senior fellow at the Center for Global Development and professor at the INSEAD Business School, based in Washington, D.C. Can A New Vaccine Put An End To Malaria? The World Health Organization estimates that every two minutes, a child somewhere in the world dies of malaria. As of 2018, the parasite-induced disease kills a total of more than 400,000 people every year—most of them children under the age of five in sub-Saharan Africa. While the quest for a malaria vaccine is more than 50 years old, there is still no licensed, fully approved option. The closest to approval, called RTS,S, is being piloted in several countries, with efficacy estimates hovering around 56 percent. But after a new vaccine, called R21, demonstrated more than 75% efficacy in a small trial in Burkina Faso, is there hope for a more efficient push to reduce the global burden of malaria? Ira talks to malaria vaccine researcher Prakash Srinivasan and Biden administration malaria coordinator Raj Panjabi about the implications of a vaccine milestone—and the work remaining ahead. Plus, how the COVID-19 pandemic might inform future progress in global health. Zombie Wildfires Can Rage On For Months Wildfires are becoming more intense. California saw a record breaking wildfire season—burning 4 million acres across the state last year. Scientists say there is an increase in another type of wildfires called “zombie wildfires.” Forest fires that ignite in the summer and pop back up during the spring. Roxanne Khamsi talks about a new study that tracks the occurrence and causes of these wildfires. Plus, a look at a “black fungus” infection COVID-19 patients in India.   Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. Big electric vehicle news this week. Ford introduced a new truck to their F-150 series called the Lightning, an electric version of the popular truck. This is a defining moment for our company, a watershed moment for our industry. It's a truck that will lusher in a cleaner future for our country. That's Bill Ford, Chairman of the company. The F-150 truck has been the best-selling vehicle in the country for the past 40 years, with sales worth $1.4.4. $42 billion per year. That's more revenue than McDonald's, Visa, or Nike. And this truck helps the company cruise into the massive EV market. And this new EV is already sending shockwaves through the entire auto industry. Even Tesla's Elon Musk tweeted, congrats to Ford for embracing an electric future. Tesla, Chevy GM, and many smaller brands all have electric trucks in the works. We'll watch that and see how that all works out.

Other science news this week, wildfires are becoming more intense. California saw a record-breaking wildfire season, burning 4 million acres across the state last year. Scientists say there is an increase in another type of wildfire, something called zombie wildfires, forest fires that ignite in the summer and pop back up during the spring. Their study was published in the journal Nature. Roxanne Camsey is here to fill us in on that story and other sites. headlines from the week. She's a science journalist based out of Montreal, Quebec. Welcome back, Roxanne. Thank you, Ira. It's great to be here. So in the nature study, the scientists were tracking these fires, and what did they find? So what they did is they looked at satellite imagery

from 2002 to 2018. And, you know, there was a lot of variability in how much the zombie fires accounted for fires in the north. But what they did find is that in one year, it was almost 40% of the burned area. So that was in 2008. So these zombie fires really do have an influence. They found that with hot summers, there's basically more of these things happening. And interestingly, as the fire burns through vegetation, it's giving off carbon dioxide. But then when the peat is smoldering after that, it's producing methane. So these zombie fires are kind of a double whammy when it comes to greenhouse gases. And I think that that's something that researchers want to highlight and say, you know,

these things matter. Not only is climate change or global warming making these zombie fires overwinter more often, but they're also producing a lot of the carbon and methane that enters our atmosphere. Yeah. And they last? I mean, why are they called zombies? They start. They stop.

How come they're lasting? Yeah, so they just don't go away. And interestingly, there's other fires that have been lasting for decades. So there's a fire that has been going for 59 years in southwest China. And it began when an oil exploration team drilled a natural gas well, but they left it unexplored. And this thing has been going on for decades. So, I mean, the fact that it shocked me, first of all, that we have zombie fires. It is kind of like a horror movie in a way that these things kind of keep coming back and keep producing these greenhouse gases.

Where are the zombies I should ask? So the zombie fires that these scientists looked at were in. Canada and in Alaska, so actually not that far from where I am. I'm in Montreal. And what they found was that these overwintering fires were really associated with hot summers and like burning deep in the organic soils. They've become more frequent in recent decades. That's partly to do with our warming climate. Let's move on to another story. India is still experiencing a massive surge in COVID-19 cases. And now there is a black fungus hitting some Indian COVID patients. What is this? Yeah, this is so terrible. I mean, India's already coping with a really tragic and horrible burden with COVID-19. And what happened was this week, the country's health authorities kind of sounded the alarm about something that's been increasingly of concern. And it's a black fungus. that is called mucormycosis, it has a mortality rate of around 50 percent, and it's affecting COVID-19 patients, so it's quite terrible. Is it an opportunistic infection?

Is it because you have COVID, that you get this? Well, this is something that they're thinking. This is one of the things that they're wondering is, why are we seeing this huge uptick? How, what is the link between COVID-19 and the outgrowth of this fungus? And some of the theories include the fact that putting patients, with COVID-19 on steroids to help them, you know, get through that infection of COVID-19, that might predispose people to getting the black fungus. And what happens is, oddly, it strikes about 12 to 15 days after recovery from COVID. So something is laying the ground for this fungus to

take off. Notably, I should also add that people with diabetes are also prone to these kind of opportunistic infections, as you just mentioned and describe them. And that, um, that, um, We're seeing an uptick in fungal infections around the world. So COVID-19 patients, not only India, but also Italy, Austria, Belgium, all these different countries and the U.S., we're seeing fungus emerge like other fungi. This is not good news. I mean, can they be treated with this fungus? When it comes to this black fungus, oftentimes the treatment is removal of like a jawbone or an eye. So unfortunately, another thing that doctors are saying is we need to pay attention to the fact that fungal infections are actually evolving resistance to the antifungals that we use against them.

So there was a giant cover story in Scientific American this month from Marin McKenna. And she tackles this topic about how we need to look at fungal infections the way we look at bacterial infections where there's antibiotic resistance that's emerged. Okay, let's move on to your next story. A group of scientists detected a new coronavirus. and humans that originated in dogs. And we're not talking about COVID-19 or a variant, right? Right. And I hate to be the bad coronavirus news update person.

But yeah, so this, unfortunately, you know, we're seeing a coronavirus that's emerged in dogs. And, you know, in some ways, it's not all that shocking because we've seen in the last 20 years or so a few examples of a new coronavirus that's gone from animals to humans. So there was the original SARS about 18 years ago that we think went from civets to people. And then MERS, which was Middle Eastern Respiratory Syndrome, went from camels to people. And then, of course, this coronavirus that we're living through, the SARS-CoB-2.

But Duke University researchers developed a test and they wanted to see what other coronaviruses were out there. And that's how they struck on this. We still don't know the animal source of COVID-19. So what could the source tell us about a coronavirus? So I think that this is a really interesting from that regard because there's a lot of debate about, you know, the origin stories of SARS-Cobie 2. And I think what's fascinating about this is it really broadens our understanding of the vast difference in types of animals that can pass coronavirus to humans. And, you know, this happened in Malaysia. It's a different geographic location.

So we can take that into account as well. Yeah, I think this is going to be something that we might actually see more and more often. is now that we've got our antenna up for the coronaviruses around us, I think we're going to be seeing a lot more of these examples. Let's move on to your next story, which is one of the most unusual research I've ever seen. I mean, I've been doing this for a few years. And it's a study about testing if mice and pigs can breathe through their rectum.

Did I get that right? Absolutely, absolutely. And it is strange. It's definitely not for the, shy, but for sure. Not for the shy. Yeah. So first, tell us about how they discover this or what they're doing or what the experiment is like. So these are Japanese researchers that did this study. And one of them actually had a father who had some difficulty with his lungs. And so he started thinking, you know, where in the animal kingdom are there examples of other ways we can get oxygen? And he knew that

some kinds of fish, for example, are able to pop their heads up above the water and gulp some air. that they don't put that air into their lungs, but that it goes through their intestines and they get some oxygen that way. So he started wondering, how could I, how could I make this apply to humans? And what happened was that team in Japan started to do experiments with mice and moved on to pigs to see, can you breathe through your behind? Yeah. And so they, this could actually turn it to something pretty useful, right? Yeah. So what they did with the pigs is they put four of them on these ventilators that You know, we're often thinking about ventilators as helping us breathe, but in the case of this science, they were actually able to suppress the breathing of the pigs. And they gave them enumas

with this fluid called plurflorocarbon. And it's kind of highly oxygenated. And what they found is that when the pigs were on those ventilators that suppressed their breathing, their oxygen levels dropped. But then when we got these enemas with this highly oxygenated fluid, their blood oxygen levels went up. So the idea is that this kind of approach might be useful in places where you can't get the machinery, the ventilators, and the equipment to help people breathe and get enough oxygen that maybe, maybe, maybe there's a way to perhaps deliver much-needed oxygen through the rectum. Wow, we'll have to keep track of that story. That really is an interesting, and who knows where that might go. Your final story looks at a

kind of fountain of youth for ants and the source is a tapeworm? Yeah. So I never, it's really fascinating to me that like ants can be infected with other things because we think they're so small. So scientists looked at these ants called temnothorax ants and they found that some of those ants were really taking it easy in the colony. Like they were supposed to be workers genetically, but they got the day off all the time. They'd have other. ants doting on them. And what they found was that these ants that were taken easy and getting all that extra service from their worker buddies were actually infected with a tapeworm that made them emit a scent that diverted attention away from the queen. So how cool is that? Wow. So what's the

strategy here for the tapeworm? How does it benefit here? Well, isn't that the interesting thing, right? So it seems like a win-win. Like the ants get a tapeworm infection from eating this tapeworm egg infested bird feces, and then they just get cared for. But what happened was, as the scientists watched the colonies, they found that over time, the queens started getting a little neglected when all of this was happening. So it's not necessarily a great thing for the entire colony when you have these ants that get infected with a tapeworm. Sure, those ones live longer, but the colony overall doesn't necessarily benefit. Roxanne Camsey, science journalist based in Montreal, Quebec.

Thanks so much, Ira. We have to take a short break when we come back. A look at how the effort to vaccinate the globe is falling short. Stay with us. This is Science Friday. I'm Ira Flato. It seems like here in the U.S., we've turned a corner in the COVID-19 pandemic. Most of the population can be vaccinated, and restrictions from masks and distancing are loosening.

But we won't be able to get a handle on this pandemic until the rest of the world, has access to a vaccine. And if you thought distributing shots to rural areas here in the U.S. was hard, imagine distributing them to every corner of the globe. President Biden this week pledged to send 20 million more vaccine doses abroad. That would total 80 million doses. So where does the world vaccination effort stand? One international effort to vaccinate the world, it's called COVAX, COVID-19 vaccines global access. member of the implementation team is joining us now. Dr. Bruce Ayelwood, senior advisor to the Director General at the World Health Organization, joins me from Geneva, Switzerland. Welcome to

Science Friday. Thank you very much, Ira. Nice to have you. So how many vaccinations do you know have been distributed so far through COVAX? Where have they gone? Can you give us a thumbnail sketch? Sure. So as of today, COVAX has distributed just over 67 million doses of vaccines. which is a relatively modest number. The important thing, Ira, is how far those doses have gone. We've distributed a vaccine now to over 124 countries around the world. And this includes almost all of the lowest income countries around the world, the low-middle-income countries.

So we've distributed doses in almost all countries of sub-Saharan Africa, of the Middle East, of Latin America, Central Asia, many, many Pacific Caribbean and other island nations as well. So across a broad swath of the world. You've also distributed doses to Canada, have you not? Why, why Canada? Well, when we set up the Act Accelerator a year ago, the goal was to establish a truly global mechanism

that would allow every country of the world to collaborate and work together, to reduce the risk, number one, of developing new vaccines, to pool the procurement to get the best possible, prices and volumes, and then to equitably collaborate in the rollout of these around the world. And so Canada is one of the 190 countries that joined the Kovacs facility. And there have been other high-income countries that have also received doses, such as South Korea, for example,

through the Kovacs facility. Pretty modest doses actually are in terms of the overall doses, because the emphasis has been to get doses to the countries that truly have no other access. I know that Kovacs had a goal of distributing at least 100 million doses worldwide by the end of March. That did not happen. Can you tell us what kind of roadblocks prevented that goal? Yeah. There's been a couple of challenges to scaling up Kovacs as rapidly as possible in terms of the volumes that we want to be pushing through this mechanism to get it out to vaccines out to as many vulnerable people around the world as possible. The first one was it took producers a long. time to get their vaccines validated by WHO is meeting the necessary international standards for safety, efficacy, programmatic quality, and also just quality of the product. So there was delays in getting

that done. Manufacturers took a lot longer than they expected. And then once the vaccine started to flow, many of our suppliers found that they had over, let's say, promised what they could actually deliver and get through their own system. So that was slow. And then, we, of course, had the big outbreak in India and the huge escalation there, which meant that a big proportion of the doses that should have come through COVAX ended up getting redirected because they were coming from India and they actually stayed in India to try and address the vulnerability and risks to the population there. So all of that has slowed down the doses through COVAX, and that is the reason that as we've gone to look for other sources, Ira, much of that is

locked up in contracts with the rich countries of the world. So that's why we have turned to them now to look at how can you work with us to try and fill that gap as rapidly as possible. You know, I'm having a feeling of deja vu all over again because just a few weeks ago, we had Sadd O'Meer from Yale urging on developed nations to donate vaccines. Here we are again. You're saying basically the same thing. Have we known this is going to happen all along? Absolutely. That's the reason we established the Kovacs facility. We knew one year ago from our experience in pandemic flu and in other crises like this, that as you develop these new tools that you need, the new countermeasures, new vaccines, new tests, new treatments, they're going to be

in very scarce supply. So right from the very beginning, you have to develop mechanisms to ensure fair sharing, let's say, of those products as they become available. And that's why we establish this global mechanism. Is there any way to incentivize rich countries to donate the vaccines to covacs. Absolutely. And in approaching that, I mean, we look at two things. First of all, why share doses? We like to say share. You know, it's the right thing to do, people know. The second thing is it makes great economic sense, right? If we look at high-income countries, they're going to lose estimated $9 trillion this year in economic losses. Well, globally, that is. Half of that will be lost if they only vaccinate the high-income countries. So there's a huge

economic incentive in the trillions to vaccinate globally, to get the global economy moving. And then, of course, we have the virus itself telling us, look, it makes sense from a health security perspective because otherwise I'm going to mutate and variants are going to arise and they could make your tools, your vaccines that you're already using ineffective. So you need to approach this on a global scale. So there's lots of incentives from that side. But then when it comes to COVAX itself, you know, why do it that way instead? of bilaterally. And, you know, most countries like the U.S., they want to have the biggest impact they can. They want to get to as many countries as possible, as fast as possible,

and make sure the people who really need these doses get them. And that's what the Kovacs facility offers, because we can get to every country in the world. We're already getting to them. We can get there very, very fast. The first donation that we had, Ira, was only about 10 days ago or two weeks ago from France. And within 24 hours of that deal being signed, the vaccine was in the air on a way to Mauritania. So we can move fast and we make sure it gets the places and to the people that really need it. I would imagine then you might feel like you're racing against the clock here, considering what you said about the aggressiveness of the virus and the mutation of the virus. Yeah. And even without the virus,

Ira, if you look today at the graphs, right, we're still at one of the peaks of this pandemic. People are dying every single day that should not be dying. Healthcare workers are getting sick who should not be getting sick. Now, most of those increasingly are in low-income, lower middle-income countries, and we have enough vaccine in the world. We don't even have to be very generous. We have enough vaccine in the world to make it a much safer place for the people who are trying to save lives and to keep alive.

our older cherished populations. So if we have all of that vaccine in total, what is the main reason we're not getting those out to the people who need them? Well, every leader in every country is there to take care of their people first, right? And so what they've been trying to do is ensure that they get their health care workers vaccinated, their older populations vaccinated. And then, And in the face of an evolving virus, they thought, well, maybe we better get even more people vaccinated more robustly to give us more protection against that. So, you know, they've been struggling to try and find that balance and find that tipping point where they feel like, okay, we're confident that we've got this under control or at least we're going the right direction and now we can be sharing. And we're seeing more and more of that,

Ira. If we go back three months ago, we had no donations. And if you look today, you know, you've got the UAE, you've got Sweden, you've got Spain, you've got Norway, you've got France, all saying that they want to donate doses and do it very quickly. The key is, Ira, we need people to donate and move doses fast because every day that we don't get a vaccine into somebody somewhere, a health care worker gets sick, an older person dies, and that's avoidable. And that's where we're going to have to leave it because our time has run out. I want to thank you very much for taking time to talk with us. It's been my pleasure, Ira. Thank you. Dr. Bruce A. L.Word, senior advisor to the Director General at the World Health Organization in Geneva, Switzerland.

So, the vaccine supply chain has hit some roadblocks. How much of this could have been foreseen? Joining me now is an expert on medical supply chains. Prashant Yadav is a senior fellow at the Center for Global Development and a professor at InSiyad Business School, based in Washington, D.C. Welcome to Science Friday. Thank you for having you in the show. We were talking just now about how distributing vaccines to the world has proven to be a difficult task to say the least. How does what we're seeing now with the COVID vaccine supply chain compared to how medicine distribution has gone historically? So medicine distribution is concentrated in certain geographies in India, in China, in parts of Italy, in Puerto Rico, in Ireland.

vaccine manufacturing has some similarities, but at the same time, it has many aspects which are different. And there is concentration of vaccine manufacturing in the U.S. and in India and China and Brazil. But the total amount of vaccine manufactured globally still is only a fraction of what we are seeing as the demand for COVID vaccines. It's not just a question of distribution, it's also a question of supply, making enough vaccines? Yeah, so portal manufacturing capacity, the estimates vary, but let's say it's somewhere between $8 to $10 billion for 2021, and that is, in some ways, sufficient,

but the timing of when that manufacturing capacity comes online is where the challenges are. If most of it only becomes available in the fourth quarter of 2021 or in the first part of 2022, then we will have a long wedge in a delay between having achieved over 50 to 60 percent vaccination coverage in a large number of developed countries. At the same time, many developing countries would not even have covered their essential healthcare professionals and high-risk populations. You talk about vaccine being manufactured outside of the United States.

There has been a lot of talk about COVID-19 vaccine patents, recently. Some people have called on manufacturers to forego intellectual property rights in an effort to get as many people vaccinated as possible. Is it that simple? So in the long term, having better access to intellectual property may help us. Medium term, what we need is more manufacturing capacity that can come online rapidly. It requires manufacturing sites with the right kind of equipment, which can do cell cultures. Second and most importantly, in my opinion, it requires having chemistry, manufacturing,

and control specialists, lab people who can make sure that the process parameters remain stable. There is process consistency and quality of manufacturing is not compromised. And a third thing, which is a new constraint we've seen in the last few months, is a lot of the equipment that goes into manufacturing. especially because we are starting to use more and more of single-use bioreactors and single-use filters

for growing cells and other biological processes. And these have now become in short supply. There are only four or five manufacturers globally which makes such equipment. So in a way, patent waivers will not help us enhance manufacturing capacity unless we can solve for more people. people who know chemistry manufacturing and controls, and somehow we can add more output for single-use bioreactors and other single-use equipment and also some other critical materials that are needed. So all of these things together perhaps can help. But then it raises the question, the fastest way to get on the learning curve of stabilizing a manufacturing process,

achieving the process consistency, maybe to have the team, which has in the first place develop the process, grant for this know-how. And that could be achieved, in my opinion, through voluntary licensing, the kinds of arrangements that we have seen between AstraZeneca and the CIRM Institute of India, or Johnson and Johnson biologically. And a number of such voluntary licensing arrangements have been done. The benefit is that the team which has worked on developing a manufacturing process from scratch and has worked hard and gotten up high on the learning curve,

transfer that very quickly, instead of the receiving company's team having to iterate multiple times, trying various combination of the process parameters, till the time they can get to perfect. In case you've just joined us, I'm Ira Plato, and this is Science Friday from WNYC Studios. So how do you pass this knowledge on from those people who know how to do it, who've developed it, and getting it to the places where they can use it? Our traditional modality has been a group of people who are a part of the original team travel to the new site, and they work closely with the team at the new site in helping them establish the process, right? Well, wouldn't this small group of people take a long time to get to all those sites? That is our binding constraint at the moment.

And I think in the medium term, as we think about preparedness and as we think about future pandemics and, how would we have sufficient manufacturing capacity? One key area we have to invest in is to have a larger pool of people who know biologics manufacturing, who are spread out globally or are at least available to carry out such technology transfer with short time notice. And that's a key preparedness investments that we will have to make. And so what is the takeaway from this pandemic as we look forward and we know there are going to be other viruses that emerge. What is the preparedness take away and lesson to be learned from this?

Three things in my opinion. The first is vaccine manufacturing capacity is a huge global public good. Having some surplus vaccine manufacturing capacity is an investment that society should be willing to make. We have to figure out how to keep it running live and sustainable, which means that capacity may have to be flexible so that in routine times it can be at least kept alive by making a modest amount of other vaccines. Vaccine supplies have to be managed in a way that we respect the global nature of the vaccine we have to acknowledge both in the political process, in the way our global treaties are organized and also population level of awareness of the fact that by,

By closing borders, we are not helping anyone, not ourselves and not the world, just because the vaccine supply chain is intrinsically very global. And the third thing that probably is equally important is to have some decentralized manufacturing capacity and decentralized in places where it is easy to export product out and it's easy and has good trade and transport links, instead of a concentration in U.S., EU, and India, if it was somewhat more geographically distributed, I think we may be better.

Very interesting lessons. It's nice to get your opinion on this. Thank you very much for taking time to be with us today. Thank you for having me in the show. Prashat Yadav, senior fellow at the Center for Global Development, and a professor at the InSiyadh Business School based in Washington. We have to take a break. And when we come back, you know, lost in the disease news, but still a potent killer, is malaria,

which kills 400,000 people each year, many of them children. A new vaccine has shown promising result. What's next? That's what we'll talk about after the break. Stay with us. This is Science Friday. I'm Irafledo. Every year, malaria, a disease caused by a blood-borne parasite, kills more than 400,000 people.

most are children under the age of five. The malaria parasite has long been one of the major causes of global deaths in poor countries, especially. The first and only licensed vaccine so far, called RTSS, has shown only a 50% efficacy rate in clinical trials. But now a team of researchers from Oxford University have preliminary trial results for another promising vaccine, called R21. And this time, the efficacy was over 75%. I have two experts to talk about this. First, Dr. Prakash Srinivasan, an assistant professor of molecular microbiology and immunology at Johns Hopkins University's Malaria Research Institute. Welcome to Science Friday. Thank you, Ira. Good to be here. Nice to have you. Okay, let's talk about this new vaccine R21. How does it work to arm the body against malaria parasites?

So the parasite has a complex life cycle, and as you rightly pointed out, it's the forms of the parasite that grows inside the red blood cells or the erythrocyte that causes disease. When the mosquito feeds on a human host, it takes up these parasites along with the blood meal. Certain forms of the parasite enter into the salivary glands or the saliva of the mosquito, such that when this infected mosquito feeds on another naive vertebrate host, in this case, or humans, it transfers along with the saliva, the parasites, and deposits into the skin of the host. From there, the parasites find their way through the blood vessels to the liver specifically. And it is these stages of the parasites that this new R21 vaccine targets. And this parasite stage, because it does not cause any clinical symptoms, is also referred to as the silent stages of the parasite life cycle.

And so the R21 vaccine, the researchers at the General Institute in Oxford, What they have done is to, similar to a spike protein on the coronavirus, they've used a protein on the surface of these parasites and using adjuvants that train our immune system to make antibodies against these proteins. They've been able to generate enough antibodies to prevent the parasites from infecting the liver cells. But this R21 vaccine essentially has built up on the success of the RTSS vaccine, essentially by targeting the same protein, but providing it in a form that is, is making more antibodies against that protein and therefore more effective than RTSS in these preliminary stage trials. Is that effectiveness, that 77 number, would that be good enough to release to the world? Well, you know, a measles virus vaccine is over 90% effective.

And we've heard about the SARS-CoV vaccines that are over 90% effective. And so to be really effective, we want as close to the 100% as possible. but 77% is definitely a big improvement over current RTSS vaccine efficacy. But I should point out, however, that even at the early stages of the trials for RTSS vaccine done in different countries around the world, efficacy ranged anywhere from 50 to even 80%. So it remains to be seen when R21 vaccine is tested in different conditions, different transmission rates in different countries, what the efficacy of the vaccine is going to be.

But it's something to look forward to for the next stages. of the clinical trials. What happens in the next stages and what happens to the actual approval process? Yeah, so taking a vaccine candidate from discovery at the bench to widespread deployment is a very complex, lengthy, and expensive process. And so the stage where the R21 vaccine is often called the phase two study where it is done in a few individuals, in this case, the group size was about 150 kids ranging from five months to 17-month-old. And in the next step, which is called the phase three, that would be expanded

to thousands of individuals and across multiple sites. And that is going to evaluate both the safety, efficacy, and immunogenicity under different conditions. Then the next step would be for it to be taking a positive opinion from the WHO and towards licensure. Do you see the R-21 as becoming the sole vaccine, or do you think the other one is still useful in the law? In the law, in the long run? Both the vaccines target the same protein on the parasite surface. So if one is better than the other, certainly my view is that that one would be sufficient. But your question points to a much bigger problem, which is even if they are able to achieve 77% efficacy consistently, that still means 23% of the people who would go on to develop an infection. And since this vaccine targets

the silent stages of the parasites, clinical disease is still possible in those individuals. individuals where the vaccine was not effective. And therefore, an eventual malaria vaccine, I suspect, will be also targeting the forms of the parasite that causes disease, that is, the parasites that grow within the red blood cells. And so, for example, in our lab, we are focusing on a parasite protein where the parasite injects this protein onto the host cell surface to enter into their host cells. So we think that targeting such important interactions could be a way forward for developing an effective blood-stage malaria vaccine, and that eventually combining vaccines that target such blood-stage parasites, along with vaccines like RTSS and R-21, to form a

multi-stage, multi-target vaccine is going to be more effective in the long term. Now, we know that researchers have been working on a malaria vaccine, what, since the late 1960s? Can you tell us why there is a reason that malaria has been so difficult to develop? a vaccine against? So unlike some of the viral vaccines, the viral genome codes for a few proteins. The malaria parasite genome codes for over 5,000 proteins. Wow. Which protein do you target? Which candidate do you target? The parasite also changes its code to escape the immune system. And so a vaccine for it to be effective has to make sure that the targeting protein are effective, that the antibodies targeting those proteins can effectively prevent parasites from causing disease or

infection, but at the same time also allow for preventing the mutations from happening. And if it does happen, that you have a backup strategy to prevent those parasites from infecting. The second important thing is the life cycle of the parasite itself. As I mentioned to you, the parasites' life cycle critically depends on the mosquito vector. While that might be thought of as a bottleneck, that is also a step that has eluded parasites from being effectively cleared from the immune system because there's always the mosquitoes carrying the parasites and it's much more difficult to eliminate all the mosquitoes as you probably are aware of in your own backyard to get rid of all these mosquitoes during the rainy season. Is there enough money to look at all these different

ideas? Well, I would say certainly the funding for malaria research is not where it should be And I suspect the challenge comes from the fact that most of the countries that are directly affected by malaria are developing countries. And therefore, we do need a lot more investment in malaria. So there's been a lot of work on characterizing different vaccine candidates. And as I mentioned to you, there is a number of steps along this pathway towards vaccine development. But as soon as the preclinical studies are done in the lab, progressing candidates to clinical trials is a big hurdle because there is a substantial

requirement of investment to move learnings from the lab into the field and to be able to test it in clinical trials requires a lot of funding investment. Well, thank you for keeping us up to date on this. Absolutely. It was a pleasure to speaking with you, IRO. Take care. Dr. Prakash Sharina Vassan, Assistant Professor of Molecular Microbiology and Immunology, Johns Hopkins University's Malaria Research Institute. I want to turn now to the bigger picture of eliminating malaria worldwide. This is a goal the World Health Organization is working toward,

with help from partners around the world, including in the U.S., an office called the President's Malaria Initiative, with a budget of $770 million per year. The president's malaria coordinator joins us, Dr. Raj Punjabi, a physician and founder of the nonprofit Last Mile Health. Welcome to Science Friday. Thanks for having me on, Ira. It's our pleasure. You know, we just heard a lot about the decades-long effort to develop vaccines against malaria, and there's still nothing fully licensed or available in the world yet. Where could more resources make a critical difference? First of all, as far along as the current vaccine can

it's our, and it's very exciting to see. We do need more investment in developing more tools, including more candidate vaccines. We also need investment in the tools that we know work. Medicines that save lives, tests that allow you to detect malaria, and bed nets and mosquito sprays that actually kill the mosquitoes that carry malaria to humans. So those are the areas where we need further investment, but we also need it in health workers, nurses and community health workers that are on the front lines of delivering treatments for and tests and sprays and bed nets to families around the world. We've got to do more to invest in them. The World Health Organization has set this goal of reducing malaria mortality by 90% by 2030.

That's almost around the corner. How much could vaccines help? It's worth taking stock of the progress we've made so far. I grew up in Liberia, which has one of the highest burdens of malaria in the world. When I was first infected with malaria as an infant in 1981, nearly a million people died that year from the disease. By 2004, that number had nearly doubled to about two million. But since then, the world's made incredible progress. A billion and a half infections have been prevented since 2000. Dozens of countries are moving towards elimination. So, We've also seen in the countries we directly work with, death rates amongst children have fallen by about 60%. So there's a lot of cause for optimism. But as you said, to reach that goal of reducing the disease and the death rate further, and also moving towards ending malaria within our generation, we've really got to face these major threats. COVID has set us back. Testing rates in parts of the world for malaria have fallen by 31%. And the WHO predicts, there could be as many as 100,000 excess malaria debts. And that's on top of the fact that more people died from malaria in Africa last year during the COVID pandemic than from COVID-19 itself.

So we've got to do a lot more to get back on track to ending malaria if we're going to have a chance of doing it within our generation. And I still think that's possible, but we've really got to rethink the way we deliver the tools we have and also develop new tools. If we want to move the needle from 400,000 debts a year down towards zero, we're going to have to reach the unreached. So in these areas where you might have to walk, hike through a forest to reach a village where there's no clinic or no physician for hours

or days in some cases. This is Science Friday from WNYC Studios. You know, I'm listening to this and I'm almost matching it one for one the words I hear from COVID-19 trying to reach people who are unreachable. How similar is that? You know, there is a truism in infectious disease that the poor and the marginalized are more likely to be left out of reach of new medicines, new vaccines, new tests. A billion people are still out of reach of the most basic of medical advances. About 13 million children every year don't even get a single dose of any vaccine. That's for measles or for other conditions. There are models of care that allow you to deliver care to go that extra mile and reach those that have been unreached. A lot of it starts by shifting the way we think

in medicine from bringing care to patients rather than waiting for patients to come to care, meeting people where they are. And if you look, Ira, at the most successful vaccination programs, the ones that succeed in reaching marginalized communities, whether it's in rural areas or poor urban areas, they often have a community-based model. They bring vaccination sites from hospitals into community centers, sometimes all the way to the doorstep. Those are the types of things that we need to do if we're going to succeed in bending the curve and defeating these pandemics. Well, it sounds like what you're saying is that we need an ongoing system.

I mean, we're jumping from one disease to another, one pandemic to another, and then setting up these systems on the fly almost. It's like these systems don't stay around so that they can remain and be applied to the next disease? I think you're right. You know, the most effective response, it may not be an emergency response system per se, but an everyday system that's able to surge and respond to an emergency when it happens. A few years ago, there was an Ebola epidemic in West Africa, as we all remember, and that took many thousands of people in Liberia, many hundreds of health workers. The reason that spread so widely is because in rural areas of the country, clinics and lab systems, and lab systems,

and health workers were too few, and we just didn't see it until it was already widespread. After the Ebola epidemic, the U.S. government with others, worked with the Liberian government to do a number of things. One of the most important investments they made was to hire, train and equip local health workers, community health workers, outreach nurses, to reach those rural areas that had not been reached before, where the highest risk of future epidemics are likely to emerge. those workers first were looking for the next Ebola, but they were also leveraged by us at PMI to deliver testing and treatment for malaria.

So all of a sudden, in a country where malaria is the ranking problem in the country, about 50% are sick with malaria at any one point, we actually were able to extend the reach of malaria testing and treatment because these community health workers went door to door. Now, when COVID-19 hit, it's actually these same workers that are going door to door.

door to screen patients for COVID symptoms. This past year has certainly shown us how quickly researchers can create a vaccine for a new disease. If money and the collective energy is there, do you think we'd be able to get sort of an operation warp speed for malaria vaccines to help us finish what has already been started? Let's first acknowledge we've been not only tracking, but investing in malaria vaccine development for many, many years. In fact, for more than 50 years. And since 2000, we've invested $130 million. This has been 100 years nearly in the making since the parasite of malaria was first discovered.

So one of the critical issues is certainly the political and economic attention. The other is the complexity of malaria. And so what we need, in addition to seeing progress through on these latest vaccine candidates, is to ensure we're doing much more to invest in upstream or early-stage research. That has all kinds of benefits, Ira, not only for helping us accelerate progress on making malaria vaccines, but also in expanding knowledge for vaccine delivery systems for other pathogens, in fact, for COVID-19 itself. And so while we need to do more on COVID-vaccine research, the more we do on malaria

of vaccine research, not only will that be a win for children and families across the world that suffer with this disease, but it actually can help us advance science against other conditions as well. Well, this has all been very interesting. I want to thank you for taking time to be with us today. Thank you, Ira. Dr. Raj Punjabi coordinator of the U.S. President's Malaria Initiative. And that's all the time we have for this hour.

Charles Berkis is our director. Our producer is our Christy Taylor, Katie Feather, and Kathleen Davis, Senior producer Alexa Lim, contributing editor, John Dan Kosky, BJ Leiterman composed our theme music. Of course, if you missed any part of the program, or you'd like to hear it again, sure. Subscribe to our podcasts or ask your smart speaker to play Science Friday. Also on the SciFriVox Pop app, we want to know if you've had a conversation with your doctor about medical marijuana. Do you use marijuana to treat a medical issue like chronic pain or nausea, and is it something you talk about with your doctor? Why or why not? We want to hear about your

experience. Have a great weekend. I'm I Refledo.