By Dr. Lucas Otieno Tina
There’s a common saying in my community: ‘‘It’s better to start early than go to a witch doctor.” By this, we mean, it’s better to prevent the disease than to treat it when it’s often too difficult, or too late.
My community is a town called Kisumu, which is located in western Kenya along the shores of Lake Victoria. There, I work as a physician and researcher at the Kenya Medical Research Institute/US Army Medical Research Unit/Kenya collaboration program, otherwise known as the KEMRI/Walter Reed Project.
I work to protect children against big killers
Every day, I work to protect African children against the big killers in our region: pneumonia, diarrheal diseases and—particularly for us at the KEMRI/Walter Reed Project—malaria. And every day, when I see these children and their parents suffering, I feel compelled to do something. First, to treat the disease, and second to prevent it.
And that is where we find the beauty of immunization with vaccines. We’ve learned from various diseases, including the classic cases of polio and smallpox, that prevention is better than cure. Vaccination, typically easier and cheaper than curing, averts the suffering of children and the burden on the family and community.
Across the road from my research center, you will find the Kombewa District Hospital, where we treat the participants in our clinical trials and other members of the public. In the course of my work, I have repeatedly witnessed the problems of poverty, lack of access to proper healthcare, and resource limitations. It’s been especially troubling to watch the medical personnel and facilities struggling with illnesses that are mostly preventable and treatable. These are primarily infectious diseases—malaria, tuberculosis, diarrhea, and HIV/AIDS—and malnutrition.
I have gained invaluable experience in several large trials
We’ve known for 40 years that a vaccine against malaria is biologically feasible. The KEMRI/Walter Reed Project has been in the thick of this research and has worked on malaria and various vaccine candidates for many decades. Through my work with them, I have gained invaluable experience in several large trials of malaria vaccines. I consider our contribution a great achievement given that a malaria vaccine has the potential to change the face of the war against malaria forever.
I’m happy to say, we are completing a Phase 3 clinical trial on the most advanced malaria vaccine candidate to date: RTS,S. No other vaccine candidate has made it this far in the development process. Walter Reed worked with GSK in the early development of RTS,S in the 1980s. In 2009, a unique public/private partnership involving the PATH Malaria Vaccine Initiative (MVI), GSK and 11 African research centers—including my center in Kombewa—launched this large-scale trial with over 15,000 infant and young child participants.
In the results so far, clinical malaria cases were reduced by about half in young children ages 5 months to17 months and by about a quarter in infants 6 weeks to 12 weeks after 18 months of follow-up. We’re very much looking forward to the trial’s final results at the end of this year or early 2015, which will provide 30 months of follow-up and give us data on the effects of a booster dose.
So where do we see RTS,S in the months to come?
Later this year, GSK plans to submit a regulatory application for RTS,S to the European Medicines Agency (EMA). If the data and public health information is deemed satisfactory, and the EMA gives a positive opinion, the WHO has indicated that a policy recommendation for the RTS,S malaria vaccine candidate is possible by the end of 2015. This would pave the way for local regulatory submissions and decisions by African nations regarding implementation of the vaccine through their national immunization programs.
With this in mind, in Kenya, as in other countries in my part of Africa, like Tanzania and Uganda, efforts are already underway to ensure a timely decision on whether to adopt this new tool, if it is licensed and recommended for use. If we have an effective and approved tool for use against this terrible disease, I’d hate to see it sit on the shelf when I do my rounds in the pediatric ward full of sick kids.
It’s been a very gratifying experience to work with WRAIR and our partners on this “big picture” intervention—a vaccine—for one of our biggest and most persistent public health problems—malaria.
Dr. Lucas Otieno is a medical doctor working as a Research Officer and Certified Physician Investigator with the Kenya Medical Research Institute (KEMRI)/Walter Reed Project in Kenya. He is currently a Principal Investigator for the Phase III malaria vaccine trials of RTS,S.