In Uganda, like many countries, malaria is endemic and deadly.
“Almost every month we are in the hospital," Carol Wenyisa says. "When the child falls sick ... you feel you’re paralyzed, the whole body.”
But that might soon change. After 40 years in development, the WHO has approved the first ever malaria vaccine.
Today, On Point: Malaria has shaped human history. Could that story now be coming to a hopeful end?
Dr. James Tibenderana, global technical director at the Malaria Consortium.
Dr. Ripley Ballou, program lead and principal investigator at IAVI.
Rodney Ogwang, a PhD student who is researching malaria.
Carol Wenyisa, a mother to four children.
Ricardo San Martin, scientist at UC Berkeley and consultant for Desert King International.
Sonia Shah, science writer and author of “The Fever."
Transcript: Highlights from the show's open
MEGHNA CHAKRABARTI: Rodney Ogwang was sick. Very, very sick.
RODNEY OGWANG: I went down to the hospital to get checked and even walking was difficult. So it starts with a fever. And you feel a bit feverish. Then you start feeling joint pain, and then the headaches begin. Then I started puking. So then I finally got meds and went back home. And all I can remember is for comfort laying on the floor for hours. I could barely eat. I mean, I live on my own at the time, and it was just an excruciating experience. I'm looking for the right words, you're going to die.
CHAKRABARTI: Ogwang was suffering from malaria. He's 31 years old now and a malaria researcher. He was born and raised in Uganda, the nation with the third highest malaria burden in the world. As a teen, he went to boarding school in Kampala. And when he contracted malaria last year, it was not his first time.
OGWANG: I started getting malaria when I was in high school and literally would get it every term. I remember being picked up from school, and I had to be carried out of the school clinic. And I was driven to a hospital in Kampala. And I remember, I struggle to put my finger on the feeling. But I just remember largely that I was barely conscious. I could only remember opening my eyes every so often. And seeing my parents and my auntie sitting on the side of the bed. And slipping in and out of sleep. And I don't know if it's sleep or something else, but feeling extremely cold. So covering up, and yet sweating extensively.
CHAKRABARTI: Malaria is one of the oldest and most devastating diseases known to humankind. The malaria antigen has been detected in Egyptian remains approximately 5,000 years old. The disease has shaped human history, even human biology. It killed between 150 million to 300 million people in the 20th century alone. And today, 40% of the world's population lives in places where malaria is transmitted. But by far, it's the people of sub-Saharan Africa who suffer the disease's greatest impact.
OGWANG: I think for us, it's almost normal. If you haven't had malaria before, you are an odd one out.
CHAKRABARTI: Malaria is especially devastating to children. UNICEF estimates that every two minutes a child under the age of five dies of malaria. In Uganda, the disease is still a top cause of infant and child illness and death. Malaria researcher Rodney Ogwang has seen why when he suffered from malaria as a teen, Ogwang lived in the capital city of Kampala. He went to a private boarding school and he had a family with the means to get him quickly to hospital. It saved his life. Children living elsewhere in Uganda are not so lucky.
OGWANG: It was around 2017, and it was in the height of an almost malaria epidemic at that point. So I, working in the lab, every 10 or so children you test, five to seven of them would be positive for malaria. These are school-going children, right? But they had to walk from — I don't know what kind of distance — to get to the hospital to find some kind of treatment.
OGWANG: And many of them, by the time they even arrive at the hospital, the malaria has progressed so much that a child is even getting comatose and the child is beginning to have now severe disease. Now they're going to even have more problems. Because they're going to have cognitive problems, and some will suffer long term seizures and maybe even develop epilepsy later in life. And such a child would definitely have had severe impact, simply because they couldn't get medication fast enough.
CHAKRABARTI: Carol Wenyisa is mother to four children. They live in Moroto Town, northeastern Uganda. Her three month old infant got malaria just two weeks after being born. Her almost three year old toddler has suffered from malaria consistently for his entire life. She can't count the number of times the child has had the disease. Which means Wenyisa and her babies are constantly in and out of the hospital, which is where she spoke to us over Zoom.
CAROL WENYISA: Almost every month, we are in the hospital. The baby was crying some, he cried endlessly. Then he had high fever. He had some cough.
OK, at that time, yes, I was scared because I could not believe a child of two weeks could suffer from malaria. Of course, as a mother, it is too scary and you feel like you got a child and the child has to grow in a healthy manner, in a good condition. But now when the child falls sick, and all the time you’re in the hospital, you get scared.
WENYISA: Malaria being a killer disease, all the time on a drip. Treatment, treatment, injections. Swallowing tabs. With mosquito net, I make sure I put him in the net by five and while he sleeps, his legs are on the side of the net. And then mosquitos get that chance of biting him. Maybe that is the case but he enters the net early enough. I make sure he enters early enough.
WENYISA: ... Of course, when they fall sick, they tend to remain home, we retain them home, they don't attend school. That means they miss a lot from school when they're at home, being attended to, to treat them to get better. How it affects my life ... on the side of working class people and me as well, it affects because all the time we spend all the time or most of the times in the hospital with the children. And then we tend to look after to care for them and we neglect our work. Even our bosses, they also get demoralized, also I almost lost a job because of that.
WENYISA: Even health wise, I'm not fine. I'm not comfortable when the child falls sick. Everything you feel ... paralyzed, the whole body. You never be in peace. You cannot rest. And even the work they are doing is paralyzed, you cannot again concentrate, not until that child recovers and you see that they are now normalized and is doing well.
CHAKRABARTI: Carol Wenyisa wants one simple thing: for her children to grow up normally, disease free. It's not often that we can say this, but there is good news on the horizon. After thousands of years of human suffering, hundreds of years of research and decades of intense application of modern medicine, on October 6, 2021, the World Health Organization made an historic announcement.
TEDROS GHEBREYESUS [TAPE]: As some of you may know, I started my career as a malaria researcher. And I longed for the day that we would have an effective vaccine against this ancient and terrible disease. And today is that day.
CHAKRABARTI: Dr. Tedros Adhanom Ghebreyesus, director, announcing the approval of the first-ever malaria vaccine. And the first-ever vaccine for a parasitic disease. Dr Matshidiso Moeti, W.H.O. Africa director, says the vaccine could change lives across the continent.
MATSHIDISO MOETI [TAPE]: Today's recommendation, therefore offers a glimmer of hope for the continent. We expect many more African children will be protected from malaria and grow into healthy and productive adults.
CHAKRABARTI: Truthfully, that will take time. But today we're going to talk about this remarkable good news. What did it take to develop a malaria vaccine? Is it effective enough? And what remains to be done before the scourge of malaria can truly end?
What difference might this vaccine make if it becomes widely available in Uganda?
Dr. James Tibenderana: "It will make an important difference. I think the first thing to realize is that it's a preventive tool. And earlier, you said that malaria is treatable, but I want to highlight that malaria is preventable. I think it is for those who may fall sick and then require treatment. But I think we just have to keep it in mind that this is a preventable disease.
"And for those who then fall sick, there are opportunities for good treatment. And then there's a proportion of a variety of factors. Sometimes factors, as you saw with the case of Rodney, where distances come to play, or there may be a situation where they get a very severe form of malaria called severe malaria that really has a very high mortality rate.
"So I think it's a mindset that we have an additional tool that can prevent malaria. And with all the bad news and the devastation that COVID-19 has had, with the news that malaria has been stalling, I think it's a positive message that really will help ... governments to recommit themselves to the fight against malaria. But also for the population to really embrace the idea that these new tools exist, and will be coming on board and that malaria elimination is something that they should embrace."
On the effectiveness of the vaccine
Dr. James Tibenderana: "This is the starting point. I think let's keep the perspective. This is a 30-plus year old vaccine and technology has sort of moved on. So the anticipation is that the next generation of vaccines, we probably have more protective effect. But I think the point here for me is that even when we look back at things like nets, at some of the other tools that we've deployed, we've tended to start off with fairly reasonable effect sizes.
"And over time we've learned how to use them in combination. Like Ripley was saying, by combining RTS,S [protein-based malaria vaccine] with seasonal use of treatments, you can increase the effect to reducing about 70% of deaths. So I think individually some of these tools are not perfect, but by having the tools available and by having a positive recommendation from W.H.O., it then opens the door for implementers and national programs to really adapt and identify their best use.
"So back to the point about Gavi [the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria], I think we are certainly in a bit of a dilemma because we we have a a cost effective but slightly more expensive tool. And yet we know that the funding that's necessary for us to deploy our existing tools is far lower than we require. So I think what we have to be looking at is new financing. It's not to sort of compromise our existing tools or identify funding that currently exists. I think for this, we need to be working with Gavi and other financing instruments to really identify new funding that can come for the procurement of the vaccine. But also the delivery of the vaccine through either immunization programs or as Ripley was saying, seasonal malaria chemoprevention programs."
On the possibility of eradicating malaria, and malaria's economic impact
Dr. James Tibenderana: "We need political commitment across all levels of governance. I think it's important that national governments in Africa, who in Abuja declared 15% contribution to the health sector, also step up and meet their obligations. And then they have the moral authority to really stand up and challenge the international community to really look at the long goal of malaria elimination.
"I think we can no longer keep talking about controlling malaria. We really have to globally commit and say, what is the investments that's required, especially for new tools. And not just look at malaria as a health. I think what some of your speakers have shown is that malaria is an economic problem. Countries on average that are endemic for malaria go 1.3 percent of GDP per capita slower than countries that don't have malaria. So this is an issue that needs to be discussed at the World Bank, at the IMF, Africa Development Bank, not just Gavi, Global Fund, President's Malaria Initiative. This is an economic issue, and therefore we need to be looking at it from the health side and economic side."
This program aired on October 18, 2021.