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We predict the effects of introduction of a pre-erythrocytic vaccine against Plasmodium falciparum into a malaria-endemic population in Africa. We use a stochastic simulation model that includes components of transmission, parasitology, and clinical epidemiology of malaria and was validated using the results of field trials of the RTS,S/AS02A vaccine. The results suggest that vaccines with efficacy similar to that of RTS,S/AS02A have a substantial impact on malaria morbidity and mortality during the first decade after their introduction, but have negligible effects on malaria transmission at levels of endemicity typical for sub-Saharan Africa. The main benefits result from prevention of morbidity and mortality in the first years of life. Vaccines with very short half-life or low efficacy may have little overall effect on incidence of severe malaria. A similar approach can be used to make predictions for other strategies for deployment of the vaccine and to other types of malaria vaccines and interventions.
Received September 18, 2005. Accepted for publication February 9, 2006.
Acknowledgments: We thank the members of the Technical Advisory Group (Michael Alpers, Paul Coleman, David Evans, Brian Greenwood, Carol Levin, Kevin Marsh, F, Ellis McKenzie, Mark Miller, Brian Sharp), the Project Management Team at the Program for Appropriate Technology in Health (PATH) Malaria Vaccine Initiative, and GlaxoSmithKline Biologicals S.A for their assistance.
Financial support: The mathematical modeling study was supported by the PATH Malaria Vaccine Initiative and GlaxoSmithKline Biologicals S.A.
Disclaimer: Publication of this report and the contents hereof do not necessarily reflect the endorsement, opinion, or viewpoints of the PATH Malaria Vaccine Initiative or GlaxoSmithKline Biologicals S.A.
* Address correspondence to Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, PO Box, CH 4002, Basel, Switzerland. E-mail: Thomas-A.Smith{at}unibas.ch
Authors’ address: Nicolas Maire, Fabrizio Tediosi, Amanda Ross, and Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002, Basel, Switzerland, Telephone: 41-61-284-8273, Fax: 41-61-284-8105, E-mails: nicolas.maire{at}unibas.ch, fabrizio.tediosi{at}unibas.ch, amanda.ross{at}unibas.ch, and Thomas-A.Smith{at}unibas.ch.
Reprint requests: Thomas Smith, Swiss Tropical Institute, PO Box, CH-4002, Basel, Switzerland.
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