These two children have just received the first malaria vaccine to move beyond the stage of clinical testing—a landmark event in the battle against a disease that each year takes more than 400,000 lives, most of them children in Africa. The researchers figured they would know which children have died. "Unfortunately, we still have no death registration in this country," Mathanga says. Some experts question whether that is worth the cost and effort.

"We had to train hospital staff to collect these data.

“We salute WHO and Malawi for their leadership in realizing this historic mileston…

Development of Mosquirix began in the 1980s. Sign up to the Quartz Africa Weekly Brief here for news and analysis on African business, tech and innovation in your inbox. Those are paltry numbers compared with the measles vaccine, which is 97.5% protective. The blood cells burst, causing fever, headache, chills, muscle aches, and often anemia. If this pilot shows that RTS,S is a cost-effective tool against malaria, it will help us save more children’s lives.” This story was supported by the European Journalism Fund.

Program costs included service delivery and direct household expenditures related to vaccination visit. The WHO-coordinated pilot programme is a collaborative effort with ministries of health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organization, and GSK, the vaccine developer and manufacturer, which is donating up to 10 million vaccine doses for this pilot. Mosquirix targets so-called sporozoites after they are injected by a mosquito and before they move to the liver.

Pilot evaluation staff use motorbikes to visit the chiefs regularly and collect the paper files; they also interview relatives of deceased children to identify the most likely cause of death. Cracks and holes in the walls of her brick house are smeared with loam to keep mosquitoes out. The decision came after early studies showed that chloroquine and Hydroxychloroquine are effective in inhibiting the disease when tested in vitro with primate cells. The poorest children suffer the most and are at highest risk of death,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Read the Q&A on the malaria vaccine implementation programme (MVIP) Just being enrolled in the trial meant children received better care, and their mortality was 70% lower than among children near the study sites who weren't enrolled. One-third of the children with meningitis died. "There are effective measures available that we can use even better," says Micaela Serafini of Doctors Without Borders in Geneva, Switzerland.

Health worker Dennis Nkuma opens a vaccine registry book in a health center in southern Malawi. Whether the researchers will have enough data to make a decision remains to be seen, however. She was delighted to hear about the arrival of the vaccine, but her son can't get it because they live in a control area. It has a complex life cycle that begins when an infected female mosquito bites a human and spits Plasmodium cells called sporozoites into the bloodstream. During the conference, FDA commissioner Dr. Stephen Hahn said the regulator is preparing to test the drug in a clinical trial with coronavirus patients. "Many people were very skeptical at the time, because there had been so many attempts done and so many failures," says molecular biologist Joe Cohen, who led the effort until he retired from GSK in 2012. Instead, the team built a new system based on a cultural practice: In rural Malawi, town chiefs must allocate a place for the dead to be buried. "The only challenge we are having here, is that people from the nonvaccine areas come and ask for it.". He worries that even without a clear safety verdict, the global health community will exert enormous pressure to get the vaccine approved around Africa. What's more, a declining number of meningitis cases and deaths in the three countries—although good news—may mean researchers need to continue the pilot longer than expected to detect statistically significant differences. THE MALARIA PARASITE is a challenging target for a vaccine. But these "verbal autopsies" aren't always correct. But among children first vaccinated between 17 months and 25 months of age, malaria infections overall were down by 40%, and severe infections by about 30%. Mentions of chloroquine have also been trending on Twitter in Nigeria and Ghana. "We have a lot of checks on the evaluation. AAAS is a partner of HINARI, AGORA, OARE, CHORUS, CLOCKSS, CrossRef and COUNTER.

Vaccines that contain a living, weakened pathogen—such as the vaccines against measles and tuberculosis—strengthen the immune system generally, Aaby and Stabell Benn say, making recipients better able to fight off other infections.