A theory of malaria vaccination

Plasmodium falciparum malaria: some epidemiological implications of parasite and host diversity

Observations are accumulating concerning: (1) the antigenic diversity of Plasmodium falciparum; (2) the diversity of the genetic immuno-competence of human hosts; (3) the associations between these diversities and disease, protection and defined immune responses; and (4) the possible mechanisms of acquired protection at different steps of the host-parasite interaction. These observations have led to speculations concerning the distribution of disease, the acquisition of protection, and vaccination prospects. Speculations on the latter have varied from pessimism about the possibility of developing a vaccine that would protect most people against most parasites, to optimism based on the hypothesis that a local P. falciparum population is composed of a few discrete subpopulations. If this hypothesis is correct, it may be possible to prevent most severe disease with a narrow-spectrum vaccination against a virulent minority of the subpopulations, or transmission could be interrupted by a relatively low coverage of a broad-spectrum vaccination. A conceptual model that might accommodate the observations is outlined. Its plausibility and testability are considered, as well as some of its implications for the planning and interpretation of epidemiological surveys and intervention trials, and perhaps for selection of antigens for inclusion in vaccines.

Transmission dynamics of Plasmodium falciparum

Recent models of malaria have been developed by Gupta and her co-workers. A frequent assumption used to illustrate these models is that levels of malaria are controlled by lifelong strain-specific immunity. In this article, Allan Saul examines the predictions this model makes about the equilibrium values of parasite prevalence and the dynamics of an epidemic following the introduction of a new strain. He reaches the conclusion that the stability of malaria makes long-term strain-specific immunity highly improbable, thus rendering models requiring lifelong strain-specific immunity unlikely to be of relevance in most epidemiological contexts.

[Towards a vaccination against malaria]

For 20 years, the prospect of anti-malarial vaccination has aroused many hopes, but in the end, it has mostly given rise to doubts and disappointment. If most attempts have been to no avail, this is because the issue at stake is amazingly difficult. Besides the very complex antigenic structure of the protozoa Plasmodium, there is first the existence of at least three different targets during the plasmodial cycle, then the necessity of appropriate adjuvants and, most of all, the imperfection of our experimental models. Recently, Pattaroyo and the various groups who worked with him have eventually met success with vaccine trials in man: they used a synthetic antigene, SPf66, on volunteers in South America, then on a larger population sample in East Africa. The results are still quite modest: people are protected against the malarial disease but not against the parasitemia and only in approximately 40% of cases. Nevertheless, these results have the merit of representing the first successful anti-malarial vaccination in man. Although great advances are still needed, a decisive step forward has been taken. Other types of vaccine will soon be tested by other groups (anti-gametocyte vaccines) and prospects of significant improvements are offered by the technique of DNA-vaccines. If it is now certain that one or several vaccines will be available in a near future, no one is able to set the time delay necessary to reach this stage. In any case, hoping that this type of vaccine will eradicate the disease is not realistic since a disease as complex as malaria, in terms of epidemiology, cannot be eliminated by only one method.(ABSTRACT TRUNCATED AT 250 WORDS)

The practicality and sustainability of vaccination as an approach to parasite control

The development of a successful vaccine depends not only on the production of the vaccine itself, but also on the design pf the vaccination programme. This involves a better understanding of the epidemiology of the disease to be controlled, the delivery system to be used and the costs involved. This review focuses on current understanding of parasite population dynamics and epidemiology, and on the logistic experience gained from immunization programmes using existing viral and bacterial vaccines. The feasibility and sustainability of any new vaccine would greatly benefit from research into epidemiology and health systems which are conducted in parallel, rather than sequential to, vaccine development.