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Indrihutami K, Chand K, Fahmia R, Rahardjani M, Wulandari F, Subekti D, Noviyanti R, Soebandrio A, Mallisa NT, Mardika IM, Budiman W, Suriswan I, Ertanto Y, Chen MC, Murshedkar T, Abebe Y, Sim BKL, Hoffman SL, Richie TL, Chen S, Elyazar IRF, Ekawati LL, Baird JK, Nelwan EJ. Implementation of a Randomized, Placebo-Controlled Trial of Live Attenuated Malaria Sporozoite Vaccines in an Indonesian Military Study Population. Am J Trop Med Hyg 2024; 110:892-901. [PMID: 38531102 PMCID: PMC11066349 DOI: 10.4269/ajtmh.23-0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/24/2023] [Indexed: 03/28/2024] Open
Abstract
Malaria eradication efforts prioritize safe and efficient vaccination strategies, although none with high-level efficacy against malaria infection are yet available. Among several vaccine candidates, Sanaria® PfSPZ Vaccine and Sanaria PfSPZ-CVac are, respectively, live radiation- and chemo-attenuated sporozoite vaccines designed to prevent infection with Plasmodium falciparum, the leading cause of malaria-related morbidity and mortality. We are conducting a randomized normal saline placebo-controlled trial called IDSPZV1 that will analyze the safety, tolerability, immunogenicity, and efficacy of PfSPZ Vaccine and PfSPZ-CVac administered pre-deployment to malaria-naive Indonesian soldiers assigned to temporary duties in a high malaria transmission area. We describe the manifold challenges of enrolling and immunizing 345 soldier participants at their home base in western Indonesia before their nearly 6,000-km voyage to eastern Indonesia, where they are being monitored for incident P. falciparum and Plasmodium vivax malaria cases during 9 months of exposure. The unique regulatory, ethical, and operational complexities of this trial demonstrate the importance of thorough planning, frequent communication, and close follow-up with stakeholders. Effective engagement with the military community and the ability to adapt to unanticipated events have proven key to the success of this trial.
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Affiliation(s)
| | - Krisin Chand
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Rizka Fahmia
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Mutia Rahardjani
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Fitria Wulandari
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Decy Subekti
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Rintis Noviyanti
- Eijkman Research Center for Molecular Biology, National Research & Innovation Agency, Cibinong, West Java, Indonesia
- EXEINS Health Initiative, Jakarta, Indonesia
| | - Amin Soebandrio
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Noch T. Mallisa
- Presidential Staff Office, Republic of Indonesia, Jakarta, Indonesia
| | | | - Waras Budiman
- Muhammadiyah University, Surabaya, East Java, Indonesia
| | | | - Yogi Ertanto
- Army Medical Center, Army of the Republic of Indonesia, Jakarta, Indonesia
| | | | | | | | | | | | | | | | | | - Lenny L. Ekawati
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - J. Kevin Baird
- Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Erni J. Nelwan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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