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Can India Eliminate Malaria by 2030?
Context: India has made commendable strides in cutting its malaria burden by over 80% between 2015 and 2023 — yet tribal districts like Lawngtlai (Mizoram) and Narayanpur (Chhattisgarh) still report high infection rates, showing that the fight is far from over.
Why Is Malaria So Hard to Eliminate?
- The complexity lies in the parasite’s adaptability and the mosquito’s growing resistance to insecticides.
- While Africa mainly battles Plasmodium falciparum, India faces a dual threat with the addition of Plasmodium vivax — a species known to remain dormant in the liver and relapse weeks or months later.
- In some Indian states like Jharkhand, mixed infections (P. falciparum + P. vivax) account for nearly 20% of cases, and asymptomatic carriers continue to act as silent reservoirs of the disease.
Are New Vaccines Turning the Tide?
- Effectiveness of current malaria vaccines: The RTS,S vaccine, launched in 2021, offered 55% protection in the first year, but its efficacy dropped after 18 months, requiring booster doses.
- The R21/Matrix-M vaccine, developed by Oxford and India’s Serum Institute, showed up to 77% efficacy and received WHO approval in 2023. It requires fewer doses and is cost-effective, but like RTS,S, it targets only one stage of the parasite.
- Whole-parasite vaccines: Whole-parasite vaccines, like PfSPZ and PfSPZ-LARC2, use radiation-weakened parasites to mimic natural infection. These are delivered intravenously and have shown up to 96% antibody response and 79% protection after three doses and potential for one-dose regimens in hard-to-reach or outbreak-prone areas.
Can Blood-Stage and Transmission-Blocking Vaccines Complement Each Other?
- PfRH5 as a potential game-changer: Unlike earlier-stage vaccines, PfRH5 targets the blood stage when symptoms appear.
- Since this protein is essential for red blood cell invasion and doesn’t mutate easily, it offers cross-strain protection — crucial for diverse infections in India.
- Working of transmission-blocking vaccines: TBVs (Transmission-Blocking Vaccines) aim to prevent the parasite from multiplying inside the mosquito, thereby cutting off transmission.
- Pfs230D1, tested in Mali, reduced transmission by 78%.
- India’s first indigenous dual-stage vaccine — AdFalciVax — combines both pre-erythrocytic (PfCSP) and TBV (Pfs230, Pfs48/45) antigens.
- In mice, AdFalciVax produced immune responses that lasted the equivalent of a decade in humans and remained stable at room temperature for 9 months — a huge advantage for rural deployment.
- India is also advancing TBVs for P. vivax with collaborations underway for Pvs230D1M, which showed 96% transmission reduction in Thailand.
What Are the Latest Innovations in Vaccine Platforms?
- Immune system boosters: By pairing ferritin nanoparticles with known adjuvants like CpG (used in Hepatitis B vaccines), scientists reduced liver-stage parasite load by 95% in mice.
- Even mild adjuvants like alum produced >90% protection in AdFalciVax — comparable to stronger, more inflammatory agents.
- mRNA vaccines: mRNA technology, famous for its COVID-19 success, is being tested for malaria:
- CureVac and NIH created an mRNA-lipid nanoparticle targeting Pfs25, which completely blocked transmission in mice for over 6 months.
- However, BioNTech’s BNT165e blood-stage vaccine hit a roadblock, with FDA placing its Phase I/IIa trial on hold in early 2025.
How Are Scientists Enhancing Vaccine Precision?
- Immune Targeting: New strategies aim to improve immune targeting, like linking malaria proteins (PfCSP) to immune-recruiting molecules (MIP3) — boosting both T-cell and antibody responses by up to 88% in mice.
- Gene Editing: P. falciparum evades the immune system using RIFIN proteins that bind immune ‘off switches’ like LILRB1.
- A new antibody, D1D2.v-IgG, outcompeted the parasite by binding 110x more strongly and restoring immune function in lab tests.
- Gene drives: CRISPR-based gene drives have wiped out entire mosquito populations in labs by altering fertility genes.
- Other approaches tweak genes like FREP1 to block parasite development or kill infected mosquitoes early. These methods are promising but raise ethical, ecological, and evolutionary concerns.
What Are the Key Challenges for India?
- Vivax-specific research is slow due to regulatory restrictions on monkey models.
- Translation from lab to trials takes time — even AdFalciVax may need 7–8 years to complete all trial stages.
- Other Issues include: GMP-grade manufacturing, Biomarker development and Benchmarking efficacy against RTS,S and R21.
What is the Way Forward?
- India needs vaccines, antibodies, diagnostics, and new drugs — for both P. falciparum and P. vivax.
- Doctor training, resistance monitoring, and vector control must continue in parallel.
- Success demands coordination between researchers, industry, regulators, and local governments.
