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What next for the malaria RTS,S vaccine candidate?
Editorial
Canada’s healthy future?
Mico Smiljanic/Xinhua Press/Corbis
Justin Trudeau, Canada’s new Prime Minister-designate, laid out several policies in his Liberal Party’s manifesto in the run-up to the Oct 19 national election, which will see the return of the Trudeau family to 24 Sussex Drive, Ottawa. There are promises to re-engage with First Nation Canadians, abandoned from health service planning by the Stephen Harper stewardship of the past decade; appoint a Chief Science Officer within government (to help the nation re-connect with a community often viewed by the previous administration with mistrust and suspicion); legalise cannabis; commit to stronger action on climate change; and increase funding for the devolved provincial and territory health systems to offer improved services, notably in the areas of elderly care and mental health. Delivery on these policies could have positive effects on Canada’s future health and reverse a decade during which health has been largely ignored by the federal government. Beyond the election pledges, Trudeau’s new administration should articulate the meaning of public health for Canada at a federal level, how it can influence policy
in the devolved regional health systems, and how it can redistribute resources to help contribute to national health equity. Globally, the new government should build on Harper’s Muskoka Initiative—one surprisingly positive legacy of the Harper years, which highlighted Canada’s outstanding advocacy for a global health programme that has already had a substantial impact in maternal, newborn, and child health across seven low-income settings, mainly in sub-Saharan Africa. Canada has committed a further CAN$3·5 billion over the next 5 years to the next phase of the Muskoka Initiative. We would like Trudeau to embrace the Muskoka movement and broaden it to define Canada’s future global health strategy in the new era of sustainable development. Pre-election excitement and post-election euphoria bring high expectations. But If Trudeau appoints bold, progressive, and technically able ministers—and we will learn more when his cabinet is announced on Nov 4—then Canada could well have a healthier future, and recover from its lean Harperesque past. The Lancet
Stephen Morrison/epa/Corbis
What next for the malaria RTS,S vaccine candidate?
See Correspondence pages 1735 and 1736
For the Article on the RTS,S/ASO1 vaccine see Articles Lancet 2015; 386: 31–45
1708
On Oct 23, the Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC) announced their much-anticipated recommendations for the world’s first malaria vaccine candidate known as RTS,S/AS01. Their decision is not to recommend widespread deployment of the vaccine based on existing evidence, but instead to assess the feasibility of delivering the vaccine and its impact in real-world settings. This decision was perhaps unexpected given the fact that earlier this year the European Medicines Agency reviewed the same safety and efficacy data, and approved the vaccine’s use in young children. In trials, RTS,S/ASO1 shows about 30% efficacy against Plasmodium falciparum malaria in young infants and children aged 5–17 months, and requires four doses. The final dose is crucial to sustain the protective effect of the vaccine. Overall mortality is a concern because of the potential risk for an increased incidence of meningitis and cerebral malaria with this vaccine. SAGE and MPAC recommend three to five demonstration pilots with 200 000 children (totalling about 1 million) over 3–5 years
in areas of medium-to-high risk of malaria. These studies will provide evidence for whether children consistently return for this crucial final dose and more information about the risk of adverse events, which is especially relevant in low-income countries with weak health systems. These pilots will be a huge undertaking, and will need substantial funds, technical expertise, and systems for monitoring and surveillance. Some critics believe that this money could be spent more appropriately to improve existing interventions, such as bednets and drugs. Médecins Sans Frontières immediately supported the pilots, but state that based on the present data, they would not be using the vaccine in their programmes. The final policy recommendation on the vaccine from WHO is expected by the end of 2015. It has always been stressed that the vaccine could complement—not replace—existing proven malaria interventions. That might still be the case. But it is essential to show efficacy and feasibility outside a trial setting. SAGE and MPAC’s recommendation is an important first step to determine the vaccine’s future. The Lancet www.thelancet.com Vol 386 October 31, 2015
Canada’s healthy future?
Mico Smiljanic/Xinhua Press/Corbis
Justin Trudeau, Canada’s new Prime Minister-designate, laid out several policies in his Liberal Party’s manifesto in the run-up to the Oct 19 national election, which will see the return of the Trudeau family to 24 Sussex Drive, Ottawa. There are promises to re-engage with First Nation Canadians, abandoned from health service planning by the Stephen Harper stewardship of the past decade; appoint a Chief Science Officer within government (to help the nation re-connect with a community often viewed by the previous administration with mistrust and suspicion); legalise cannabis; commit to stronger action on climate change; and increase funding for the devolved provincial and territory health systems to offer improved services, notably in the areas of elderly care and mental health. Delivery on these policies could have positive effects on Canada’s future health and reverse a decade during which health has been largely ignored by the federal government. Beyond the election pledges, Trudeau’s new administration should articulate the meaning of public health for Canada at a federal level, how it can influence policy
in the devolved regional health systems, and how it can redistribute resources to help contribute to national health equity. Globally, the new government should build on Harper’s Muskoka Initiative—one surprisingly positive legacy of the Harper years, which highlighted Canada’s outstanding advocacy for a global health programme that has already had a substantial impact in maternal, newborn, and child health across seven low-income settings, mainly in sub-Saharan Africa. Canada has committed a further CAN$3·5 billion over the next 5 years to the next phase of the Muskoka Initiative. We would like Trudeau to embrace the Muskoka movement and broaden it to define Canada’s future global health strategy in the new era of sustainable development. Pre-election excitement and post-election euphoria bring high expectations. But If Trudeau appoints bold, progressive, and technically able ministers—and we will learn more when his cabinet is announced on Nov 4—then Canada could well have a healthier future, and recover from its lean Harperesque past. The Lancet
Stephen Morrison/epa/Corbis
What next for the malaria RTS,S vaccine candidate?
See Correspondence pages 1735 and 1736
For the Article on the RTS,S/ASO1 vaccine see Articles Lancet 2015; 386: 31–45
1708
On Oct 23, the Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC) announced their much-anticipated recommendations for the world’s first malaria vaccine candidate known as RTS,S/AS01. Their decision is not to recommend widespread deployment of the vaccine based on existing evidence, but instead to assess the feasibility of delivering the vaccine and its impact in real-world settings. This decision was perhaps unexpected given the fact that earlier this year the European Medicines Agency reviewed the same safety and efficacy data, and approved the vaccine’s use in young children. In trials, RTS,S/ASO1 shows about 30% efficacy against Plasmodium falciparum malaria in young infants and children aged 5–17 months, and requires four doses. The final dose is crucial to sustain the protective effect of the vaccine. Overall mortality is a concern because of the potential risk for an increased incidence of meningitis and cerebral malaria with this vaccine. SAGE and MPAC recommend three to five demonstration pilots with 200 000 children (totalling about 1 million) over 3–5 years
in areas of medium-to-high risk of malaria. These studies will provide evidence for whether children consistently return for this crucial final dose and more information about the risk of adverse events, which is especially relevant in low-income countries with weak health systems. These pilots will be a huge undertaking, and will need substantial funds, technical expertise, and systems for monitoring and surveillance. Some critics believe that this money could be spent more appropriately to improve existing interventions, such as bednets and drugs. Médecins Sans Frontières immediately supported the pilots, but state that based on the present data, they would not be using the vaccine in their programmes. The final policy recommendation on the vaccine from WHO is expected by the end of 2015. It has always been stressed that the vaccine could complement—not replace—existing proven malaria interventions. That might still be the case. But it is essential to show efficacy and feasibility outside a trial setting. SAGE and MPAC’s recommendation is an important first step to determine the vaccine’s future. The Lancet www.thelancet.com Vol 386 October 31, 2015