 Hello and welcome to NewsClick. Today we have with us Professor Satyajit Rat and we will be discussing not just COVID-19 but vaccines in general, particularly the new malaria vaccine which seems to have been proven successful. We will also discuss why it took so long to get a vaccine and what are the implications of these vaccines in the future. Vaccine hesitancy, the techno economics of this, particularly the economics of the vaccine itself. All these issues are something that we need to discuss because they are going to determine, as we know with COVID-19 itself, the success or the failure of the vaccine. Satyajit, first a simple question. What kind of a vaccine is it? Because we have been discussing different kinds of vaccines which are there. We have talked about the inactivated virus vaccine. We have also talked about the sub-protein, sub-unit protein vaccine, which I don't really understand what it is. We've talked about the mRNA vaccine virus vector being used as a vaccine, carrying a certain part of the protein. So in this gamut of vaccines that we have now known about it because of COVID-19, where does it belong? So it's interesting to think about this new malaria vaccine and to think about it in the broader context of this societal discussion we've been having about COVID vaccines. So to answer your specific question, this is a protein vaccine. Let's keep in mind that so far in the deployed vaccines for COVID-19, there are no protein vaccines out there properly as yet. Novavax comes closest, but even that as you know is still hanging fire with approvals and deployment. The inactivated virus vaccines are in a certain sense protein vaccines, but they are a straightforward virus inactivated and injected. Whereas what's the Novavax COVID vaccine for example is, is the spike protein created by bacteria in a fermentation technology which is very straightforward and properly folded, put together and formulated as a vaccine. The malaria vaccine, Moskerex it is called, Moskerex is a malaria vaccine like the COVID vaccine of Novavax. It's a little more complicated in its nuance. So it is as though they had taken the spike protein receptor binding domain, stitched it as a protein to another protein from a completely different source, the hepatitis B virus protein. And that has been made in bacteria as a fused protein, purified and allowed to assemble. The hepatitis virus protein is useful because we already know, we've known for 50 years that it forms organized clumps and organized particles, clumps are much more strong stimulation of immune responses. But these are now clumps which are carrying the malarial parasite equivalent of the spike protein on them. And that's how Moskerex the protein vaccine has been created. It's an interesting story, but it has not simply the scientifically interesting component, but implications in terms of as you point out the technology, the socioeconomics, as well as vaccine histories. The hepatitis B vaccine has been there for some time. So in that sense, it's not a new technology, but using to splice another part of the malaria infective agent, so to say, is the new part that is here and putting it together. So let me remind all our audience, this vaccine, the RTS comma S vaccine Moskerex has been in design since before I became a faculty member. Since the 80s, 1987, I have known friends and colleagues of those days who were young researchers involved in the design of this vaccine. So it's been 35 years in the making. So clearly, it's not a novel technology. Just as we have pointed out in these discussions earlier, even the so-called mRNA technology, the DNA technology, the adenovirus technology, all of these have been road tested in a variety of ways at different stages and levels for 20-25 years. This is an even older technology and yet it has taken this long to come up with a vaccine. So that brings me to the next question. Why is it that we could get a COVID vaccine within, say, 12 months and we could get many more than one and it has taken more than 50 years to get a vaccine. After all, the Salk vaccine is in the 50s. Why has it taken 50 years to get a malaria vaccine, which we would assume has social value as much as, say, COVID-19 vaccine today as malaria used to be much more widespread. Now it's a little better under control. Why has it taken us 50 years? So again, that's an interesting question with scientific components that we should keep in mind in response and socioeconomic ones. So let me point out the socioeconomic, the very obvious socioeconomic ones that have been staring us in the face over the past year and a half, which is that the larger the market is and the larger the rich paying profit-providing market potential is, the more rapidly private sector pharma industries gear up to make products such as vaccines. And that's what we've seen over the past year and a half. COVID vaccines have all been designed, 90% of the cases of the hundreds of efforts out there in public sector research institutions and laboratories and have been developed after design in private sector pharma industry after Technology France. Co-vaccine, Covishield, both are excellent examples of exactly that kind of transition in India and in the United Kingdom respectively. So clearly, there is a socioeconomic component because malaria as a disease of tropical countries in the main where the mosquito vectors are prominently to be found has been a disease of the poor in the global South. And as a result, the amount of potential profit to be made. Keep in mind that what I'm talking about is not simply a calculation of the number of users but the amount of profit. And there's a difference between those between the global North and the global South, which is a lesson that the Moderna COVID vaccine has taught us where 90% of its restricted manufacture is sold in the global North for a very tidy profit. But there is also a scientific component that provides a difference between the malaria vaccine and the COVID vaccines. And that I think is instructive as well. So malaria is a parasite, it's not a virus. Not only is malaria a parasite or the malaria parasite is much more closely related to us than any viruses. Not only that, malaria is a disease is not caused by a single kind of parasite. It's caused by at least four major species of parasites that are quite different from each other that don't provide protection against each other. And in fact, this particular vaccine, Moskirix, the malaria vaccine provides protection only against falsiparam malaria. And only about half of malaria in India is falsiparam malaria. So this is not a huge answer to the problem of malaria. Number one, number two, think about all the discussions we've been having about protection against COVID by vaccines. And we've been saying, oh, they have only 60% protection. No, somebody else has 70%, somebody else is 80%, somebody else is 90%. And we've been saying, oh, why can't they make vaccines that are really, really excellently protected, like the Moderna or the Pfizer vaccines? Look at the results of Moskirix. How much protection does it give? The number varies between 35 and 40%. So the level of protection that a strongly promoted vaccine against malaria gives is just above the 30% threshold that had been set for saying, oh, this is good enough to be used. Diseases are not all equal, all simple, all straightforward. We've discussed how viruses are particularly susceptible to vaccine-mediated block and protection. Malarial parasites are not that easy to deal with. So there is a great deal of sobering reflection that the trade-off and comparison between the malaria vaccine and the COVID vaccines should provide us with. Alciparum malaria is also the more dangerous of the malaria diseases? Yes and no. So, alciparum malaria in India, for example, has been a little more strongly associated with cerebral malaria and situations of that sort. Falciparum malaria in Africa, however, is somewhat different in its behavior in the community from Falciparum malaria in India for a variety of reasons that I don't think that the field understands absolutely clearly. Falciparum malaria in Africa kills children. This is why, and I come to yet another point of comparison, this is why the malaria vaccine that we are discussing is intended for, designed for and tested in only children, not just children, children below the age of two years. So all our conversation about, oh, are vaccines safe for children and so on and so forth that we've been having about COVID vaccines? We should look at that on the background that here is a vaccine that has been developed for children, tested in children shown to be efficacious in children, not in children below six months of age, but in children between six months to two years of age and is being recommended at 35 to 40% protection for widespread usage under WHO ages in such children. So, of course, the answer is that we seem to have a very high bar when it comes to vaccines for COVID-19 and that is not a bar which is realistic in new vaccines appearing. And when we look at that, the protection we give is to get with the bonus. You know, Sathit, when you were talking about malaria and the drug development, vaccine development thereof, it's interesting the last major millennial drugs were actually produced by the American military when they were fighting in Vietnam and, of course, they were fighting malaria as well. And one of the outcomes of that war was the malaria drugs and they were virtually the last set of drugs which are produced except much later we have another drug which comes in. Now, this is my last question before we finish the round today, is that even after vaccines have arisen on COVID-19, Africa has only 2% vaccines, fully vaccinated people. We have 30% because we are one of the largest producer of vaccines but nowhere near what we targeted that we should target at least 70-75% of the people should be fully vaccinated by the year end, if not 100%. But coming back to malaria, who is going to bear the cost and are we going to see a similar scenario rise that it's really going to be asking with a begging bowl philanthropic money to come in and giving subsidizing the drug companies rather than the people. So the short answer that I have as a sense of the situation to your question is, yes, I think that this is primarily going to be driven by philanthropy. The reason why I think that might even work to some extent is the following. Number one, the problem of Falsipar and malaria is perceived to be a problem of the global south, particularly in specific pockets of high prevalence of the disease. So you can do targeted vaccinations. What that allows the pharma sector to do is to make relatively small amounts and numbers of vaccine doses to sell them at relatively low prices, not that there's no profit there either, but at relatively low profit, but rack up the browning points that provide for non-financial, cloud non-financial, and that is going to be the business model that the WHO, governments across the world and the great philanthropies are going to allow. But let me bring up an interesting point in the COVID context. All of us think that the malaria vaccine is a great idea. And yet, all of us are familiar with COVID vaccine hesitancy. And I think one of the differences is they're not in my backyard syndrome, the so-called NIMBY syndrome. Malaria for both people of the global north and the elites in the global south is not our problem. We don't need to be vaccinated against malaria. We don't need our children to be vaccinated against malaria. We can therefore provide a vaccine that requires four doses, four injectable doses for a 40% protection level to the children of the poor and call that a great achievement. Set that against the extraordinary degrees of vaccine hesitancy that the communities of the global north and the elites of the global south have about COVID vaccines. And it opens up a picture for us that's not particularly ethically enlightened. That's a particularly edifying picture. Thank you Satyajit for being with us, discussing the complications, both in terms of science and technology, because vaccines are technology, as well as the social economic implications of vaccines, vaccine hesitancy, et cetera. We'll be discussing these issues, not just COVID-19, but also other issues in our future discussions with Satyajit and hope that you will tune in to NewsClick and also visit our website.