I got my fourth COVID shot today.
It was the updated booster, a bivalent vaccine with templates for both the original Wuhan strain and the BA.5 Omicron variant that’s been circulating recently. The hope is that it will provide more durable protection against the coronavirus, which has mutated furiously since its original appearance.
Obviously, this isn’t what we were aiming for. We all hoped that the initial vaccine would provide lifelong immunity. But, in retrospect, we underestimated our enemy. Unlike diseases such as measles, which can’t tolerate mutations to their surface proteins without losing the ability to infect us, SARS-CoV-2 is an adaptable and canny foe.
Although the days of overwhelmed hospitals and massive surges of illness are likely over, the U.S. is still suffering thousands of cases and hundreds of deaths each day. According to the World Health Organization, COVID is becoming an endemic illness, like the flu: something that doesn’t overwhelm hospitals or disrupt society, even if it continues to exact a slow and steady toll. If the initial stage of the pandemic was open warfare, this is more like a simmering, low-level insurgency.
On the other hand, we shouldn’t downplay our achievement. Even the original vaccine remains highly effective at preventing hospitalization and death. By one estimate, COVID vaccines have saved almost 20 million lives. And it would have been more if low-income countries had gotten the logistical support they needed to vaccinate more of their population.
Especially compared to the plodding pace of past vaccines, this is a scientific triumph. If this disease had emerged ten or twenty years earlier, it would have been far, far worse. And bigger wins are on the horizon.
Enter the malaria vaccine
If the phrase “malaria vaccine” doesn’t send a thrill down your spine, it should. The mere idea holds out the prospect of vanquishing humanity’s oldest and deadliest foe.
Malaria is the biggest killer in history, and it’s not close. By one speculative estimate, it may have killed half of all humans who have ever lived. (To be fair, skeptics have questioned this figure, but even lower estimates bring the toll down to 4 to 5 percent of humanity—still an enormous number.)
Malaria has tormented us for thousands of years. It bedeviled the Greek, Roman, Egyptian and Chinese civilizations. In fact, it’s shaped our species’ evolution. The painful, debilitating illness of sickle-cell anemia, as well as the blood disorders of thalassemia and G6PDD, are adaptations that spread because they protect against malaria. Despite the harm they cause, the tradeoff is worth the cost.
If the phrase “malaria vaccine” doesn’t send a thrill down your spine, it should.
In the modern era, we’ve lowered malaria’s death toll with better drugs (especially artemisinin), bed nets and insecticides. But it still infects tens of millions and kills hundreds of thousands of people per year, mostly children, mostly in Africa. A vaccine would be the holy grail, but until now, the Plasmodium parasite that causes malaria has been an elusive enemy.
Now we may have that vaccine. A team at the University of Oxford has a candidate, R21/Matrix-M, that uses a highly conserved protein of the malaria parasite. A recent Phase II clinical trial shows that it confers up to 80% protection against malaria. This is far superior to the only approved vaccine, Mosquirix, which is lower to start with and wanes over time. Scientists are describing the Oxford vaccine as “world-changing“.
If a larger ongoing trial pans out, the malaria vaccine could be rolled out very soon. Indian manufacturers are already prepared to churn out 200 million doses a year. We privileged readers in Western countries are unlikely to notice a difference, but this could be the biggest single improvement in human welfare in decades.
More in the pipeline
While the malaria vaccine is the biggest development, there are more vaccines coming to fight other diseases we suffer from. For example, a vaccine for Lyme disease is in Phase III trials. If it passes the final test, it could be on the market as soon as 2025.
Ironically, this shouldn’t be necessary. We have a safe and effective vaccine for Lyme disease already—but it’s only given to animals. Anti-vaccine groups rallied against using the vaccine in humans, claiming it caused arthritis, even though safety studies found no evidence of this. The manufacturer took it off the market so as not to deal with the bad publicity.
Vaccines are the most potent weapon in our medicinal arsenal.
Researchers are also starting human trials for a vaccine against schistosomiasis, another parasitic disease whose burden falls heaviest on poorer countries, and whose death toll is second only to malaria.
Last but not least, the monkeypox outbreak that made headlines this summer is declining. People changing their behavior is part of the reason why, but another part is the rapid distribution of Jynneos, a vaccine that’s effective against smallpox and other viruses in the same family.
Winning the invisible war
Even when our lives seem peaceful and calm, we live in the midst of an invisible war. Pathogens of all kinds are swarming around us, always seeking their chance to colonize our bodies. Our immune system does an excellent job of patrolling the borders and keeping us healthy—most of the time. But life is a constant evolutionary battle, and there will always be times when microbes get the upper hand.
For most of the ten-thousand-year history of human civilization, we had no defenses besides what evolution has given us. It’s only very recently, in historical terms, that we even knew what caused disease. And it’s still more recently that we came up with ways to fight back—inventions like sanitation, antibiotics, sterilization.
However, vaccines are the most potent weapon in our medicinal arsenal. Other strategies let us control diseases and minimize their toll, but vaccines are the way to actually eradicate them from existence. Insofar as this word means anything, they’re the only natural way to boost our immune systems, making them stronger and better equipped. If life is an evolutionary war, then vaccines are like getting advance notice of the enemy’s battle plan. Vaccines are life.