A Shot at Ending Malaria and NTDs with breakthroughs in Immunizations
Tina Lines, Amaanat Gill, Momar Ndao, Alison Krentel
Some preventable infectious diseases are rebounding, buoyed by an ecosystem of insecurity, funding cuts to public health, and mistrust in science-based efficacy and safety of immunizations. While these complex challenges are likely to persist, there are opportunities for progress. Canada has a treasure of infectious disease scientists contributing to the advancement of their prevention and treatment. This includes scientific collaboration for diagnostic, drug and vaccine development at home and abroad, even for the most neglected diseases.[1] These breakthroughs in vaccine development are opening new possibilities for protecting communities and catalyzing disease elimination.
Malaria and neglected tropical diseases (NTDs) are largely preventable, treatable diseases that disproportionately affect people living in subtropical and tropical regions. They affect people and communities living in poverty, without adequate access to primary health care and clean water and sanitation. Malaria, a parasitic disease transmitted by the Anopheles mosquito, infects approximately 282 million people each year[2] and NTDs, caused by a wide range of parasites, bacteria, viruses, fungi and toxins affect more than 1 billion people. Together, these diseases have a profound impact on child survival; with malaria alone accounting approximately 9% of all global deaths among children under five [3]. While effective tools exist to prevent and treat malaria and most NTDs, there remains a critical need for safer, more effective interventions, particularly for children. Malaria and some of the most common NTDs (soil transmitted helminths (STH), lymphatic filariasis (LF), schistosomiasis, onchocerciasis and trachoma), often require repeated rounds of treatment throughout childhood due to frequent reinfection. However, more tools are needed, particularly to bridge the gap in pediatric medicine for some of these diseases, among other NTDs[4], and vaccines are a critical gap in prevention.
The recent introduction of vaccines for malaria – the first of its kind for human parasitic diseases, and some NTDs are game-changing. Already, 25 countries are rolling out malaria vaccines to target 10 million children a year[5]. With the first introduction of the RTS/S vaccine in 2021, and a second vaccine candidate in 2023 (the R21/Matrix-M that is up to 75% effective[6]), with new vaccine candidates being actively trialed to beat this disease.
The malaria vaccines that are available to children today took decades of sustained investment in research and development. To reach all children at risk, additional funding and political commitment will be needed to reach the many populations without access to the vaccine. Expanding vaccines for malaria and NTDs also strengthens routine immunization platforms, which creates further opportunities for children and families to engage with primary health care systems.
NTDs have historically been and continue to remain vastly underfunded. The penny is pinched the most at the human clinical trial stage for developing new treatments, including vaccines. And yet, the need for new vaccines for dengue (a viral disease spread by the Aedes mosquito, affecting up to 400 million people each year in more than 100 countries globally) is growing with the continued spread of this disease. While there is no specific, standard treatment for dengue, vaccines are making their way into public health immunization strategies in Latin America and Asia. These immunization campaigns tend to target specific populations. In Brazil, recent campaigns targeted children 10-14 years of age and health care workers, since these groups have higher hospitalization rates, and some vaccines are only effective and safe for people with previous exposure to the virus[7].
In 2024, Gavi, The Vaccine Alliance invested in a vaccine for human rabies to reduce human cases to zero by 2030. Rabies is a vaccine-preventable zoonotic virus that is 100% fatal without prompt treatment. Rabies still persists as a public health problem in many countries, resulting in 59,000 human deaths per year, primarily in Asia and Africa, with 40% of rabies deaths occurring in children under 15 years of age. While this vaccine already existed, Gavi rolled it out as part of routine immunization to eliminate human rabies cases in over 50 high burden countries. This investment prioritized a neglected disease within national strategies[8].
Schistosomiasis – a parasitic infection affecting nearly 300 million people worldwide – can cause a wide-range of damage to the digestive and urogenital tract. There are at least four vaccines targeting one or more forms of human schistosomiasis in early phase clinical trials[9]. Because schistosomiasis re-infection is common and requires frequent treatment, with primarily one medicine used for treatment (praziquantel), vaccine development is considered essential to disrupt transmission and achieve disease elimination.
The complex biology of Soil Transmitted Helminths (STH), which account for the majority of NTDs today, make vaccine development challenging. Nevertheless, scientists have not been deterred, and early phase clinical trials have been carried out for some candidates. Additionally, in the UK and the Sudan, there have already been early phase vaccine trials for Leishmaniasis, a complex parasitic disease carried by sandflies[10]. While vaccine development for parasitic infections has been difficult in the past, these advancements signal a growing momentum across multiple NTD pipelines.
It’s evident that malaria and some NTDs are heading towards new and improved disease prevention options with vaccine discovery, trialing, manufacturing, and distribution. While some of these medical countermeasures are being developed in the US and other high-income countries, there has also been a concerted effort to shift manufacturing to low- and middle-income countries – keeping production close to the people and communities that need them the most.
Sustained protection for every generation is a shared responsibility. While Canada should invest in global immunizations – which have a far-reaching impact, at least some of the opportunities for Canada are not far from home. Canada can invest in our shared global health security, and make the most of its diverse scientific powerhouse – a valuable resource that can be amplified through global partnership. Canada has a strong legacy as a contributor to vaccine discoveries (for smallpox, polio, diphtheria, pertussis, tetanus[11], and more recently, developing the core technology for developing an Ebola vaccine[12]). Canadian investments in vaccine research, partnerships, and engagement with multilateral vaccine initiatives can help ensure future malaria and NTD vaccines reach children and communities who need them most. While scientific breakthroughs are currently accelerating, continued leadership from Canada can help translate these discoveries into actionable disease elimination. Canada’s continued contributions towards creating vaccine history through collaborative research and development partnerships protects us all, one shot at a time.
Reference list
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[2] World Health Organization, 2024
[4]World Health Organization, 2023
[5] World Health Organization, 2024b
[11] Canada Science and Technology Museum, 2024
[12] Government of Canada, 2025
