A mother’s grief and the quest for a malaria vaccine

Dr. Ripley Ballou of GlaxoSmithKline Biologicals explains why he devoted his life to beating malaria.

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What I remember most clearly were her eyes.

A young mother, whose only son had died a few weeks earlier, sat with her husband across the single room of a tidy but impossibly small hut in the Gambia. I sat on the boy’s now empty bed.

The story was all too familiar. He had been a perfectly happy little boy of 18 months until a few days earlier when he had become irritable, then feverish, and in less than 48 hours, slipped into an unresponsive state punctuated by seizures. Sometime during the night, after receiving ineffective treatment, his life slipped away.

Now, his mother’s eyes were brimming with tears and a profound sense of loss.

Last week, I thought back to that day as the world marked an important milestone in the quest for a malaria vaccine. A vaccine developed by GlaxoSmithKline, in partnership with PATH’s Malaria Vaccine Initiative, provides 56 percent efficacy against malaria clinical malaria and 47 percent efficacy against severe disease over the first 12 months following vaccination in children 5 to 17 months of age. If all goes well, the vaccine could be ready in 2015.

My trip to The Gambia in the early 1990s was to get a better feel for the impact malaria has on those who live under its constant threat. The pain of loss I could only imagine from the look in that mother’s eyes. Though the pain of illness, I knew.

In the spring of 1987, I was a young Major leading an experimental challenge study of the world’s first candidate malaria vaccine that had been collaboratively developed by the Walter Reed Army Institute of Research, the US National Institutes of Health and GSK. There was a tradition in our institution that before giving a new vaccine to strangers, you were to test it on yourself.

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Testing the vaccine on myself
So, together with a handful of my research buddies at WRAIR, we rolled up our sleeves and injected each other with something called FSV-1.

A few weeks later we rolled up our sleeves again, this time to let five hungry mosquitoes, all heavily infected with falciparum malaria, feed on our blood to test the vaccine. The results were fascinating and extremely important –one of the team members was completely protected, showing for the first time that a vaccine could actually protect a human from malaria. Unfortunately, that person was not me.

It was the worst illness I have ever experienced. I clearly remember a series of profound symptoms starting with chills that literally caused my entire body to shake, followed by a high fever and severe headache, then by drenching, sheet-soaking sweats, and finally a period of utter exhaustion and a sense of relief that I was going to be OK. Then the whole eight-hour cycle would repeat. I received treatment within 24 hours of my first symptoms, but the final cycle did not resolve until two days later. I was left physically and mentally drained -– but also with an absolutely clear vision about what my life’s work would be.

Ripley Ballou
The author today
Over the next decade I worked with colleagues at GSK to develop and test a series of vaccine candidates, but none seemed to work. Everything changed in 1997 when we hit upon RTS,S –- a revolutionary strategy developed by GSK scientists led by my friend and colleague Joe Cohen. The results were astounding –six of seven volunteers who got the vaccine were protected.

This set the stage for a long, sometimes frustrating, but incredibly exciting development program, which has included such partners as the PATH Malaria Vaccine Initiative -– with monies from the Bill & Melinda Gates Foundation -– and a team of world-class African researcher leading the trial on the ground, among many others. Appropriately enough, the first of field trial in Africa was conducted in the Gambia, not far from the village I had visited years earlier. RTS,S did not come in time to help that little boy. But when I think about the millions of children who might be protected from malaria in the future, it makes me proud to have been one of the hundreds of committed scientists around the world who have worked on this project.

It also makes me believe that the team motto my WRAIR colleagues borrowed from Cato the Elder, “Malaria Delenda Est” (malaria must be defeated), will someday come true. There is still a long road ahead, but the possibility of one day having a safe, effective vaccine to add to the other tools against malaria is something I think about every day.

Dr. Ripley Ballou is vice president & head of clinical research & translational Science at GlaxoSmithKline Biologicals