A journey of a thousand miles begins with one step, so goes the saying. That journey began more than 30 years ago for scientists searching for the elusive antidote to the number one killer disease, malaria.

Like any young child being immunised, Danny Otieno let out a wail when he was given the malaria jab. But he may well live to be grateful for his discomfort.
He is one of over 16,000 children in Kenya under the age of two who are on the malaria vaccine trial.

Malaria is the main threat to children throughout sub-Saharan Africa. It kills more children than any other disease. It is estimated that one child dies from malaria in Africa every half a minute. Children have no immunity to the disease.

But malaria has proved a formidable enemy in the race to find a vaccine.  "The main challenge is the complexity of the parasite itself,” says Dr Bernhards Ogutu, a representative of the Malaria Clinical Trials Alliance, (MCTA) in Kenya. “It is as elusive as ever.”

But scientists are finally closing in on the deadly parasite.  The third phase trial of the world’s most clinically advanced malaria vaccine candidate, RTS,S, has finally taken off in  Kenya.

In a small village in Kisumu district sits a modern lab right in the middle of a rural setting. Each day, mothers and their young ones stream into Kombewa trial site to take part in perhaps the biggest study ever involving children under the age of two at 11 sites in seven African countries. “This vaccine candidate has the potential of reducing the number of malaria cases in the country,” says Dr Ogutu.

Kombewa is among three sites in Kenya that are engaged in trials. The launch follows the initiation of the trial at the Bagamoyo Research Training Centre in Tanzania in May. Scientists have been working day and night to try and come up with what many call the magic bullet and the principal investigator at Kombewa, Dr. Walter Otieno, says so far so good, “Going by the response, this will take a short time,” he says. “Maybe within a year we shall have enrolled all the children needed for the study.”
The trials began following the success of Phase 2 studies in Kenya and Mozambique, where RTS,S was shown to have reduced clinical reports of malaria by 53 percent. It also had a promising safety and tolerability profile when used alongside standard infant vaccines.

This is the first potential malaria vaccine to reach the Phase 3 stage and does so after 17 years of tests on its safety and effectiveness. Scientists will tell you that at least 80 percent of vaccines that enter this phase end up on the market.
“This is the first time we are getting a malaria vaccine candidate which actually works well and gives you very good efficacy,” says Dr Otieno.

But spreading enthusiasm about the vaccine trials was no small feat in Kombewa, where medical care is rare and deadly illness illness abundant. “Initially, the villagers were sceptical about the study because they were told that a lot of blood is taken away from you,” says Tom Oyoo, a village representative.

But the good news is that the tide is now changing and the villagers eagerly await a malaria vaccine, having seen the practical part of the research and liked it.

Another site that is gaining momentum is the Siaya District hospital. The first dose of the vaccine was administered here sometime in June under the auspices of the Kemri/CDC Research and Public Health Collaboration.

Scientists are also at work in Kilifi, having also embarked on Phase 3 trials—which will demonstrate how the vaccine performs in children aged six to 12 weeks and those aged five to 17 months.
 
All this work would not have been possible without the help of  MCTA, an African-led institution established to build capacity in the fight against malaria.
MCTA, which is funded to the tune of $17 million by the Bill and Melinda Gates Foundation, is made up of scientists within and outside Africa. 

It provides training and technical assistance to research centres in nine African countries—Mozambique, Tanzania, Malawi, Gabon, Nigeria, Ghana, The Gambia, Kenya and Senegal—and helps leverage the capabilities of the INDEPTH Network to strengthen global research and development activities targeting malaria.

Scientists agree that a vaccine will not be a one-shot answer to defeating malaria. Other strategies, including the use of insecticide-treated bednets and anti-malarial drugs, are crucial. If a vaccine is added to those weapons, the war on malaria could be won.

Researchers would love to see 100 percent protection. If all goes to plan, the vaccine could be licensed in 2011 and introduced as part of the child vaccination series in Kenya by 2015.