Splainer

Friday, October 8 2021


Dive In

 

‘Cats’ was off-the-scale all wrong. There wasn’t really any understanding of why the music ticked at all. I saw it and I just thought, ‘Oh, God, no.’ It was the first time in my 70-odd years on this planet that I went out and bought a dog. So the one good thing to come out of it is my little Havanese puppy.

That’s legendary composer Andrew Lloyd Webber finally commenting on the movie adaptation of his Broadway musical ‘Cats’—a train wreck that was once called “a purr-fectly dreadful hairball of woe.” See? There’s never a bad reason to get a dog!


Stuff to check out: The latest episode of the splainer podcast ‘Press Decode’ looks at the vast gap between the very wealthy and the rest of humanity—as revealed in the Pandora Papers and Squid Game. Be sure to head over to the IVM website, Spotify or Apple Podcasts to listen to it.

 
Big Story

A new vaccine to fight a deadly scourge

The TLDR: This week, the WHO made medical history by approving the first-ever malaria vaccine—one of medicine’s greatest achievements that has not received the attention it deserves. We explain why this is a very big deal.

 

What is this vaccine?

  • The vaccine is called RTS,S aka Mosquirix—and it attacks the most lethal form of malarial parasite called Plasmodium falciparum. 
  • It is administered in four doses. The first three are given a month apart—and the final booster shot is given 18 months later.
  • It was trialled in three countries in Africa: Ghana, Kenya, and Malawi—where more than 2.3 million doses have been administered, reaching more than 800,000 children. 
  • The results showed that it is safe, cheap and can prevent 40% of malaria cases, reduce severe illness in 30% of the cases.

 

An India angle: Bharat Biotech is expected to be the sole manufacturer of Mosquirix by 2029.

 

Only 40%? Why is this a big deal?

The problem with malaria: We’ve been looking for a malaria vaccine for a century. And this is the first to be approved for widespread use. The reason for this long wait: The malarial parasite is constantly evolving—and you often have to catch malaria multiple times to even get limited immunity:

 

“Malaria is caused by a parasite which is far more insidious and sophisticated than the virus that causes Covid. Comparing them is like comparing a person and a cabbage… It has a complicated life cycle across two species (humans and mosquitoes), and even inside our body it morphs between different forms as it infects liver cells and red blood cells.”

 

The challenge: Any vaccine has to ‘block’ the parasite while it is changing inside you—which is “like nailing jelly to a wall.” Mosquirix targets a particular “sporozoite” form of the parasite—which it takes between the time you are bitten and before it reaches the liver. And that is why it is only 40% effective.

 

The achievement: To begin with, this is not just the first malaria vaccine, but also the first ever to be developed for a disease caused by parasites—which doctors say is “a huge jump from the science perspective.” More importantly, look at the numbers:

 

  • There are 229 million cases of malaria each year, 409,000 deaths. Of these, 94% are in Africa—where 260,000 children died from the disease in 2019.
  • A modeling study estimated that the vaccine can prevent 5.4 million cases of malaria and 23,000 deaths in children younger than 5 each year. That’s not a small achievement.

 

Most importantly this: The vaccine isn’t a magic bullet, but it is radically more effective when combined with current antimalarial medicines. A study showed that a double-prong approach reduced illness by 62.8%, hospital admission by 70.5%, and deaths by 72.9%. And it is more effective—and surprisingly far easier to distribute—than commonly used measures like insecticide-treated nets, which cut deaths in children under 5 only by about 20%. Think of Mosquirix as a powerful new addition to an arsenal of weapons. 

 

Big point to note: This is just the first-generation vaccine—and paves the way for others which may be far more effective. For example, the University of Oxford is testing a vaccine—manufactured by India’s Serum Institute—that has proven 77% effective in initial trials. 

 

What about malaria in India?

Where we are: India has made the biggest strides in reducing the number of malaria cases—which fell from 20 million in 2000 to 5.6 million in 2019. This is the biggest single drop in Southeast Asia. But we still account for 86% of deaths in the region—around 7,700 in 2019. And this: We had actually almost eradicated malaria back in 1950—but lost a lot of ground because of a shortage in DDT. Now our new target for eradication is 2030. 

 

Point to note: A 2017 World Malaria Report flagged the fact that India has among the poorest systems for malaria surveillance—and likely detects only 8% of its cases.

 

The vaccine: targets only one form of the malarial parasite: Plasmodium falciparum. It accounts for 99% of all malaria cases in Africa, but only about 50% in Southeast Asia. To deploy the vaccine in India, it would first have to be approved by the government—which typically requires local trials. And it isn’t clear if malaria is a priority for now.

 

The bottomline: While we fret over a neverending pandemic, it is good to remind ourselves that we have been fighting a far deadlier enemy—and for a longer time. And we may have scored our first significant victory.

 

Reading list

New York Times and BBC News offer the best overviews. The Print has the Bharat Biotech angle, while Quartz looks at the implications for India. Time magazine has a very good read on why medical breakthroughs alone cannot fight pandemics.

 

 
Headlines that matter

One language thing

The Oxford English Dictionary has added more than 20 Korean-origin words to its latest edition. The spike is attributed to the global rise of Korean pop culture—be it K-pop, K-beauty or K-dramas. The Guardian runs through the list of new additions.

 

Modi auction is (mostly) a bust

The government can not find enough takers for 1,348 mementos gifted to the Prime Minister—which were being sold at an e-auction. There were zero bids on items such as PV Sindhu’s badminton racket (Rs 8 million) and a painting of PM Modi with Donald Trump (Rs 350,000). OTOH, the javelin used by Olympic gold medalist Neeraj Chopra received the highest bid at Rs 1.5 crores (15 million). (The Hindu)

 

Two animal things

One: We include this one to demoralise all dog owners. Here’s a news flash: Genius dogs can learn the names of over 100 toys. The average pooch can learn commands to some degree, learning the names of items is almost impossible for them. The Guardian has more on the latest study of six Einstein-ian pups. (The Guardian)


Two: Every year, Alaskan bears put on ridiculous amounts of weight as they get ready to hibernate. And every year, people vote on who is the chunkiest of them all. This year’s winner: 480 Otis—who won for the fourth time. Washington Post offers an excellent read on the competition—and the heated (and amusing) debate it inspires. Also: Look who’s a big boy now!

 

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In today’s edition

Sanity Break

  • This 2012 Vogue gallery of eye-popping photo shoots pays tribute to fairytales

 

Weekend Advisory

  • Good stuff to watch this weekend
  • A list of good reads
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