Malaria vaccines in Africa.

Besides being a leading cause of morbidity and mortality, malaria is also a cause and consequence of rampant poverty in Africa, where current control efforts are mainly frustrated by antimalaria drug and insecticide resistance. The development of malaria vaccines is therefore a priority for Africa. The paper examines the still limited role played by African institutions in trials of malaria vaccines. The process of antigen discovery and validation is mainly restricted to universities and public research institutions in the north, and relies on public funding. Industry is generally uninterested in malaria vaccine development; travellers' vaccines are attracting limited industrial interest. Public funding of neglected phases (asexual and transmission blocking) of malaria vaccine candidates is very recent. Malaria vaccine trials in Africa favour sites with historical affiliations to Europe (UK and France); recently the USA entered the race. Trials at neutral or African led, or African owned sites are rare, although they are essential for multi-centre Phase III trials. The selection of new trial sites should consider epidemiological, ownership and leadership criteria. Establishment of new sites should be guided by needs assessment, followed by capacity strengthening to fill the gaps in personnel, equipment, transport and infrastructure. All systems (e.g. financial, management, ethics and regulatory review) should be strengthened. Given the enormity of the challenges involved public-private partnerships are essential.