The Potential Role of Vaccines in the Elimination of Falciparum Malaria and the Eventual Eradication of Malaria

Received 19 August 2009; accepted 20 August 2009; electronically published 30 October 2009. Potential conflicts of interest: S.L.H. is the founder and chief executive officer of Sanaria, which is developing an attenuated Plasmodium falciparum sporozoite vaccine. All other authors: no conflicts. Financial support: C.V.P. is supported by the Howard Hughes Medical Institute and the Doris Duke Charitable Foundation. Reprints or correspondence: Stephen L. Hoffman, Sanaria, Inc, 9800 Medical Center Dr, Ste 209A, Rockville, MD 20850 (slhoffman@sanaria.com). The Journal of Infectious Diseases 2009;200:1646–9 2009 by the Infectious Diseases Society of America. All rights reserved. 0022-1899/2009/20011-0005$15.00 DOI: 10.1086/646613 There has been a recent call for global malaria eradication. The prospects of achieving this ambitious goal are diminished by the limited tool set now available—notably, the lack of a licensed malaria vaccine. This is in large part because the multistage Plasmodium parasites that cause malaria have a much more complex life cycle and larger genomes than do the viruses that cause smallpox and polio, the only infectious agents that have been completely or nearly eradicated from the world by vaccines. We think that (1) vaccines could play as important a role in the elimination of Plasmodium falciparum as they have played in the global eradication of smallpox and the elimination of polio from the Western Hemisphere, and (2) they ultimately could be an important component of the armamentarium used to eliminate the 3 other species of Plasmodium parasites that infect only humans: P. vivax, P. malariae, and P. ovale. In this Perspective article, we argue that the linchpin of such an effort must be a highly effective preerythrocytic-stage vaccine, and we describe how elimination could be accomplished based on the epidemiology of malaria in different transmission settings. We also discuss how a highly effective sexualand mosquito-stage vaccine could complement the effectiveness of such a preerythrocytic-stage vaccine in geographically focused programs to eliminate P. falciparum.