Implementation of a Randomized, Placebo-Controlled Trial of Live Attenuated Malaria Sporozoite Vaccines in an Indonesian Military Study Population

Am J Trop Med Hyg. 2024 Mar 26;110(5):892-901. doi: 10.4269/ajtmh.23-0597. Print 2024 May 1.

Abstract

Malaria eradication efforts prioritize safe and efficient vaccination strategies, although none with high-level efficacy against malaria infection are yet available. Among several vaccine candidates, Sanaria® PfSPZ Vaccine and Sanaria PfSPZ-CVac are, respectively, live radiation- and chemo-attenuated sporozoite vaccines designed to prevent infection with Plasmodium falciparum, the leading cause of malaria-related morbidity and mortality. We are conducting a randomized normal saline placebo-controlled trial called IDSPZV1 that will analyze the safety, tolerability, immunogenicity, and efficacy of PfSPZ Vaccine and PfSPZ-CVac administered pre-deployment to malaria-naive Indonesian soldiers assigned to temporary duties in a high malaria transmission area. We describe the manifold challenges of enrolling and immunizing 345 soldier participants at their home base in western Indonesia before their nearly 6,000-km voyage to eastern Indonesia, where they are being monitored for incident P. falciparum and Plasmodium vivax malaria cases during 9 months of exposure. The unique regulatory, ethical, and operational complexities of this trial demonstrate the importance of thorough planning, frequent communication, and close follow-up with stakeholders. Effective engagement with the military community and the ability to adapt to unanticipated events have proven key to the success of this trial.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Female
  • Humans
  • Indonesia / epidemiology
  • Malaria Vaccines* / administration & dosage
  • Malaria Vaccines* / immunology
  • Malaria Vaccines* / therapeutic use
  • Malaria, Falciparum* / epidemiology
  • Malaria, Falciparum* / prevention & control
  • Malaria, Vivax* / epidemiology
  • Malaria, Vivax* / prevention & control
  • Male
  • Military Personnel*
  • Plasmodium falciparum* / immunology
  • Plasmodium vivax / immunology
  • Sporozoites* / immunology
  • Vaccines, Attenuated* / immunology
  • Vaccines, Attenuated* / therapeutic use
  • Young Adult

Substances

  • Malaria Vaccines
  • Vaccines, Attenuated