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♪ ♪

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♪ ♪

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NARRATOR:
This tiny creature
is at the center

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of one of medical science's
greatest quests...

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A battle to save
millions of lives

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and end a scourge
that has shaped human history:

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malaria.

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One child dies every
single minute from malaria.

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So you might ask yourself,
"Why are kids still dying?"

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♪ ♪

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NARRATOR:
For almost a century,

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scientists have had one goal.

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We don't want to use the word
"the Holy Grail,"

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but if we got vaccines,

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then, of course,
that would be transformational.

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KATIE EWER:
The chances of success

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are really, really small.

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But the rewards, if you do it,
are enormous.

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NARRATOR:
This is the inside story,
across four continents,

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of a new vaccine against malaria

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and the struggle to make it
succeed against the odds.

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The field of malaria vaccine
research

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is littered with failure.

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ADRIAN HILL:
It didn't work,

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it didn't work,
and it didn't work.

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UMESH SHALIGRAM:
I remember very openly and
straight telling

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that this is not going to work.

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And after many
tweaks and changes,

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it did.

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Well, to me, it was unthinkable
before it happened.

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♪ ♪

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This could be a gamechanger.

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You are touching human life.

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You are going
to save the human life.

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It's not one or two,
it's millions of lives.

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Amazing.

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NARRATOR:
"The Battle To Beat Malaria,"

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right now, on "NOVA."

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♪ ♪

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ANNOUNCER:
Major funding for "NOVA" is
provided by the following:

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♪ ♪

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TIMOTHY WINEGARD:
Throughout our history,
the mosquito has been

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the paramount killer
of humanity.

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If we look at
our Neverland nightmares,

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we're taught to fear

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all these other creatures

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because they kill so many
humans.

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That's just simply not true.

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For example, wolves and sharks

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kill only about ten people
per year.

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Whereas the mosquito,

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this tiny little animal the size
and weight of a grape seed,

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is responsible for up
to a million deaths a year.

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But it's not
the mosquito itself.

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It's the pathogens that hitch
a free ride

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that cause so much suffering,
death, and destruction.

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And of all the pathogens
that mosquitoes carry,

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by far the most lethal and
the biggest killer of humanity

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has been malaria.

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♪ ♪

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NARRATOR:
A highly effective vaccine
against malaria

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would be
a historic breakthrough.

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And getting there starts
with knowing your enemy.

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London's Natural History Museum
is home

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to one of the world's
greatest collections of insects.

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Senior curator Erica McAlister

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looks after 150,000 specimens,

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representing
2,900 species of mosquito.

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We have maybe 350 drawers
of mosquitoes,

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but only 20 of those drawers
are the species

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of mosquitoes that are important
for the transmission of malaria.

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The difference between the males
and the females

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is very important.

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The males are all vegetarian,

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but the female has to generate
the eggs.

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Therefore, she needs a really,
really high-protein meal:

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the blood.

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We've got the proboscis,

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her fantastically
long mouthparts.

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It's composed of six stylets.

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She uses two of those
to kind of,

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like, penetrate the flesh,

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she uses two of them
to keep it open,

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and then her final two,
one is basically a tube,

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which she will
suck up your blood with.

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But the other one, through that,

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she releases her saliva
to prevent the blood clotting.

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And it is in that process
that the malaria parasite

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is able to transfer into us.

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♪ ♪

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FILM NARRATOR:
Public enemy number one:
anopheles,

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the malaria mosquito,
wanted for bringing

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sickness and misery
to untold millions.

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NARRATOR:
Today, malaria is considered
a tropical disease,

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but until very recently,
it affected people worldwide.

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And it's played a huge part
in our history.

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WINEGARD:
The United States, for example,
was awash with malaria,

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in particular across the South,

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and even parts
of the Eastern seaboard.

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♪ ♪

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The American Revolution
was decided by malaria,

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with the surrender of Cornwallis
at Yorktown.

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He surrenders

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because he only has 35%
of his troops left

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on account of, the ague

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is what the British
called malaria at the time.

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Eight U.S. presidents
contracted malaria.

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George Washington
was one of them.

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He was bled, which was one

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of the crazy cures at the time.
(girl crying)

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He had his first bout at age 17,
and had repeat infection

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throughout his life.

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At the dawn of the 20th century,

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a physician of tropical medicine
remarked

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that the future of humanity
would be decided by one battle:

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man versus mosquito.

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FILM NARRATOR:
All right, men, now
we can begin to fight.

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("Assembly" bugle call playing)

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(clangs)

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NARRATOR:
During World War II,

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military casualties from malaria

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were so high that the
authorities declared total war,

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even recruiting Walt Disney
for the fight.

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FILM NARRATOR:
Attaboy, Dopey,
kill her good and dead!

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NARRATOR:
The newly invented insecticide
DDT

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destroyed mosquito populations.

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Swamps were drained.

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Protection against bites
improved.

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As did the availability
of malaria treatments

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and tests.

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WINEGARD:
In the Western world,

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malaria was made extinct,
essentially.

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America was declared
malaria-free in 1951.

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As a result,
the malaria burden shifted

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to the lower
socioeconomic countries,

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specifically
in the global South.

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Funding for malaria research
was drastically cut,

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and malaria was generally
all but forgotten

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in most wealthy nations.

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♪ ♪

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NARRATOR:
Nine out of ten people
in Tanzania,

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East Africa, live in
the country's malaria zone.

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♪ ♪

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And it's the youngest children,

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naturally much less able
to fight off infections,

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who are most at risk.

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Farhiya Salum is three years
old.

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She lives in Kiwangwa village

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with her mother, Zuhura Abasi,
a pineapple farmer

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and small trader, and her
grandmother Huba Mohamedi.

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ABASI (translated):
Farhiya has been sick
with malaria quite a few times.

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She gets a really high fever.

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Her whole body is so hot.

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It gets particularly bad
at night.

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It's so scary

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that a single mosquito
can pass on malaria

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and potentially kill someone.

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MOHAMEDI (translated):
Growing up, we weren't aware
of malaria as a disease.

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When I was ill,

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I would be given roots and
herbs.

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That's how it was back then.

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Three of my children died.

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I'm now left with six.

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This is the area
where we buried my children.

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On one occasion,
I went to the fields

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with a healthy child.

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A fever came on suddenly there.

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And by the time we got home
and my mother attended to him,

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he was gone.

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Every time I come here,
it's so painful.

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Malaria is such a bad disease.

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Bad, so bad.

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NARRATOR:
Across Tanzania
and much of Africa,

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malaria costs
lives and livelihoods,

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undermining the potential
of an entire continent.

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Dr. Ally Olotu,
of the Ifakara Health Institute,

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serves on the medical frontline.

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(people talking in background)

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OLOTU:
I got malaria when I was young,

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and I also got malaria
when I went to the university.

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That's when I became aware

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that this is a,

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it's an awful disease.

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(people talking in background)

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OLOTU:
Globally, malaria causes
over 200 million cases

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and more than 600,000 deaths
annually.

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About 80% of these deaths
are actually

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young children
below the ages of five.

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♪ ♪

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OLOTU (speaking Swahili):

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MAMA TAWAKAR:

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OLOTU:

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NARRATOR:
Tawakar is three years old,

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and was in grave danger
of falling into a coma

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until he came to the hospital
just 24 hours ago.

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OLOTU:

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Seeing kids
who are suffering from malaria,

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emotionally,
it's always difficult.

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As a clinician, as a father,

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I have to develop interventions

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to do everything possible
to get rid of malaria.

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(speaking Swahili):

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NURSE:

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OLOTU AND NURSE:

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OLOTU:

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NARRATOR:
While Ally regularly treats
children who have been infected,

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his colleague,

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mosquito biologist
Fredros Okumu,

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works on malaria prevention.

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Hey, how are you doing?
How are the mosquitoes today?

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Have you blood fed
the mosquitoes? Uh-huh.

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To evaluate specific
products for protecting people,

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we have to rear the mosquitoes
in our labs.

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(mosquitoes buzzing)

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00:11:09,166 --> 00:11:12,800
We have to provide water,
sugar, and blood.

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NARRATOR:
Today it is lab technician
Steward Ng'ala's turn

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to feed the mosquitoes.

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STEWARD NG'ALA (translated):
I don't need to be brave.

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It's normal;
nothing to be afraid of.

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It's not painful;
just a bit itchy.

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♪ ♪

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OKUMU:
The mosquitoes we have
in the lab are malaria-free.

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It's something
that we scientists do, so...

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I mean, I do it as well.

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(mosquitoes buzzing)

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00:11:48,066 --> 00:11:49,466
(zipping)

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NARRATOR:
Fredros uses these mosquitoes

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to test insecticide-treated
bed nets.

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It's estimated that over

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the last 20 years,
tools like these have prevented

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00:12:01,233 --> 00:12:05,433
a staggering two billion
cases of malaria and nearly

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12 million deaths.

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Yes, there's been
extensive progress.

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Is it sufficient progress? No.

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Because now we have this
challenge since around 2015,

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where there are many countries
in Africa

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where malaria cases
are going up.

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♪ ♪

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There's not much killing
of mosquitoes.

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So that particular net didn't
kill enough mosquitoes, okay.

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The bed nets that we have
in the villages

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00:12:32,600 --> 00:12:35,300
are starting
to face a lot challenges.

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Mosquitoes are no longer being
killed as effectively

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because they have become
resistant

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00:12:39,766 --> 00:12:41,566
to the insecticides
that we put on the surface.

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00:12:41,566 --> 00:12:43,900
And so the bed net
can lose that quality,

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the killing effect.

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NARRATOR:
Despite concerns
about increasing resistance,

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00:12:51,100 --> 00:12:54,066
bed nets treated with
insecticide

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00:12:54,066 --> 00:12:57,566
remain the world's number one
weapon against malaria.

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00:12:57,566 --> 00:13:01,066
But research shows they reduce

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child deaths by less
than 20 percent.

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00:13:06,400 --> 00:13:08,366
We need a transformational tool,

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and I do not think there
is any medical intervention

255
00:13:11,166 --> 00:13:14,166
that has done better
or more than vaccines.

256
00:13:16,466 --> 00:13:19,466
♪ ♪

257
00:13:19,466 --> 00:13:23,466
NARRATOR:
When it comes
to transforming human health

258
00:13:23,466 --> 00:13:24,966
and saving lives,

259
00:13:24,966 --> 00:13:29,233
vaccination is up there with
clean water and sanitation.

260
00:13:33,800 --> 00:13:36,966
Smallpox,
which killed up to 500 million

261
00:13:36,966 --> 00:13:39,766
in the 20th century alone,
was eradicated

262
00:13:39,766 --> 00:13:43,733
in the 1970s
thanks to vaccination.

263
00:13:43,733 --> 00:13:47,100
And there's also been
huge success against polio,

264
00:13:47,100 --> 00:13:50,766
measles, and recently COVID-19.

265
00:13:52,233 --> 00:13:57,266
But a highly effective malaria
vaccine has never emerged.

266
00:13:58,833 --> 00:14:01,666
That's not for lack of trying.

267
00:14:01,666 --> 00:14:04,333
Ally himself has worked

268
00:14:04,333 --> 00:14:06,200
on multiple vaccine candidates.

269
00:14:08,866 --> 00:14:10,866
OLOTU:
So do you know
what Daddy is working on?

270
00:14:10,866 --> 00:14:12,433
What am I working on?

271
00:14:12,433 --> 00:14:14,566
Malaria.
Malaria what?

272
00:14:14,566 --> 00:14:17,200
Malaria vaccine.
Okay.

273
00:14:17,200 --> 00:14:18,733
So that you can,

274
00:14:18,733 --> 00:14:20,100
you can protect
children isn't it,

275
00:14:20,100 --> 00:14:21,633
from getting malaria?

276
00:14:21,633 --> 00:14:23,766
IRFAAN OLOTU:
Because children below,
under five years

277
00:14:23,766 --> 00:14:28,300
who have malaria are in much
bigger danger than others.

278
00:14:28,300 --> 00:14:30,433
And they die?
Yes, they can die.

279
00:14:30,433 --> 00:14:33,066
But if you go to hospital fast,
you survive.

280
00:14:33,066 --> 00:14:35,733
I saw a child, three years old,

281
00:14:35,733 --> 00:14:37,400
who had malaria in the hospital.

282
00:14:37,400 --> 00:14:38,733
But he was treated

283
00:14:38,733 --> 00:14:42,766
and he will get better,
but he was very lucky.

284
00:14:44,033 --> 00:14:48,066
As night falls, this
is the most vulnerable time.

285
00:14:48,066 --> 00:14:51,233
That's when
the mosquitoes come in.

286
00:14:54,266 --> 00:14:57,433
When the mosquito bites,
it inject into that child

287
00:14:57,433 --> 00:14:59,200
small parasites.

288
00:14:59,200 --> 00:15:02,566
We call them sporozoites.

289
00:15:02,566 --> 00:15:06,000
These spend a very
few minutes in the blood.

290
00:15:06,000 --> 00:15:10,733
And then quickly go and start
to multiply within the liver.

291
00:15:12,500 --> 00:15:15,100
♪ ♪

292
00:15:15,100 --> 00:15:17,033
And these kids
could be playing around.

293
00:15:17,033 --> 00:15:18,666
They could be playing football,
they could be singing

294
00:15:18,666 --> 00:15:20,833
with their parents.
(children laughing)

295
00:15:20,833 --> 00:15:23,800
Nobody can suspect anything.

296
00:15:23,800 --> 00:15:26,833
But from the liver,
within a few days

297
00:15:26,833 --> 00:15:30,066
you could have thousands and
thousands of parasites

298
00:15:30,066 --> 00:15:32,266
released into the blood.

299
00:15:32,266 --> 00:15:36,100
They attack our red blood cells,
destroying them.

300
00:15:36,100 --> 00:15:38,366
And this is what

301
00:15:38,366 --> 00:15:41,100
actually give rise
to malaria symptoms.

302
00:15:43,466 --> 00:15:46,300
That child you saw
playing with his friends

303
00:15:46,300 --> 00:15:51,433
just a few days ago can
quickly become severely sick.

304
00:15:51,433 --> 00:15:53,833
And if not diagnosed
and treated very fast,

305
00:15:53,833 --> 00:15:56,633
that child might lose life.

306
00:15:59,600 --> 00:16:03,533
NARRATOR:
It's this process,
the way the body is overwhelmed

307
00:16:03,533 --> 00:16:05,333
before it has a chance
to fight back,

308
00:16:05,333 --> 00:16:09,900
that makes malaria so dangerous,

309
00:16:09,900 --> 00:16:14,033
and the development
of a vaccine so challenging.

310
00:16:14,033 --> 00:16:16,333
We have developed vaccines
for other diseases, of course,

311
00:16:16,333 --> 00:16:18,566
but most of these
are viruses and bacteria,

312
00:16:18,566 --> 00:16:20,133
which are much simpler

313
00:16:20,133 --> 00:16:22,933
pathogens compared to malaria.

314
00:16:22,933 --> 00:16:26,166
It's a very complex parasite.

315
00:16:26,166 --> 00:16:27,800
So I was really excited

316
00:16:27,800 --> 00:16:30,600
to be part of the consortium
of scientists

317
00:16:30,600 --> 00:16:32,966
put together
by the University of Oxford

318
00:16:32,966 --> 00:16:35,400
to work on
a new malaria vaccine.

319
00:16:38,100 --> 00:16:39,866
NARRATOR:
The University of Oxford

320
00:16:39,866 --> 00:16:43,200
is home to one of
the world's largest academic

321
00:16:43,200 --> 00:16:46,866
vaccine development programs.

322
00:16:46,866 --> 00:16:48,700
In 2020,

323
00:16:48,700 --> 00:16:51,566
the university's
Jenner Institute created

324
00:16:51,566 --> 00:16:55,000
the Oxford AstraZeneca COVID-19
vaccine,

325
00:16:55,000 --> 00:16:57,433
and since then,

326
00:16:57,433 --> 00:17:02,033
three billion doses have
reached 170 countries.

327
00:17:02,033 --> 00:17:04,433
♪ ♪

328
00:17:04,433 --> 00:17:07,400
Adrian Hill and his colleagues
have found malaria

329
00:17:07,400 --> 00:17:09,966
much more difficult.

330
00:17:09,966 --> 00:17:11,966
HILL:
We've known for
over a hundred years

331
00:17:11,966 --> 00:17:14,666
that it would be fantastic
to have a malaria vaccine.

332
00:17:14,666 --> 00:17:17,333
People have been trying
for about 120 years,

333
00:17:17,333 --> 00:17:19,400
ever since the parasite
was discovered.

334
00:17:22,500 --> 00:17:25,033
I did a count about six months
ago of how many vaccines

335
00:17:25,033 --> 00:17:27,000
had been made and gone

336
00:17:27,000 --> 00:17:28,466
into clinical trials for
malaria,

337
00:17:28,466 --> 00:17:29,866
how many different ones.

338
00:17:29,866 --> 00:17:32,400
And that number was 142.

339
00:17:32,400 --> 00:17:34,333
I'm not sure there's
another disease

340
00:17:34,333 --> 00:17:37,866
where they've been that many
vaccines that didn't work.

341
00:17:37,866 --> 00:17:41,000
(indistinct chatter)

342
00:17:41,000 --> 00:17:43,066
KATIE EWER:
But don't you finish
at quarter past 12?

343
00:17:43,066 --> 00:17:46,500
NARRATOR:
Katie Ewer is the lead
immunologist

344
00:17:46,500 --> 00:17:49,833
on the Oxford team.

345
00:17:49,833 --> 00:17:52,066
EWER:
I think malaria is more
personal for me

346
00:17:52,066 --> 00:17:53,966
because it's children.

347
00:17:53,966 --> 00:17:56,266
I think you'd have to be a very
hard-hearted person

348
00:17:56,266 --> 00:17:59,600
not to be moved by a death toll
of 400,000 kids a year

349
00:17:59,600 --> 00:18:02,266
dying in Africa, under
the age of five, from malaria.

350
00:18:03,966 --> 00:18:05,866
It's a huge motivator

351
00:18:05,866 --> 00:18:07,966
to work on something where

352
00:18:07,966 --> 00:18:10,333
the chances of success
are really, really small.

353
00:18:10,333 --> 00:18:13,466
But the rewards, if you do it,
are enormous.

354
00:18:14,733 --> 00:18:16,700
♪ ♪

355
00:18:16,700 --> 00:18:19,933
NARRATOR:
For the last 13 years,

356
00:18:19,933 --> 00:18:24,733
the Oxford team has been working
on a vaccine called R21.

357
00:18:26,033 --> 00:18:29,466
Its goal is to fire up
the body's immune defenses,

358
00:18:29,466 --> 00:18:31,466
to be ready to attack the
parasite

359
00:18:31,466 --> 00:18:33,333
at its most vulnerable moment;

360
00:18:33,333 --> 00:18:37,500
just after it enters our blood.

361
00:18:39,666 --> 00:18:42,066
When an infected female mosquito
takes a bite

362
00:18:42,066 --> 00:18:45,066
and injects sporozoites,
malaria parasites,

363
00:18:45,066 --> 00:18:47,700
there's about a half-hour
to two-hour window

364
00:18:47,700 --> 00:18:49,966
before the parasites
invade the cells in your body

365
00:18:49,966 --> 00:18:51,500
and set up infection there.

366
00:18:51,500 --> 00:18:53,600
And that's the window
that we're trying to target

367
00:18:53,600 --> 00:18:55,666
with our vaccine.

368
00:18:55,666 --> 00:18:58,300
NARRATOR:
What the R21 vaccine must do

369
00:18:58,300 --> 00:19:02,633
is mobilize an army of
antibodies.

370
00:19:03,933 --> 00:19:06,466
The problem has been to produce
enough antibodies

371
00:19:06,466 --> 00:19:09,233
to clear all of those parasites
very quickly.

372
00:19:11,266 --> 00:19:13,133
When people are infected
with malaria,

373
00:19:13,133 --> 00:19:15,233
they make antibodies
in the blood

374
00:19:15,233 --> 00:19:18,200
that stick to the outside
of the parasite.

375
00:19:18,200 --> 00:19:20,900
They're meant to stop it in
its tracks

376
00:19:20,900 --> 00:19:23,066
before they can reach the liver.

377
00:19:23,066 --> 00:19:25,033
But in a natural infection,

378
00:19:25,033 --> 00:19:28,066
there just aren't enough
antibodies.

379
00:19:28,066 --> 00:19:31,533
NARRATOR:
Threatened by just
a few invading parasites,

380
00:19:31,533 --> 00:19:36,500
our antibody response
is usually too little, too late.

381
00:19:36,500 --> 00:19:39,766
But luckily,
the malaria sporozoite

382
00:19:39,766 --> 00:19:42,200
has an Achilles heel.

383
00:19:42,200 --> 00:19:47,233
To invade the liver, it relies
on a coating called CSP,

384
00:19:47,233 --> 00:19:50,933
the circumsporozoite protein.

385
00:19:50,933 --> 00:19:54,366
HILL:
What we need are large amounts
of very specific antibodies

386
00:19:54,366 --> 00:19:59,500
that bind as tightly as possible
to the circumsporozoite protein.

387
00:19:59,500 --> 00:20:02,533
Then we should be able to stop
the parasites.

388
00:20:02,533 --> 00:20:05,700
♪ ♪

389
00:20:05,700 --> 00:20:09,300
NARRATOR:
This is where the R21 vaccine
comes in.

390
00:20:09,300 --> 00:20:12,566
It is built from the CSP
protein,

391
00:20:12,566 --> 00:20:16,266
and so induces the body
to produce an army of antibodies

392
00:20:16,266 --> 00:20:19,966
tailor-made and ready
to neutralize the parasite.

393
00:20:21,733 --> 00:20:25,833
But this is not a new idea.

394
00:20:25,833 --> 00:20:28,100
First designed in 1987,

395
00:20:28,100 --> 00:20:33,933
a vaccine called RTS,S already
does this.

396
00:20:33,933 --> 00:20:37,533
I have had the privilege to work
on RTS,S malaria vaccine.

397
00:20:37,533 --> 00:20:40,100
And the overall efficacy

398
00:20:40,100 --> 00:20:42,100
of RTS,S is about 40 percent

399
00:20:42,100 --> 00:20:43,466
against clinical disease.

400
00:20:43,466 --> 00:20:48,866
40 percent may sound
as not very good efficacy,

401
00:20:48,866 --> 00:20:51,533
but you have to think
about the burden of malaria.

402
00:20:51,533 --> 00:20:55,533
We have well over 600,000 deaths
annually.

403
00:20:55,533 --> 00:20:57,366
(cheers and applause)

404
00:20:57,366 --> 00:21:01,933
NARRATOR:
After lengthy deliberations,
in 2022 RTS,S

405
00:21:01,933 --> 00:21:06,733
became the first malaria
vaccine approved by the W.H.O.,

406
00:21:06,733 --> 00:21:09,200
the World Health Organization,

407
00:21:09,200 --> 00:21:12,566
35 years after
it was initially developed.

408
00:21:13,766 --> 00:21:17,200
But RTS,S is expensive to
produce,

409
00:21:17,200 --> 00:21:18,900
supply is currently limited,

410
00:21:18,900 --> 00:21:20,700
and it falls
short of the W.H.O.'s

411
00:21:20,700 --> 00:21:25,700
own target of having a
75 percent effective vaccine,

412
00:21:25,700 --> 00:21:28,366
by 2030.

413
00:21:29,500 --> 00:21:34,500
And so the Oxford team had long
set their sights on an upgrade.

414
00:21:34,500 --> 00:21:37,300
R21 was born out
of the idea that perhaps

415
00:21:37,300 --> 00:21:39,866
we could make a slightly
better version of RTS,S.

416
00:21:39,866 --> 00:21:42,866
So it started with a PhD student
called Kat Collins

417
00:21:42,866 --> 00:21:44,466
taking this on as her project.

418
00:21:44,466 --> 00:21:46,166
♪ ♪

419
00:21:46,166 --> 00:21:51,866
NARRATOR:
The RTS,S vaccine is made
of billions of tiny particles.

420
00:21:51,866 --> 00:21:54,600
They're built
from a virus protein

421
00:21:54,600 --> 00:21:57,533
that forms a harmless,
empty shell,

422
00:21:57,533 --> 00:22:03,566
and part of the same CSP protein
that coats the malaria parasite.

423
00:22:03,566 --> 00:22:07,233
Together, they trigger
the body's immune response,

424
00:22:07,233 --> 00:22:09,900
but unlike the malaria parasite,

425
00:22:09,900 --> 00:22:14,200
less than a quarter of each
particle's surface is CSP.

426
00:22:15,700 --> 00:22:18,933
Kat Collins and
her Oxford colleagues wondered,

427
00:22:18,933 --> 00:22:21,600
could increasing the amount
of CSP,

428
00:22:21,600 --> 00:22:26,766
to better mimic the malaria
parasite, make a better vaccine?

429
00:22:26,766 --> 00:22:29,466
We kept on trying different ways

430
00:22:29,466 --> 00:22:31,633
to get that
to form into a particle.

431
00:22:31,633 --> 00:22:34,433
And it didn't work, it didn't
work, and it didn't work.

432
00:22:34,433 --> 00:22:37,966
And, eventually, after many
tweaks and changes,

433
00:22:37,966 --> 00:22:40,266
it did.

434
00:22:40,266 --> 00:22:42,533
That was a big day.

435
00:22:43,966 --> 00:22:46,100
You can literally
see these particles

436
00:22:46,100 --> 00:22:47,666
with an electron microscope.

437
00:22:47,666 --> 00:22:50,066
And, boy,
those images are memorable.

438
00:22:50,066 --> 00:22:52,566
And we thought, "Fantastic,
we immunized mice."

439
00:22:52,566 --> 00:22:54,200
And guess what?

440
00:22:54,200 --> 00:22:55,833
They were nearly
all protected very well.

441
00:22:55,833 --> 00:22:57,866
This was 2012.

442
00:22:57,866 --> 00:22:59,566
We were finally getting there.

443
00:22:59,566 --> 00:23:02,100
And, of course,
getting there means you're ready

444
00:23:02,100 --> 00:23:05,100
to try and manufacture
and go into the clinic.

445
00:23:05,100 --> 00:23:10,433
♪ ♪

446
00:23:10,433 --> 00:23:12,933
NARRATOR:
Oxford University's R21

447
00:23:12,933 --> 00:23:15,900
was doing
exactly as they'd hoped,

448
00:23:15,900 --> 00:23:18,800
creating a strong
protective immune response.

449
00:23:18,800 --> 00:23:21,333
But that was just in mice.

450
00:23:21,333 --> 00:23:25,900
The big challenge now
would be testing it in humans.

451
00:23:27,700 --> 00:23:30,900
For this,
they called on Eleanor Berrie,

452
00:23:30,900 --> 00:23:35,166
a specialist in vaccine
manufacture for human trials.

453
00:23:35,166 --> 00:23:38,300
Vaccines are actually one
of the most

454
00:23:38,300 --> 00:23:40,400
complicated things
you can manufacture.

455
00:23:40,400 --> 00:23:44,533
But Adrian and Kat

456
00:23:44,533 --> 00:23:47,233
were so enthusiastic about R21,

457
00:23:47,233 --> 00:23:51,300
they had generated some
excellent pre-clinical data,

458
00:23:51,300 --> 00:23:54,200
and that enthusiasm
rubs off on you.

459
00:23:54,200 --> 00:23:59,500
So, you know, you begin to feel,
well, we could do this, yeah.

460
00:23:59,500 --> 00:24:02,300
NARRATOR:
Eleanor and her team

461
00:24:02,300 --> 00:24:04,500
only needed to make enough R21

462
00:24:04,500 --> 00:24:07,733
to inject a small
number of healthy people.

463
00:24:07,733 --> 00:24:11,366
Less than half a cup's worth,
but thousands of times

464
00:24:11,366 --> 00:24:14,066
more than Adrian's team
had created

465
00:24:14,066 --> 00:24:16,366
in the lab for their mouse
tests.

466
00:24:16,366 --> 00:24:21,100
And this time,
with human safety on the line.

467
00:24:22,633 --> 00:24:25,766
BERRIE:
We started the project in 2012,

468
00:24:25,766 --> 00:24:29,533
and it took us
three-and-a-half years.

469
00:24:29,533 --> 00:24:31,900
If we had been
in a commercial situation,

470
00:24:31,900 --> 00:24:34,166
I would have think
that they would have

471
00:24:34,166 --> 00:24:38,366
just stopped
the project on many occasions.

472
00:24:38,366 --> 00:24:41,333
We kept going and kept spending,
and find...

473
00:24:41,333 --> 00:24:44,866
finding and spending more
money to get it manufactured.

474
00:24:44,866 --> 00:24:46,900
The major feeling was just

475
00:24:46,900 --> 00:24:49,466
a sense of relief
that we had got there.

476
00:24:51,666 --> 00:24:54,466
HILL:
The 10th of November 2015.

477
00:24:54,466 --> 00:24:57,733
85 vials certified.

478
00:24:57,733 --> 00:24:59,533
Three doses per person,

479
00:24:59,533 --> 00:25:01,833
20 to 30 people
that would cover.

480
00:25:01,833 --> 00:25:04,300
Not exactly
vaccinating the world, is it?

481
00:25:04,300 --> 00:25:07,000
But it's where we started.

482
00:25:08,066 --> 00:25:09,966
NARRATOR:
With these precious few doses

483
00:25:09,966 --> 00:25:12,200
of R21,

484
00:25:12,200 --> 00:25:15,133
the Oxford team began
small-scale human trials.

485
00:25:15,133 --> 00:25:17,433
First, they mixed
the vaccine with a substance

486
00:25:17,433 --> 00:25:19,766
called Matrix-M,

487
00:25:19,766 --> 00:25:22,100
which helps
strengthen the immune response.

488
00:25:22,100 --> 00:25:24,433
They injected 28 healthy adults,

489
00:25:24,433 --> 00:25:26,800
and reported it induced

490
00:25:26,800 --> 00:25:29,100
an antibody response comparable
to RTS,S

491
00:25:29,100 --> 00:25:32,033
at a much lower vaccine dose.

492
00:25:32,033 --> 00:25:36,066
Next, they purposely
exposed a few vaccinated people

493
00:25:36,066 --> 00:25:39,566
to infectious mosquitoes,
in what's known

494
00:25:39,566 --> 00:25:41,400
as a malaria challenge trial,

495
00:25:41,400 --> 00:25:44,300
and found that they
were protected from malaria.

496
00:25:44,300 --> 00:25:48,200
Such exciting
early results drew attention

497
00:25:48,200 --> 00:25:50,700
beyond Oxford.

498
00:25:50,700 --> 00:25:53,766
HILL:
Word got around, and we
academics talk at meetings

499
00:25:53,766 --> 00:25:55,600
and you never know
who's in the room,

500
00:25:55,600 --> 00:25:57,000
but my guess is there was
somebody

501
00:25:57,000 --> 00:25:58,433
from the Serum Institute
of India.

502
00:25:58,433 --> 00:26:01,433
And the next month,
Umesh Shaligram turned up here

503
00:26:01,433 --> 00:26:05,166
wanting to talk about malaria.

504
00:26:05,166 --> 00:26:06,566
Certainly, Oxford data

505
00:26:06,566 --> 00:26:08,933
was very convincing early data.

506
00:26:08,933 --> 00:26:10,566
So that certainly made a big

507
00:26:10,566 --> 00:26:11,866
difference in our conviction.

508
00:26:12,966 --> 00:26:15,233
HILL:
They'd heard about the initial
challenge results.

509
00:26:15,233 --> 00:26:17,533
They came to us.

510
00:26:17,533 --> 00:26:19,600
Normally,
we go begging to companies,

511
00:26:19,600 --> 00:26:21,033
asking them to work with us.

512
00:26:21,033 --> 00:26:24,600
We made a kind of
a handshake deal

513
00:26:24,600 --> 00:26:26,866
that we could
manufacture the product.

514
00:26:26,866 --> 00:26:28,900
That's how
the whole thing started.

515
00:26:28,900 --> 00:26:34,266
♪ ♪

516
00:26:35,933 --> 00:26:37,900
NARRATOR:
The Serum Institute of India

517
00:26:37,900 --> 00:26:41,933
is the largest vaccine
manufacturer in the world.

518
00:26:41,933 --> 00:26:44,900
Two-thirds of all babies
born globally

519
00:26:44,900 --> 00:26:48,666
get at least one
of Serum's childhood vaccines,

520
00:26:48,666 --> 00:26:50,900
made here in Pune.

521
00:26:52,900 --> 00:26:55,600
It's made this family-run
company a global life-saver

522
00:26:55,600 --> 00:27:00,500
and CEO Adar Poonawalla
a multi-billionaire.

523
00:27:03,400 --> 00:27:05,533
ADAR POONAWALLA:
Every time we look at a vaccine,

524
00:27:05,533 --> 00:27:08,000
the way we look at it is that
unless we can make

525
00:27:08,000 --> 00:27:10,566
hundreds of millions of doses
for the whole world,

526
00:27:10,566 --> 00:27:12,666
and unless it has that
need and demand,

527
00:27:12,666 --> 00:27:14,100
we don't get into it.

528
00:27:14,100 --> 00:27:17,233
Ah... Baitho.
What's happening?

529
00:27:17,233 --> 00:27:19,200
(voiceover): These are very
large populations,

530
00:27:19,200 --> 00:27:21,200
so they need a lot of vaccines.

531
00:27:21,200 --> 00:27:22,766
It'd be unimaginable

532
00:27:22,766 --> 00:27:24,566
if they had to pay $10,
$20 for a vaccine.

533
00:27:24,566 --> 00:27:26,033
They wouldn't
be able to afford it.

534
00:27:27,366 --> 00:27:30,366
We charge pennies on the dollar
for the vaccine.

535
00:27:30,366 --> 00:27:33,433
But the economies of scale that
we operate at enable us

536
00:27:33,433 --> 00:27:35,600
to do that and
still make a modest profit.

537
00:27:35,600 --> 00:27:37,666
You can go ahead with that.

538
00:27:37,666 --> 00:27:40,233
♪ ♪

539
00:27:40,233 --> 00:27:42,800
NARRATOR:
In 2017,

540
00:27:42,800 --> 00:27:44,966
Serum took
over manufacturing R21,

541
00:27:44,966 --> 00:27:47,100
and spent two years developing

542
00:27:47,100 --> 00:27:51,866
a new, reliable method
to produce it at scale.

543
00:27:53,300 --> 00:27:57,200
The team chose the West African
country Burkina Faso,

544
00:27:57,200 --> 00:28:00,766
where around half the population
gets malaria each year,

545
00:28:00,766 --> 00:28:04,000
for the vaccine's
first real-world test.

546
00:28:05,866 --> 00:28:11,000
In 2019,
450 very young children,

547
00:28:11,000 --> 00:28:13,500
the group most
in need of protection,

548
00:28:13,500 --> 00:28:16,066
were vaccinated
in a Phase Two trial.

549
00:28:16,066 --> 00:28:18,933
For success, these babies would
have to experience

550
00:28:18,933 --> 00:28:21,166
no unexpected side effects

551
00:28:21,166 --> 00:28:24,833
and there would need to be a
significant reduction

552
00:28:24,833 --> 00:28:28,800
in malaria cases in those who
received R21.

553
00:28:28,800 --> 00:28:32,466
♪ ♪

554
00:28:32,466 --> 00:28:36,433
The UK team waited for news.

555
00:28:36,433 --> 00:28:39,100
It was actually my
colleague Mehreen who said,

556
00:28:39,100 --> 00:28:41,566
"Look at your email,
we've got the results."

557
00:28:41,566 --> 00:28:45,733
77 percent efficacy, as good
as we could possibly have hoped.

558
00:28:45,733 --> 00:28:46,933
I wasn't even sure that

559
00:28:46,933 --> 00:28:48,500
I could quite believe what I was
reading.

560
00:28:48,500 --> 00:28:49,600
You know,

561
00:28:49,600 --> 00:28:51,000
we showed that the vaccine,

562
00:28:51,000 --> 00:28:53,000
albeit just over six months,

563
00:28:53,000 --> 00:28:54,500
had worked in

564
00:28:54,500 --> 00:28:55,866
the target population,

565
00:28:55,866 --> 00:28:57,666
in the target age group.

566
00:28:57,666 --> 00:29:00,533
But if you've seen really
good results,

567
00:29:00,533 --> 00:29:05,133
you know what's coming--
large scale, Phase Three trials.

568
00:29:05,133 --> 00:29:07,500
Definitely
a very daunting prospect.

569
00:29:07,500 --> 00:29:09,833
♪ ♪

570
00:29:09,833 --> 00:29:14,733
NARRATOR:
Phase Three is the largest
clinical trial.

571
00:29:14,733 --> 00:29:16,866
It will need to be
big enough to determine

572
00:29:16,866 --> 00:29:19,266
if R21 can safely prevent
malaria

573
00:29:19,266 --> 00:29:21,666
in thousands of children.

574
00:29:22,666 --> 00:29:27,600
And this will cost
around $20 million.

575
00:29:27,600 --> 00:29:31,566
Me and Adrian went almost every
door to door

576
00:29:31,566 --> 00:29:33,800
and tried to search
for the funding.

577
00:29:33,800 --> 00:29:35,133
Somebody should support us.

578
00:29:35,133 --> 00:29:39,466
And we had really a tough time.

579
00:29:39,466 --> 00:29:41,566
HILL:
We're fighting for funding
against people

580
00:29:41,566 --> 00:29:43,833
dealing with other very
important medical diseases.

581
00:29:43,833 --> 00:29:47,266
People are more likely to try
and invest in something

582
00:29:47,266 --> 00:29:50,000
that sounds new
than the old idea

583
00:29:50,000 --> 00:29:51,766
of making a vaccine against
malaria,

584
00:29:51,766 --> 00:29:54,000
which has failed and failed
and failed over decades.

585
00:29:55,366 --> 00:29:56,900
SHALIGRAM:
After a year's try,

586
00:29:56,900 --> 00:29:59,900
I remember I said,
"Mr. Poonawalla, sir,

587
00:29:59,900 --> 00:30:02,966
"I'm having a big
challenge of getting the funding

588
00:30:02,966 --> 00:30:04,833
for the Phase Three."

589
00:30:04,833 --> 00:30:06,166
And he said,
"No, no, don't worry,

590
00:30:06,166 --> 00:30:08,333
"malaria is very close to my
heart

591
00:30:08,333 --> 00:30:12,200
and I want to support
the Phase Three."

592
00:30:12,200 --> 00:30:17,300
NARRATOR:
The Serum Institute CEO
agrees to fund the trial.

593
00:30:17,300 --> 00:30:19,000
The results had demonstrated
that the vaccine

594
00:30:19,000 --> 00:30:20,600
is giving you protection.

595
00:30:20,600 --> 00:30:22,600
So instead of wasting time,

596
00:30:22,600 --> 00:30:25,433
we just wanted
to get on with the work.

597
00:30:26,400 --> 00:30:29,000
♪ ♪

598
00:30:29,000 --> 00:30:31,600
NARRATOR:
In April 2021,

599
00:30:31,600 --> 00:30:35,266
Phase Three trial preparations
begin in Burkina Faso, Mali,

600
00:30:35,266 --> 00:30:38,133
Kenya, and here in Tanzania.

601
00:30:38,133 --> 00:30:40,633
♪ ♪

602
00:30:40,633 --> 00:30:45,433
Mehreen Datoo is a British
infectious disease doctor.

603
00:30:45,433 --> 00:30:49,033
But her key role on the R21 team

604
00:30:49,033 --> 00:30:51,900
is to oversee its ultimate test.

605
00:30:51,900 --> 00:30:53,400
(people greeting each other)

606
00:30:53,400 --> 00:30:56,000
DATOO:
What we wanted to propose
today to do

607
00:30:56,000 --> 00:30:58,566
is a mockup vaccine preparation
for us,

608
00:30:58,566 --> 00:31:01,200
just to check it's all
running smoothly.

609
00:31:01,200 --> 00:31:04,566
NARRATOR:
Nearly 5,000 very young
children

610
00:31:04,566 --> 00:31:07,166
are set to receive shots in the
Phase Three trial,

611
00:31:07,166 --> 00:31:10,000
hundreds of them in Tanzania.

612
00:31:12,333 --> 00:31:15,933
For every two children
that receive R21,

613
00:31:15,933 --> 00:31:19,133
one child will
receive a control vaccine.

614
00:31:19,133 --> 00:31:23,566
In this case,
a vaccine against rabies.

615
00:31:23,566 --> 00:31:26,400
This should look just like R21,

616
00:31:26,400 --> 00:31:30,566
but offer no protection
at all from malaria.

617
00:31:30,566 --> 00:31:32,866
The rabies vaccine
is a good option because

618
00:31:32,866 --> 00:31:35,666
it's not a vaccine that children
would normally receive

619
00:31:35,666 --> 00:31:37,233
in that part of the world,

620
00:31:37,233 --> 00:31:40,300
so it does provide
some benefits.

621
00:31:40,300 --> 00:31:42,333
NARRATOR:
Crucially,

622
00:31:42,333 --> 00:31:45,100
Mehreen and almost everyone
involved

623
00:31:45,100 --> 00:31:47,533
is blind to which vaccine
each child receives.

624
00:31:48,933 --> 00:31:53,133
So they must monitor cases of
malaria across the whole trial,

625
00:31:53,133 --> 00:31:55,966
and only learn
much later if those cases

626
00:31:55,966 --> 00:32:00,600
were in the R21 vaccine
or the control group.

627
00:32:00,600 --> 00:32:02,733
The only people that are
unblinded

628
00:32:02,733 --> 00:32:05,066
are the pharmacy team
who prepare the vaccine.

629
00:32:06,433 --> 00:32:08,633
You want to make sure the whole
volume is covered.

630
00:32:08,633 --> 00:32:10,300
(voiceover): The whole idea
of this is to not know

631
00:32:10,300 --> 00:32:11,666
which vaccine the child has
received

632
00:32:11,666 --> 00:32:13,233
to ensure there's no bias.

633
00:32:13,233 --> 00:32:14,666
It means that, you know,

634
00:32:14,666 --> 00:32:16,400
we will get
the most accurate data.

635
00:32:16,400 --> 00:32:17,766
That's why
there's two of you to do it.

636
00:32:17,766 --> 00:32:21,500
♪ ♪

637
00:32:21,500 --> 00:32:26,333
(indistinct chatter)

638
00:32:28,300 --> 00:32:31,000
My family
are actually from East Africa.

639
00:32:31,000 --> 00:32:33,433
Unfortunately, when I was doing
some research there previously,

640
00:32:33,433 --> 00:32:37,966
I got malaria
and I was very, very sick.

641
00:32:37,966 --> 00:32:39,966
I basically
fainted and collapsed.

642
00:32:39,966 --> 00:32:42,000
And then was
diagnosed with severe malaria.

643
00:32:42,000 --> 00:32:43,600
I don't remember a lot
of it because

644
00:32:43,600 --> 00:32:46,900
I was just very, very unwell.

645
00:32:46,900 --> 00:32:50,200
I was in my early 20s,
so I can't even imagine

646
00:32:50,200 --> 00:32:52,633
how it affects very young
children.

647
00:32:54,466 --> 00:32:57,933
♪ ♪

648
00:32:57,933 --> 00:33:00,566
NARRATOR:
Here in Tanzania,

649
00:33:00,566 --> 00:33:03,333
Dr. Ally Olotu
is managing the vaccination

650
00:33:03,333 --> 00:33:06,266
and monitoring of 600 children.

651
00:33:07,400 --> 00:33:09,000
OLOTU (speaking Swahili):

652
00:33:09,000 --> 00:33:10,033
WOMAN (speaking Swahili):

653
00:33:10,766 --> 00:33:12,866
OLOTU:

654
00:33:17,033 --> 00:33:18,266
 
ZUHURA:

655
00:33:18,266 --> 00:33:20,033
OLOTU: Farhiya! Okay.

656
00:33:21,700 --> 00:33:22,733
WOMAN: Irene.

657
00:33:22,733 --> 00:33:24,233
OLOTU:

658
00:33:33,033 --> 00:33:36,200
 
NARRATOR:
In late 2022,

659
00:33:36,200 --> 00:33:40,900
a precious cargo arrives at
the Kiwangwa clinic, from India.

660
00:33:42,433 --> 00:33:45,033
After an initial
three doses of either R21

661
00:33:45,033 --> 00:33:48,666
or the rabies control vaccine,

662
00:33:48,666 --> 00:33:51,333
a one-year booster shot is now
being prepared

663
00:33:51,333 --> 00:33:54,433
for Farhiya and the other trial
participants.

664
00:33:56,166 --> 00:33:58,833
ZUHURA (translated):
I enrolled my child Farhiya in
the program

665
00:33:58,833 --> 00:34:02,333
above all because they have
great services

666
00:34:02,333 --> 00:34:05,000
and really take good care
of a sick child.

667
00:34:08,566 --> 00:34:10,466
And they also have all the
tests,

668
00:34:10,466 --> 00:34:13,800
so that was an incentive for me.

669
00:34:13,800 --> 00:34:15,900
I'm really excited Farhiya

670
00:34:15,900 --> 00:34:17,933
is one of the first to get
vaccinated.

671
00:34:21,433 --> 00:34:25,000
NARRATOR:
For Zuhura,
vaccination is about much more

672
00:34:25,000 --> 00:34:28,866
than simply preventing
her daughter from falling ill.

673
00:34:30,666 --> 00:34:32,933
ZUHURA (translated):
We are a generation of
strong women.

674
00:34:32,933 --> 00:34:35,800
My mother fought hard for us,

675
00:34:35,800 --> 00:34:38,033
and she's still working hard
despite her age.

676
00:34:39,466 --> 00:34:41,666
We're busy farming
as well as running

677
00:34:41,666 --> 00:34:44,566
a small business selling bhajia
and mandazi.

678
00:34:44,566 --> 00:34:48,800
Our livelihood depends on my
small business,

679
00:34:48,800 --> 00:34:52,166
and when Farhiya falls sick,
I can't attend to it.

680
00:34:54,400 --> 00:34:56,166
And when you take her to

681
00:34:56,166 --> 00:34:57,700
the local clinic in Kiwangwa,

682
00:34:57,700 --> 00:34:59,400
they won't treat you without

683
00:34:59,400 --> 00:35:01,100
either medical insurance

684
00:35:01,100 --> 00:35:02,866
or $5,000 in cash.

685
00:35:02,866 --> 00:35:06,533
(speaking Swahili, laughing)

686
00:35:06,533 --> 00:35:09,833
HUBA MOHAMEDI (translated):
Instead of spending money
to treat malaria,

687
00:35:09,833 --> 00:35:11,666
whether for kids or adults,

688
00:35:11,666 --> 00:35:14,833
you can buy food, vegetables,

689
00:35:14,833 --> 00:35:18,133
and the like instead.

690
00:35:18,133 --> 00:35:21,000
We'll be very grateful
for the vaccine.

691
00:35:21,000 --> 00:35:24,600
(people chattering,
child cooing)

692
00:35:24,600 --> 00:35:27,033
NARRATOR:
For families and scientists
alike,

693
00:35:27,033 --> 00:35:30,100
vaccination day is special.

694
00:35:30,100 --> 00:35:32,933
They all look relatively happy.
No one's crying!

695
00:35:32,933 --> 00:35:34,966
They do.
Yeah, yep, absolutely.

696
00:35:36,766 --> 00:35:38,633
DATOO:
It's really nice to see
the relationships

697
00:35:38,633 --> 00:35:40,033
the trial team have
with the participants

698
00:35:40,033 --> 00:35:41,866
and the caregivers,
because I think that makes it,

699
00:35:41,866 --> 00:35:43,733
you know, almost a bit more
like family.

700
00:35:45,366 --> 00:35:47,666
♪ ♪

701
00:35:47,666 --> 00:35:50,433
MOHAMEDI (translated):
Farhiya being
in the vaccination trial

702
00:35:50,433 --> 00:35:52,500
gives me joy.

703
00:35:52,500 --> 00:35:55,366
She will set an example
for others.

704
00:35:55,366 --> 00:35:57,433
(indistinct chatter,
child whimpering)

705
00:36:02,200 --> 00:36:04,866
(cheers, applause)

706
00:36:04,866 --> 00:36:06,800
NARRATOR:
After vaccination,

707
00:36:06,800 --> 00:36:09,466
Farhiya and the other children
in the trial

708
00:36:09,466 --> 00:36:12,966
are closely monitored
for signs of malaria.

709
00:36:12,966 --> 00:36:16,133
The vaccine's success
or failure will depend

710
00:36:16,133 --> 00:36:18,900
on how many malaria cases
occur in children

711
00:36:18,900 --> 00:36:21,400
who received R21

712
00:36:21,400 --> 00:36:24,600
versus the control vaccine.

713
00:36:24,600 --> 00:36:28,600
While they wait for this result,
the team is also investigating

714
00:36:28,600 --> 00:36:32,066
what the vaccine
is doing inside the body.

715
00:36:32,066 --> 00:36:33,833
(baby crying)

716
00:36:33,833 --> 00:36:38,700
For that, they have
to study the children's blood.

717
00:36:41,833 --> 00:36:43,133
OLOTU:
We can now measure

718
00:36:43,133 --> 00:36:46,766
the amount of antibodies
that are in the blood.

719
00:36:48,966 --> 00:36:52,200
Some of this will be shipped
into a reference lab in Oxford,

720
00:36:52,200 --> 00:36:53,966
where samples from other sites

721
00:36:53,966 --> 00:36:57,400
which are
participating will be analyzed.

722
00:36:57,400 --> 00:37:03,933
♪ ♪

723
00:37:03,933 --> 00:37:07,100
NARRATOR:
As Phase Three
booster vaccinations proceed,

724
00:37:07,100 --> 00:37:08,866
immunologist Katie Ewer

725
00:37:08,866 --> 00:37:13,500
and her team are deluged
with these blood samples.

726
00:37:13,500 --> 00:37:15,833
EWER:
There's absolutely loads
still to do.

727
00:37:15,833 --> 00:37:18,333
I have a freezer
full of thousands of samples

728
00:37:18,333 --> 00:37:19,900
from the Phase Three that we
haven't had a chance

729
00:37:19,900 --> 00:37:22,033
to start looking at yet.

730
00:37:25,566 --> 00:37:27,566
Having had very recently
the experience

731
00:37:27,566 --> 00:37:30,466
of taking vaccines through
Phase Three for COVID,

732
00:37:30,466 --> 00:37:31,900
where we had an enormous team
of people

733
00:37:31,900 --> 00:37:33,366
and AstraZeneca working on it,

734
00:37:33,366 --> 00:37:35,533
the contrast to the team
working on malaria,

735
00:37:35,533 --> 00:37:37,200
where there are seven of us,

736
00:37:37,200 --> 00:37:39,500
it's a very different
experience.

737
00:37:39,500 --> 00:37:43,100
(equipment beeping)

738
00:37:44,566 --> 00:37:47,966
We're under pressure
to start churning out some data.

739
00:37:47,966 --> 00:37:49,500
So it's full speed ahead.

740
00:37:49,500 --> 00:37:52,100
LISA STOCKDALE:
Is plate one up on mine
or is it on yours?

741
00:37:52,100 --> 00:37:53,966
SAM MORYS:
No, but the folder's up.

742
00:37:53,966 --> 00:37:57,100
NARRATOR:
The team needs to analyze the
children's antibody responses

743
00:37:57,100 --> 00:38:00,633
to R21 and the control vaccine.

744
00:38:00,633 --> 00:38:02,366
Immunologist Lisa Stockdale

745
00:38:02,366 --> 00:38:04,700
is running a test called
an ELISA.

746
00:38:04,700 --> 00:38:06,900
LISA STOCKDALE:
We've got quite a big variation,

747
00:38:06,900 --> 00:38:09,433
some of the samples have quite
a lot of antibody

748
00:38:09,433 --> 00:38:11,133
whereas some of them don't.

749
00:38:11,133 --> 00:38:13,433
We're blinded to which group
people are in,

750
00:38:13,433 --> 00:38:16,133
but in general, it looks like
the plate is developing well.

751
00:38:16,133 --> 00:38:19,466
I've been doing
hundreds of these ELISA plates.

752
00:38:19,466 --> 00:38:21,766
Hundreds and hundreds.
(chuckles)

753
00:38:23,266 --> 00:38:24,700
NARRATOR:
To be effective,

754
00:38:24,700 --> 00:38:27,166
R21 must prime the blood with
antibodies

755
00:38:27,166 --> 00:38:30,200
that target
the malaria CSP protein.

756
00:38:30,200 --> 00:38:34,000
But the team also needs
to know if those antibodies

757
00:38:34,000 --> 00:38:37,300
can actually neutralize
real malaria parasites.

758
00:38:38,600 --> 00:38:39,766
EWER:
We take the parasites out

759
00:38:39,766 --> 00:38:41,800
by dissecting the mosquito.

760
00:38:41,800 --> 00:38:44,466
So I'm just
gonna hold it with one hand.

761
00:38:45,566 --> 00:38:48,100
Pull the head away gently.

762
00:38:50,000 --> 00:38:53,266
Okay. So we have the head off.

763
00:38:54,833 --> 00:38:57,400
You end up with two pairs
of salivary glands.

764
00:38:57,400 --> 00:38:59,566
They look like
little fat sausages.

765
00:38:59,566 --> 00:39:00,866
It's those little sacs

766
00:39:00,866 --> 00:39:02,666
that have got the parasites in.

767
00:39:06,800 --> 00:39:08,500
Aha! Got them.

768
00:39:08,500 --> 00:39:12,966
NARRATOR:
The parasites are added to
lab-grown liver cells,

769
00:39:12,966 --> 00:39:15,433
along with blood
from vaccinated children.

770
00:39:17,133 --> 00:39:19,833
If the liver cells
do not become infected,

771
00:39:19,833 --> 00:39:22,533
it suggests the antibodies

772
00:39:22,533 --> 00:39:24,300
should protect the children,
too.

773
00:39:26,700 --> 00:39:28,000
EWER:
It's just a lot of pressure

774
00:39:28,000 --> 00:39:29,233
to get through all these
samples,

775
00:39:29,233 --> 00:39:31,100
get the antibody data together.

776
00:39:31,100 --> 00:39:33,266
Should we do both of them
together then?

777
00:39:33,266 --> 00:39:34,500
Could do.

778
00:39:34,500 --> 00:39:36,166
HILL:
I am getting emails

779
00:39:36,166 --> 00:39:38,200
at 2:00 or 3:00 in the morning.

780
00:39:38,200 --> 00:39:41,500
So a lot of people
are working super hard.

781
00:39:41,500 --> 00:39:43,300
I'm a little bit anxious

782
00:39:43,300 --> 00:39:45,300
that maybe we've had to push
them too hard

783
00:39:45,300 --> 00:39:46,966
or we're too ambitious
in our timeline.

784
00:39:50,500 --> 00:39:53,100
I'm exhausted.

785
00:39:53,100 --> 00:39:56,200
I'm tired, I'm stressed,
I'm not sleeping,

786
00:39:56,200 --> 00:39:58,833
uh, yeah, I'm probably not
a great person to be around

787
00:39:58,833 --> 00:40:01,300
at the moment, if I'm honest.

788
00:40:01,300 --> 00:40:05,066
NARRATOR:
All this lab effort is crucial

789
00:40:05,066 --> 00:40:09,200
to understanding how R21 works.

790
00:40:09,200 --> 00:40:12,733
But above all,
they need to know if the vaccine

791
00:40:12,733 --> 00:40:16,033
protects enough
children in the real world.

792
00:40:17,900 --> 00:40:20,866
After around a year of
closely monitoring the health

793
00:40:20,866 --> 00:40:25,500
of all 4,800 Phase Three
children,

794
00:40:25,500 --> 00:40:28,466
the wait is nearly over.

795
00:40:35,333 --> 00:40:40,500
HILL:
The key Phase Three trial
is coming to the end point.

796
00:40:40,500 --> 00:40:42,333
The statisticians have the data

797
00:40:42,333 --> 00:40:46,300
and they are analyzing it
as we speak.

798
00:40:47,933 --> 00:40:49,500
EWER:
You know, this is something

799
00:40:49,500 --> 00:40:51,966
that we've all worked on for
years, so to be this close,

800
00:40:51,966 --> 00:40:54,966
it's, it's kind of nauseatingly,

801
00:40:54,966 --> 00:40:57,700
sickeningly anxiety-inducing,
really.

802
00:40:58,766 --> 00:41:01,033
You know, we just don't know
what we're going to see.

803
00:41:01,033 --> 00:41:04,200
And I think we'll be all really
relieved to get that result.

804
00:41:05,300 --> 00:41:08,633
NARRATOR:
Eleven years after R21
was first made

805
00:41:08,633 --> 00:41:12,400
here in the lab,
after seven years of trials,

806
00:41:12,400 --> 00:41:15,400
over 20,000 vaccinations

807
00:41:15,400 --> 00:41:17,966
and hundreds of thousands
of samples analyzed,

808
00:41:17,966 --> 00:41:20,266
an answer.

809
00:41:22,566 --> 00:41:25,000
HILL:
Even ups significance on
severe malaria.

810
00:41:25,000 --> 00:41:26,733
EWER:
72 percent, bloody hell!

811
00:41:26,733 --> 00:41:28,233
Wide confidence intervals,
but bloody hell, that's what...

812
00:41:28,233 --> 00:41:30,366
(indistinct)
I mean that's...
yeah, absolutely.

813
00:41:31,866 --> 00:41:33,733
Great.

814
00:41:33,733 --> 00:41:37,366
(sighs)
Oh, God. Get me a drink!

815
00:41:38,733 --> 00:41:40,566
(sighs)
Yeah.

816
00:41:40,566 --> 00:41:43,033
So we have
the result of the Phase Three.

817
00:41:43,033 --> 00:41:45,366
So, big moment, um...

818
00:41:47,333 --> 00:41:50,000
As, as expected
from the Phase Two,

819
00:41:50,000 --> 00:41:52,000
some really interesting
results in there.

820
00:41:52,000 --> 00:41:55,300
But yeah, really good
and really reassuring

821
00:41:55,300 --> 00:41:58,000
and, yeah, just very happy.

822
00:41:58,000 --> 00:42:00,200
(joyous exhale)

823
00:42:02,733 --> 00:42:05,566
(crying)

824
00:42:10,333 --> 00:42:12,100
(sniffles)

825
00:42:13,933 --> 00:42:17,166
(sighs)

826
00:42:17,166 --> 00:42:18,900
Yeah. We're very happy.

827
00:42:18,900 --> 00:42:21,433
Although it really didn't look
like it, but...

828
00:42:21,433 --> 00:42:25,966
Yeah, it's just a moment I've
been waiting for for so long.

829
00:42:25,966 --> 00:42:29,166
But, yeah, what we wanted
and what we hoped for.

830
00:42:29,166 --> 00:42:32,433
So really good. Yeah.

831
00:42:33,566 --> 00:42:36,566
♪ ♪

832
00:42:39,300 --> 00:42:40,833
NARRATOR:
Barely a month later,

833
00:42:40,833 --> 00:42:43,066
there's a global
medical conference in Seattle.

834
00:42:45,333 --> 00:42:48,533
The promise of the initial
Phase Three trial result

835
00:42:48,533 --> 00:42:50,433
is now sinking in.

836
00:42:50,433 --> 00:42:53,533
Across the different ages
and locations

837
00:42:53,533 --> 00:42:55,833
of children in the trial,

838
00:42:55,833 --> 00:42:58,266
around a year after they were
first vaccinated,

839
00:42:58,266 --> 00:43:02,166
R21 has reduced cases
of clinical malaria

840
00:43:02,166 --> 00:43:04,800
by about 70 to 80 percent.

841
00:43:04,800 --> 00:43:06,933
Hey, good morning!
Ah!

842
00:43:06,933 --> 00:43:10,700
NARRATOR:
So the teams from
Oxford, Tanzania,

843
00:43:10,700 --> 00:43:12,666
Kenya, Mali, and Burkina Faso

844
00:43:12,666 --> 00:43:14,566
gather to prepare

845
00:43:14,566 --> 00:43:18,366
to present their data
publicly for the first time.

846
00:43:19,466 --> 00:43:20,666
HILL:
These people
are just extraordinary.

847
00:43:20,666 --> 00:43:21,966
They are leaders in their field.

848
00:43:21,966 --> 00:43:25,466
Hello! How are you?
Good to see you.

849
00:43:25,466 --> 00:43:27,566
HILL:
The results that have
come in show

850
00:43:27,566 --> 00:43:32,133
safety looks absolutely fine in
literally thousands of children.

851
00:43:32,133 --> 00:43:34,433
And even more excitingly,

852
00:43:34,433 --> 00:43:37,600
the efficacy,
the reaction was they cheered.

853
00:43:37,600 --> 00:43:39,766
DICKO:
Very, very good news.

854
00:43:39,766 --> 00:43:43,900
OLOTU:
You know, seeing the numbers
that was a moment of excitement.

855
00:43:43,900 --> 00:43:46,333
Everybody was taken aback

856
00:43:46,333 --> 00:43:47,600
and say, you know what?

857
00:43:47,600 --> 00:43:49,700
Wow, this is, this is real.

858
00:43:49,700 --> 00:43:52,633
This is, this is something.

859
00:43:52,633 --> 00:43:56,533
When this result came out,
I was like, ah.

860
00:43:56,533 --> 00:43:58,100
Oof. Ah!

861
00:43:58,100 --> 00:44:00,333
This is, this is what I was
waiting for long.

862
00:44:01,700 --> 00:44:03,166
 
HILL:
So here we are on Sunday,

863
00:44:03,166 --> 00:44:05,033
on Wednesday we're going to try

864
00:44:05,033 --> 00:44:06,533
and tell the world
about what we've found.

865
00:44:06,533 --> 00:44:10,266
♪ ♪

866
00:44:10,266 --> 00:44:12,766
DATOO:
We know our vaccine works,
we know we have good data.

867
00:44:12,766 --> 00:44:14,533
I'm excited to see the response.

868
00:44:14,533 --> 00:44:17,600
I hope everyone
is as excited as we are.

869
00:44:17,600 --> 00:44:21,200
♪ ♪

870
00:44:21,200 --> 00:44:24,100
(applause)

871
00:44:24,100 --> 00:44:26,300
I am very pleased today
to be able to share with you

872
00:44:26,300 --> 00:44:28,900
the first data

873
00:44:28,900 --> 00:44:31,800
on the safety and efficacy of
R21/Matrix-M,

874
00:44:31,800 --> 00:44:33,600
the new malaria vaccine.

875
00:44:33,600 --> 00:44:35,233
(applause)

876
00:44:35,233 --> 00:44:37,366
MATTHEW COLDIRON:
It was extremely exciting.

877
00:44:37,366 --> 00:44:39,533
This is a vaccine that works,

878
00:44:39,533 --> 00:44:41,233
that's going to be widely
available,

879
00:44:41,233 --> 00:44:42,900
at a reasonable price,

880
00:44:42,900 --> 00:44:45,833
and that could really,
really make a big difference.

881
00:44:45,833 --> 00:44:48,233
It's trite to say gamechanger
but I really think it is.

882
00:44:48,233 --> 00:44:51,000
ANNA LAST:
It's very encouraging news
that they have

883
00:44:51,000 --> 00:44:52,500
the Serum Institute in Pune

884
00:44:52,500 --> 00:44:53,800
who is going to be able to

885
00:44:53,800 --> 00:44:55,266
really scale up the production
of a vaccine.

886
00:44:55,266 --> 00:44:56,866
♪ ♪

887
00:44:56,866 --> 00:44:58,166
NARRATOR:
For the team,

888
00:44:58,166 --> 00:45:00,700
sharing their results
is a moment to savor.

889
00:45:02,200 --> 00:45:05,933
R21 can't be
directly compared with RTS,S--

890
00:45:05,933 --> 00:45:09,066
their trials were different--
but there's now no doubt

891
00:45:09,066 --> 00:45:12,433
about this
new vaccine's potential.

892
00:45:13,733 --> 00:45:15,866
The next step is evaluation

893
00:45:15,866 --> 00:45:17,833
by the World Health
Organization.

894
00:45:17,833 --> 00:45:20,300
Its approval will be essential.

895
00:45:20,300 --> 00:45:23,066
Without it,
donor funds can't be used

896
00:45:23,066 --> 00:45:26,033
for the vaccine's
roll-out across Africa.

897
00:45:26,033 --> 00:45:29,800
It's a process
that can take years.

898
00:45:29,800 --> 00:45:31,500
(news theme playing)

899
00:45:31,500 --> 00:45:33,566
NARRATOR:
But six months later,

900
00:45:33,566 --> 00:45:36,066
as W.H.O. deliberations
continue,

901
00:45:36,066 --> 00:45:38,300
there's breaking news.

902
00:45:38,300 --> 00:45:40,700
A day of pure elation for Ghana,
for science

903
00:45:40,700 --> 00:45:42,766
and for all of humanity,

904
00:45:42,766 --> 00:45:45,733
as the FDA has granted approval
to a new vaccine.

905
00:45:45,733 --> 00:45:48,400
REPORTER: Ghana's government has
become the first in the world

906
00:45:48,400 --> 00:45:52,433
to clear the roll-out
of malaria vaccine R21.

907
00:45:52,433 --> 00:45:55,933
NARRATOR: Ghana's drug regulator
has reviewed the data on R21

908
00:45:55,933 --> 00:45:57,700
and approved it for use,

909
00:45:57,700 --> 00:46:02,633
signaling a clear and urgent
demand for this new vaccine.

910
00:46:02,633 --> 00:46:05,966
Days later, Nigeria follows suit

911
00:46:05,966 --> 00:46:08,800
and Angola looks to place
an order.

912
00:46:08,800 --> 00:46:11,333
But there's still no certainty

913
00:46:11,333 --> 00:46:13,966
that the W.H.O.
will approve the vaccine

914
00:46:13,966 --> 00:46:18,366
and so unlock the necessary
funds.

915
00:46:18,366 --> 00:46:20,100
Let's get into the
manufacturing, um,

916
00:46:20,100 --> 00:46:21,633
details of how

917
00:46:21,633 --> 00:46:23,100
to scale up
as soon as possible,

918
00:46:23,100 --> 00:46:24,866
because now I think there's
a lot of excitement.

919
00:46:24,866 --> 00:46:26,166
NARRATOR:
In Pune,

920
00:46:26,166 --> 00:46:29,466
Serum's CEO has a
very big decision to make.

921
00:46:29,466 --> 00:46:33,833
POONAWALLA:
How many doses
should we then make at risk?

922
00:46:33,833 --> 00:46:36,566
I was thinking around
20 to 25 million doses.

923
00:46:36,566 --> 00:46:38,033
Do you think that would be okay?

924
00:46:38,033 --> 00:46:40,400
SHALIGRAM:
That is,
so five million Angola wants,

925
00:46:40,400 --> 00:46:43,000
and Nigeria also wants
around five, ten million,

926
00:46:43,000 --> 00:46:44,400
and Ghana around five,
ten million,

927
00:46:44,400 --> 00:46:46,233
so 25 million is good enough.

928
00:46:46,233 --> 00:46:48,600
Or should we make around
30 million to be safe?

929
00:46:48,600 --> 00:46:49,933
I think so, we should try...

930
00:46:49,933 --> 00:46:51,333
Fine, go ahead, do it.

931
00:46:51,333 --> 00:46:53,133
Let me know what the costing

932
00:46:53,133 --> 00:46:55,000
and the risk we're taking
in that is,

933
00:46:55,000 --> 00:46:56,300
but let's just go ahead.

934
00:46:56,300 --> 00:46:58,833
What's the expiry on that?

935
00:46:58,833 --> 00:47:00,200
The expiry is about 18 months.

936
00:47:00,200 --> 00:47:01,833
Yeah, that's a matter
of concern.

937
00:47:01,833 --> 00:47:03,533
♪ ♪

938
00:47:03,533 --> 00:47:08,566
NARRATOR:
Adar Poonawalla has just risked
over $100 million

939
00:47:08,566 --> 00:47:14,000
to start production
of 30 million doses of R21.

940
00:47:16,033 --> 00:47:18,000
They'll be offered
at the very low price

941
00:47:18,000 --> 00:47:20,000
of under four dollars a dose.

942
00:47:22,000 --> 00:47:26,000
The gamble is whether W.H.O.
approval

943
00:47:26,000 --> 00:47:31,466
and sales will come before
the vaccine stockpile expires.

944
00:47:31,466 --> 00:47:34,533
♪ ♪

945
00:47:34,533 --> 00:47:35,933
POONAWALLA:
We've taken all the risk,
you know,

946
00:47:35,933 --> 00:47:37,466
for the trials,
for manufacturing,

947
00:47:37,466 --> 00:47:41,500
30 million doses, we just
hope that it's all worth it.

948
00:47:42,466 --> 00:47:44,900
I wouldn't have the freedom

949
00:47:44,900 --> 00:47:47,133
to make these sort of risky
decisions and bets

950
00:47:47,133 --> 00:47:49,066
had I been accountable

951
00:47:49,066 --> 00:47:51,866
to multiple stakeholders,
shareholders, banks, etcetera.

952
00:47:51,866 --> 00:47:54,933
Here, it's just a few
people coming together

953
00:47:54,933 --> 00:47:57,900
and quickly deciding
to go ahead on something.

954
00:47:57,900 --> 00:47:59,933
Everything is now on W.H.O.

955
00:47:59,933 --> 00:48:02,366
to approve the vaccine,
that's all we're waiting for,

956
00:48:02,366 --> 00:48:04,100
and then we can roll it out.

957
00:48:04,100 --> 00:48:08,200
NARRATOR:
In Serum's cold storage,

958
00:48:08,200 --> 00:48:11,333
the shelves rapidly
begin to fill with R21.

959
00:48:11,333 --> 00:48:12,933
R21.
R21 storage, yeah.

960
00:48:12,933 --> 00:48:14,600
SHALIGRAM:
This is a place

961
00:48:14,600 --> 00:48:17,333
where your heart fills with
a joy.

962
00:48:17,333 --> 00:48:18,900
Because finally the product

963
00:48:18,900 --> 00:48:20,933
which will get into the humans
is ready.

964
00:48:21,933 --> 00:48:23,900
This entire cold room can

965
00:48:23,900 --> 00:48:25,500
accommodate 40 million doses,

966
00:48:25,500 --> 00:48:27,166
which means 10 million

967
00:48:27,166 --> 00:48:28,300
children vaccination.

968
00:48:28,300 --> 00:48:30,366
Amazing feeling.

969
00:48:32,766 --> 00:48:35,500
♪ ♪

970
00:48:35,500 --> 00:48:39,900
NARRATOR:
It's five months since Serum's
R21 production line started.

971
00:48:41,333 --> 00:48:42,866
The team has been sharing

972
00:48:42,866 --> 00:48:44,800
continually updated evidence
with the W.H.O.

973
00:48:44,800 --> 00:48:48,200
that the vaccine
is safe and cost-effective.

974
00:48:48,200 --> 00:48:51,933
And although R21's efficacy

975
00:48:51,933 --> 00:48:54,833
does decrease a little over
time,

976
00:48:54,833 --> 00:48:56,900
a booster dose bumps it back up.

977
00:48:56,900 --> 00:48:58,500
And now...

978
00:48:58,500 --> 00:49:00,000
HILL:
Hello!

979
00:49:00,000 --> 00:49:02,800
NARRATOR:
They've been told to expect
an announcement.

980
00:49:04,766 --> 00:49:06,733
TEDROS ADHANOM GHEBREYESUS:
Good morning, good afternoon
and good evening.

981
00:49:06,733 --> 00:49:09,433
Today is a great day for health.

982
00:49:09,433 --> 00:49:12,666
A great day for vaccines.

983
00:49:12,666 --> 00:49:15,033
Almost exactly two years ago,

984
00:49:15,033 --> 00:49:18,133
W.H.O. recommended the broad use

985
00:49:18,133 --> 00:49:21,233
of the world's first malaria
vaccine called

986
00:49:21,233 --> 00:49:23,166
RTS,S.

987
00:49:23,166 --> 00:49:25,966
Today, it gives me great
pleasure

988
00:49:25,966 --> 00:49:28,266
to announce that the W.H.O. is
recommending

989
00:49:28,266 --> 00:49:30,200
a second vaccine

990
00:49:30,200 --> 00:49:34,366
called R21/Matrix-M to prevent
malaria

991
00:49:34,366 --> 00:49:37,166
in children at risk of the
disease.

992
00:49:37,166 --> 00:49:41,633
 
♪ ♪

993
00:49:41,633 --> 00:49:44,766
NARRATOR:
The W.H.O. has approved R21,

994
00:49:44,766 --> 00:49:47,966
for use in any African child

995
00:49:47,966 --> 00:49:50,800
at risk of malaria,

996
00:49:50,800 --> 00:49:54,033
a decision that should
trigger the release

997
00:49:54,033 --> 00:49:56,933
of critical donor funds.

998
00:49:56,933 --> 00:49:59,700
Congratulations!
What a great day.

999
00:49:59,700 --> 00:50:01,666
OLOTU (on computer):
Congratulations to you, too.

1000
00:50:01,666 --> 00:50:03,866
DICKO (on computer):
This is really an historic day

1001
00:50:03,866 --> 00:50:05,900
for Africa, I think.

1002
00:50:05,900 --> 00:50:08,266
HILL:
We are not talking about
hundreds or thousands,

1003
00:50:08,266 --> 00:50:09,733
but over time,

1004
00:50:09,733 --> 00:50:12,400
well over a million lives saved.

1005
00:50:12,400 --> 00:50:17,100
It, it's just staggering and,
and hugely, hugely gratifying.

1006
00:50:17,100 --> 00:50:20,633
And you just feel, wow.

1007
00:50:22,400 --> 00:50:24,800
EWER:
Really happy, really relieved,

1008
00:50:24,800 --> 00:50:29,066
and, you know,
proud that we've got here.

1009
00:50:29,066 --> 00:50:32,366
You know this opens the door for
the next stage for the vaccine,

1010
00:50:32,366 --> 00:50:34,833
which is to get out there
into the real world,

1011
00:50:34,833 --> 00:50:36,266
and, and that's the bit that

1012
00:50:36,266 --> 00:50:38,200
I'm sort of most excited about,
really.

1013
00:50:38,200 --> 00:50:40,633
♪ ♪

1014
00:50:40,633 --> 00:50:43,333
OLOTU:
I'm dreaming for that day
to come

1015
00:50:43,333 --> 00:50:45,833
and I hope it will
come sooner than later.

1016
00:50:45,833 --> 00:50:50,266
And, uh, yeah.

1017
00:50:50,266 --> 00:50:54,600
It's, uh, yeah, this is what,
this is what I want to see.

1018
00:50:54,600 --> 00:50:57,600
This is what every parent
wants to see.

1019
00:50:59,733 --> 00:51:02,600
NARRATOR:
In the long term,

1020
00:51:02,600 --> 00:51:05,933
malaria vaccines
offer great hope.

1021
00:51:07,366 --> 00:51:09,700
With climate change
opening new frontiers

1022
00:51:09,700 --> 00:51:12,166
for malaria-carrying mosquitoes,

1023
00:51:12,166 --> 00:51:15,400
more and better vaccines
will be important

1024
00:51:15,400 --> 00:51:18,166
in Africa and elsewhere.

1025
00:51:19,800 --> 00:51:23,566
And perhaps one day malaria may
even follow smallpox

1026
00:51:23,566 --> 00:51:26,700
into the history books.

1027
00:51:26,700 --> 00:51:29,066
But in Tanzania right now,

1028
00:51:29,066 --> 00:51:32,366
for people like Zuhura Abasi
and her daughter,

1029
00:51:32,366 --> 00:51:38,633
R21's mass roll out in 2024
can't come soon enough.

1030
00:51:41,300 --> 00:51:43,766
ZUHURA (translated):
I'll be very happy once malaria

1031
00:51:43,766 --> 00:51:46,233
is no more.

1032
00:51:46,233 --> 00:51:50,866
That way my child will be
able to study properly.

1033
00:51:50,866 --> 00:51:53,900
Unlike today when kids miss
school for days

1034
00:51:53,900 --> 00:51:56,066
because of malaria.

1035
00:51:58,300 --> 00:52:03,400
(singing in Swahili)

1036
00:52:06,100 --> 00:52:09,900
ZUHURA:

1037
00:52:09,900 --> 00:52:13,133
FARHIYA AND ZUHURA:

1038
00:52:13,133 --> 00:52:15,233
ZUHURA:

1039
00:52:16,466 --> 00:52:18,900
FARHIYA AND ZUHURA:

1040
00:52:18,900 --> 00:52:22,833
ZUHURA:

1041
00:52:23,800 --> 00:52:24,833
Eh?

1042
00:52:31,300 --> 00:52:33,666
♪ ♪

1043
00:52:55,200 --> 00:53:02,800
♪ ♪

1044
00:53:06,633 --> 00:53:14,166
♪ ♪

1045
00:53:15,800 --> 00:53:23,333
♪ ♪

1046
00:53:24,966 --> 00:53:32,500
♪ ♪

1047
00:53:38,233 --> 00:53:45,400
♪ ♪