[Malaria vaccines--which vaccines to whom?].

More than a third of the world's population is at risk of contracting malaria. It is estimated that 200 people, primarily children in Africa, die of malaria every hour of every day all year round. Malaria is one of the main obstacles to socio-economic development in Africa. Vaccines against malaria are considered to be the control tool most in need of development. Fundamentally there are three types of malaria vaccines: vaccines against the invading sporozoite or the parasite's development in the liver cells, vaccines directed against the parasite's invasion of and development in the red blood cells; vaccines directed against the fertilisation process in the mosquito. Each malaria vaccine has its own area of application. In spite of promising results in animals it has been difficult to reproduce the results in clinical trials in humans. Recently, however, an experimental vaccine containing a sporozoite protein coupled to a hepatitis B surface molecule with a new adjuvant has been tested in Gambia. The results of these tests are promising, but it is unlikely that the vaccine will be of use in endemic areas. Increased focus on one of the world's biggest health problems has to a certain extent promoted the funding of development work on malaria vaccines. Despite minimal interest from the pharmaceutical industry, a number of experimental vaccines for clinical phase I trials are on their way. However, it will take a huge increase in public financial resources to secure effective and safe malaria vaccines for those most in need of them: people in developing countries and particularly in Sub-Saharan Africa.