Plague hits Madagascar as Oxford team races to finish the revolutionary vaccine

By Will Brown
 Zafimana, 3 years old, is among the children suffering from malnutrition in the Fenohaivo village - Tsiory Andriantsoarana/WFP
Zafimana, 3 years old, is among the children suffering from malnutrition in the Fenohaivo village - Tsiory Andriantsoarana/WFP

A plague outbreak has killed at least seven people in Madagascar, as the island nation struggles to fend off a devastating famine and UK scientists race to develop a new vaccine for the ancient killer. 

In early September, Dr Fidiniana Randriantsarafara, the Director-General of Preventive Medicine, told local media that seven people had died and another 22 patients were being treated for pneumonic plague.

The outbreak was recorded in the Itasy region in the central highlands of Madagascar in late August. The disease is endemic to Madagascar, and the last large outbreak of the disease in 2017 infected around 2,400 people and killed at least 209 people. 

In the 14th century, a bubonic plague pandemic known as the ‘Black Death’ killed an estimated 75 to 200m people were killed across Eurasia and North Africa.

Bubonic plagues effect the lymph nodes. They are caused by the bacterium Yersinia pestis being spread from rodents to flees and onto humans. But once there are infections in humans the bacteria, can develop into the pneumonic strain which effects the lungs.

The pneumonic plague spread through flea bites but it also has the ability to be passed from person to person through tiny droplets of saliva. This makes it the 'most serious' form of the disease, according to the Centre for Disease Control in the US. 

While antibiotics can treat plague, outbreaks often happen in remote areas and spread quickly. Without treatment, the death rate for pneumonic plague is almost 100 per cent. With treatment it goes down to about 50 percent.

The latest outbreak comes at a deeply troubling time for the world's fourth-largest island. The country is teetering on the edge of a climate change-induced famine and is struggling with a Covid-19 induced financial crisis. 
The United Nations estimates that roughly 30,000 people are already suffering "catastrophic" levels of hunger and food insecurity in the country's south because of crop failure and four years without rain. In mid-August, the UN appealed for £112m in funding to help feed 1.3m people in southern Madagascar. 

Covid breakthrough could lead to a plague vaccine

The news comes as a team at Oxford University starts phase one human trials of a plague vaccine. Led by Professor Christine Rollier, now at the University of Surrey, the team uses the same viral vector in their plague vaccine as in the Oxford University-AstraZeneca coronavirus jab, called ChAdOx. 

Professor Rollier told The Telegraph that developing a vaccine for the disease was particularly challenging because it is a bacterial infection rather than a virus. "I had a few people telling me it would never work," she said. 

However, she is hopeful of a breakthrough, particularly as the ChAdOx technology has already been proven safe and effective for humans. The new plague trial is funded by InnovateUK and is still recruiting participants

"I remember during the epidemic in 2016 and 2017 there was a photograph in a journal of a mother burying a three-year-old child, and for me, that's very identifiable when you know that technology can easily prevent that," Professor Rollier said. 

"So it's quite heartwarming to see that even during a pandemic, people are still volunteering to come and try a vaccine for plague, for the poorest of the poor."  

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