Malaria Vaccine Update: Global Disease Burden and Vaccination Milestones
Update (March 4, 2025 | 11:29 AM)
 
Many thanks to David Trent of the World Animal Foundation for prompting an update on the global burden of malaria.
 
According to data published by the World Health Organization (WHO) on December 11, 2024, the estimated number of malaria cases worldwide increased to 263 million in 2023, up from 252 million in 2022, indicating a modest rise in global incidence.
 
Encouragingly, estimated malaria-related deaths declined slightly, from approximately 600,000 in 2022 to 597,000 in 2023. Whether this reduction is statistically significant remains unclear. Nonetheless, these figures highlight that malaria continues to impose a substantial global health burden.
 
Taken together, the data underscore the urgent need to improve malaria vaccines, expand equitable access to vaccination, and sustain complementary preventive measures such as mosquito control, chemoprophylaxis, and early diagnosis.

Historic Milestone: Routine Childhood Malaria Vaccination Begins
 
After more than 60 years of malaria vaccine research and development, a historic milestone was reached on January 22, 2024, when routine childhood malaria vaccination was officially launched in Cameroon.
 
On that date, infants and toddlers received RTS,S/AS01 (Mosquirix)—the first malaria vaccine recommended by the WHO in 2021—as part of the country’s standard childhood immunization schedule. This marked the first time in history that a malaria vaccine was deployed for routine use at the national level.
 
The milestone was widely reported in international media, including Reuters, which described the event as a global public health breakthrough:
 
“Cameroon begins routine malaria shots in global milestone.”
— Reuters, January 22, 2024, 5:59 PM EST

Introduction
 
For most people in Western countries, malaria only becomes a concern when planning travel to regions where the disease is endemic and widespread. A natural first question is whether a malaria vaccine is available. Unfortunately, as of today, no malaria vaccine has been approved by the U.S. Food and Drug Administration (FDA), and there are no pending FDA reviews. This situation is similar across most Western regulatory jurisdictions.
 
As a result, travelers to malaria-endemic regions must still rely on prophylactic antimalarial medications (1), such as atovaquone–proguanil (Malarone), chloroquine phosphate (Aralen), mefloquine, primaquine, tafenoquine (Arakoda™), or doxycycline. These drugs differ in mechanism of action, dosing schedules, side-effect profiles, and suitability depending on an individual’s health status, and must be prescribed by a healthcare professional.
 
In addition to medication, preventive measures—including daytime use of mosquito repellents, wearing protective clothing, and sleeping under insecticide-treated bed nets—remain essential.
 
Despite these limitations, there is encouraging progress. Two malaria vaccines have now been recommended by the World Health Organization (WHO) for use in children in sub-Saharan Africa and other regions with moderate to high malaria transmission. These vaccines represent the culmination of decades of challenging research and development (2). While they are not yet approved for travelers, there is hope that continued data collection may eventually support broader regulatory approval.

Malaria: Disease Background and Global Burden
 
Malaria is a mosquito-borne parasitic disease characterized by recurrent fever, chills, sweating, anemia, and—if left untreated—potentially fatal complications. It is caused primarily by Plasmodium falciparum and Plasmodium vivax parasites and transmitted by female Anopheles mosquitoes.
 
Malaria remains a major global health challenge. According to the World Health Organization, an estimated 247 million malaria cases and 619,000 deaths occurred worldwide in 2021, with 95% of cases and 96% of deaths concentrated in the WHO African Region (3).
 
Transmission intensity varies depending on environmental factors such as temperature, rainfall, and humidity, as well as mosquito ecology and human behavior. Malaria risk can change over time as control measures are introduced or withdrawn. Effective strategies—such as insecticide-treated bed nets, indoor residual spraying, and antimalarial therapies—have reduced malaria in some regions, while others remain highly vulnerable.
 
Travelers should always consult the most up-to-date malaria risk information, including the CDC malaria distribution map (4) and the WHO malaria threat map (5), before visiting endemic areas.

WHO-Recommended Malaria Vaccines
 
RTS,S/AS01 (Mosquirix)
 
RTS,S/AS01, marketed as Mosquirix, is the first malaria vaccine ever approved for use. Developed by the Walter Reed Army Institute of Research and GlaxoSmithKline (6), it received a WHO recommendation in 2021 (7).
 
The vaccine requires four doses and has demonstrated approximately 40% protection against clinical malaria and 30% protection against severe malaria over a four-year period⁷.
 
Mosquirix targets the circumsporozoite protein (CSP) of Plasmodium falciparum, a key surface antigen involved in liver infection. The vaccine also incorporates a hepatitis B surface antigen to enhance immune response and provide dual protection. It is a recombinant protein vaccine produced in genetically engineered yeast cells (8,9).
 
R21/Matrix-M
 
R21/Matrix-M is the second malaria vaccine to receive a WHO recommendation, announced in 2023 (10). Developed by the University of Oxford and the Serum Institute of India, it uses Novavax’s Matrix-M adjuvant technology.
 
R21/Matrix-M is the first malaria vaccine to meet the WHO target of at least 75% efficacy. In clinical trials, it reduced symptomatic malaria cases by approximately 75% during the first year after vaccination (11). The vaccine requires three doses.
 
Like RTS,S, R21 targets the CSP antigen of P. falciparum, but differs in formulation and adjuvant design—an approach previously validated in Novavax’s COVID-19 vaccine.

Current Applications and Regulatory Status
 
Neither RTS,S/AS01 nor R21/Matrix-M has been approved or authorized by the FDA for use in the United States. The FDA applies different regulatory standards and considers domestic public health need when evaluating vaccines. Since malaria is not endemic in the U.S. and most cases are travel-related, regulatory approval for general use has not been prioritized.
 
These vaccines are primarily intended for children and pregnant women in high-burden regions, where malaria remains a leading cause of morbidity and mortality. As of now, at least 28 African countries plan to introduce WHO-recommended malaria vaccines into their national immunization programs.
 
Gavi, the Vaccine Alliance, supported by the Bill & Melinda Gates Foundation, has approved funding to support malaria vaccine rollout in 18 countries (12). According to WHO timelines, RTS,S is becoming available in select African countries in early 2024, while R21 is expected to follow in mid-2024.

Future Prospects in Malaria Vaccine Development
 
A fully protective malaria vaccine has yet to be achieved. Ongoing research efforts are focused on:

• Improving the efficacy and durability of RTS,S and R21
• Developing novel antigen–adjuvant combinations
• Exploring attenuated sporozoite vaccines
• Addressing parasite genetic diversity and mutation potential (13)

While scientific and logistical challenges remain, progress continues. The Bill & Melinda Gates Foundation has articulated a long-term vision to eradicate malaria by 2040 (14), while the WHO has set a more ambitious goal of ending the global malaria threat by 2030 (15).
Although ultimate success is not guaranteed, the rapid advances seen over the past decade provide strong reasons for cautious optimism.

References
 
[1] CDC-Choosing a Drug to Prevent Malaria
[2] Amal A. El‑Moamly and Mohamed A. El‑Sweify. Malaria vaccines: the 60‑year journey of hope and final success—lessons learned and future prospects. Trop. Med. & Health (2023) 51:29. https://doi.org/10.1186/s41182-023-00516-w.
[3] World Malaria Day 2023/ Malaria by numbers: global and regional burden
[4] CDC-Where Malaria Occurs
[5] WHO-Malaria Threats Map: tracking the spread of biological threats to malaria
[6] WHO grants prequalification to GSK’s Mosquirix – the first and only approved malaria vaccine
[7] CDC-Malaria vaccine recommended for broader use by WHO: “Best thing since bed nets”
[8] Matthew B. Laurens. RTS,S/AS01 vaccine (Mosquirix™): an overview. Human Vaccines & Immunotherapeutics (2020) 16, 480-489. https://doi.org/10.1080/21645515.2019.1669415
[9] Yahiya Y. Syed. RTS,S/AS01 malaria vaccine (Mosquirix®): a profle of its use. Drugs & Therapy Perspectives (2022) 38:373–381. https://doi.org/10.1007/s40267-022-00937-3
[10] WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization
[11] Mehreen S Datoo, Magloire H Natama, et al. Efficacy of a low-dose candidate malaria vaccine, R21 in
adjuvant Matrix-M, with seasonal administration to children in Burkina Faso: a randomised controlled trial. The Lancet (2021) 397, 1809-1818. https://doi.org/10.1016/S0140-6736(21)00943-0
[12] Gavi outlines plans to build sustainable supply of malaria vaccines
[13] Wikipedia> Malaria vaccine
[14] Report by UN and Gates Foundation presents vision for eradicating malaria by 2040
[15] “A great day for science”: WHO recommends second vaccine against malaria

Direct-to-Consumer Biological Age Testing: An Expanding Market
 
Biological age determination using epigenetic clocks or telomere length testing is gaining increasing acceptance within the aging research community and among health-conscious consumers. As interest in longevity science grows, so does the number of direct-to-consumer (DTC) companies offering biological age testing—often bundled with supplements, lifestyle programs, or “anti-aging” interventions.
 
For consumers, this rapid market expansion creates a challenge: how to choose the most appropriate biological age test based on individual goals, whether for general health assessment, longevity tracking, or experimental age-reversal efforts. Although reviews and rankings of biological age testing companies are widely available in the media (1-3), conclusions often diverge and may be influenced by commercial interests. In this article, we review the underlying technologies and propose practical criteria for selecting a biological age testing company.
 
Epigenetic Clocks vs. Telomere Length Testing
 
Biological age reflects how well the body is functioning relative to chronological age. It is influenced by genetics, lifestyle, environmental exposures, and disease burden. Several laboratory methods aim to estimate biological age, most notably epigenetic testing (4-6) and telomere length measurement (7,8).
Epigenetic clocks assess chemical modifications of DNA—primarily DNA methylation—that regulate gene expression without altering DNA sequence (9,10). These clocks can estimate biological age and, in some cases, predict disease risk and mortality.
 
Telomere length testing measures the length of repetitive DNA sequences that protect chromosome ends and shorten with each cell division (11). Shorter telomeres are associated with aging and age-related disease risk, but telomere length varies widely between individuals and tissues.
Both approaches have strengths and limitations, and there is no consensus on which method provides a definitive measure of biological aging. Consequently, consumers should approach biological age testing with realistic expectations and carefully evaluate the methodology used by each company.
 
Practical Significance of Biological Age Testing
 
Is Biological Age Testing Worth It?
 
Whether biological age testing is “worth it” largely depends on personal perspective and expectations. Importantly, none of the biological age tests currently available are FDA-approved for clinical diagnosis. Moreover, if your biological age is higher than your chronological age, there is no established medical treatment beyond conventional lifestyle recommendations such as diet, exercise, sleep optimization, and stress reduction.
 
That said, the scientific foundations of biological aging and cellular rejuvenation are robust and have been recognized with multiple Nobel Prizes (12). Public demand for longevity insights continues to rise, fueling rapid growth in the biological age testing industry.
 
Critics—including some experts—have described current biological age tests as “informational” or even “entertainment” tools rather than actionable medical diagnostics (13,14). Even so, information can be empowering. For motivated individuals, biological age testing may promote learning, self-reflection, and healthier lifestyle choices—benefits that should not be dismissed.

Key Criteria for Selecting a Biological Age Testing Company
 
1. Scientific Advisory Board and Research Credibility
Most biological age testing companies are early-stage biotechnology start-ups. One of the most important factors to evaluate is the scientific advisory board. Advisors lend intellectual credibility, guide research strategy, and often contribute patents and methodological expertise.
A strong advisory board suggests that a company’s products are grounded in established science rather than marketing hype. For example, Altos Labs (15)—focused on cellular rejuvenation—includes Steve Horvath (developer of the epigenetic clock) and Shinya Yamanaka (2012 Nobel laureate for cellular reprogramming). Similarly, Elysium Health lists over 25 prominent scientists and clinicians, including multiple Nobel Prize winners (16).
 
2. Executive Team Experience and Ethical Oversight
Equally important is the executive leadership team, which is responsible for translating scientific vision into ethical, transparent, and sustainable business practices. Executives should have demonstrated experience in biotechnology, healthcare, or regulated industries.
For instance, Life Biosciences (17) is led by executives with decades of experience in biopharmaceutical development. Its CEO, Jerry McLaughlin, has contributed to multiple FDA-approved drugs and is supported by aging researcher David Sinclair on the board.
Companies should clearly disclose executive backgrounds, governance structure, and potential conflicts of interest.
 
3. Products, Services, and Scientific Transparency
After evaluating leadership, consumers should examine the scope and quality of services offered, including:

• Type of biological age test (epigenetic vs. telomere)
• Testing frequency and sample requirements
• Result interpretation and reporting clarity
• Evidence-based recommendations or interventions
• Realistic claims and limitations

 
For example, Elysium Health’s Index test uses epigenetic data to assess biological age across nine organ systems and is complemented by longevity supplements. At the other extreme, RepeatDx focuses exclusively on telomere length testing for clinical use and does not operate as a DTC biological age company.
 
Choose services that align with your goals—whether exploratory tracking or focused biomarker assessment.
 
4. Customer Support, Transparency, and User Experience
Biological age testing can raise questions, making customer support quality critical. Preferred support options include real-time chat, telephone access, and comprehensive FAQs. Transparent privacy policies, terms of service, and refund policies are essential.
 
For example, MyDNAge provides email support, direct phone access, clinic inquiry forms, FAQs, and clear legal documentation—but does not offer live chat. Whether this level of support is sufficient depends on individual expectations.
 
5. Cost, Convenience, and Value
Pricing varies widely among biological age testing companies. Consumers should compare not only cost, but value, including:

• Ease of sample collection
• Turnaround time
• Accessibility of results
• Long-term tracking options

 
Higher cost does not necessarily imply higher scientific validity, and inexpensive tests may still provide useful insights when expectations are realistic.
 
6. Reputation, Longevity, and Independent Reviews
Finally, consider the company’s reputation and standing in the longevity and biotechnology communities. Established companies may offer greater stability, while newer entrants may provide innovative approaches.
 
Seek reviews from credible, independent sources and remain cautious of overly promotional content. Reputable companies should welcome constructive criticism and continuously improve their offerings.
 
Final Thoughts
 
Biological age determination is an evolving field at the intersection of science, technology, and consumer health. While current tests are not diagnostic tools, they may offer meaningful insights for informed and motivated individuals. Careful evaluation of scientific credibility, leadership, transparency, and alignment with personal goals is essential when choosing a biological age testing company.

​References
(1) The Best Biological Age Test of 2023: Review of Top 6 Brands. Jan Vincent Beltran, Healthnews, October 16, 2023.
(2) 11 Best Biological Age Tests for 2024. Rachel Burger, LongevityAdvice, October 2, 2023
(3) 13 Top Biological Age Tests Backed by Science [2023 Review]. Nick Urban, Outliyr, August 9, 2023.
(4) The epigenetics of aging: What the body’s hands of time tell us. National Institute on Aging/ News & Events, March 26, 2021.
(5) Loss of Epigenetic Information Can Drive Aging, Restoration Can Reverse It. Stephanie Dutchen, Harvard Medical School/News & Research, January 12, 2023.
(6) Epigenetics of aging and disease: a brief overview. Pagiatakis, C., Musolino, E., Gornati, R. et al. Aging Clin Exp Res 33, 737–745 (2021). https://doi.org/10.1007/s40520-019-01430-0.
(7) Are telomeres really the key to living longer, youthful lives? Katharine Lang, Medical News Today, May 21, 2023.
(8) Telomere Length and Aging. Johnathan D. Grinstein, MNM/ Aging & Longevity, September 26, 2022.
(9) Scientists unveil new epigenetic clock to gauge a person's biological aging. Christopher Curley, Medical News Today, October 18, 2023.
(10) Turning back time with epigenetic clocks. Liam Drew, Nature 601, S20-S22 (2022). doi: https://doi.org/10.1038/d41586-022-00077-8.
(11) Are Telomeres the Key to Aging and Cancer., University of Utah/Genetic Science Learning Center/Basic Genetics.
(12) Elizabeth Blackburn, Carol Greider, and Jack Szostak shared the 2009 Nobel Prize in Physiology or Medicine for their discovery of how chromosomes are protected by telomeres and the enzyme telomerase. Shinya Yamanaka won the 2012 Nobel Prize in Physiology or Medicine for the discovery that mature cells can be reprogrammed to become pluripotent. Yoshinori Ohsumi won the 2016 Nobel Prize in Physiology or Medicine for his discoveries of mechanisms for autophagy which plays a crucial role in maintaining cellular health and function and declines with age.
(13)  Real age versus biological age: the startups revealing how old we really are. Wilfred Chang,  The Guardian/ Science/ Ageing, June 13, 2022.
(14) What Is My Biological Age? I Took These Tests to Find Out. Dominique Mosbergen, Wall Street Journal/Health, October 23, 2023.
(15) Meet Altos Labs, Silicon Valley’s latest wild bet on living forever. Antonio Regalado, MIT Technology Review/ Biotechnology and Health, September 4, 2021.
(16) Nobel winners in the Scientific Advisory Board of Elysium Health: C. Bertozzi, A. Ciechanover, E. Kandel, M. Karplus, P. Modrich, Sir R. Roberts, T. Südhof and J. Szostak.
(17) Life Biosciences management Team.

Two RSV Vaccines
 
Respiratory syncytial virus (RSV) vaccines became publicly available in the United States in 2023. I was genuinely pleased by this long-awaited medical advance and visited my local pharmacy for vaccination last October. Everything went smoothly—until two weeks later, when I discovered that two different RSV vaccines were available.
The pharmacist had selected one for me without explanation. That raised a simple but important question: Was the right choice made? Out of curiosity, I reviewed information published by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). Here is what patients should know.
 
FDA-Approved RSV Vaccines
 
Two RSV vaccines were approved by the FDA in 2023:

• Arexvy® (GSK) – Approved May 3, 2023
• Abrysvo® (Pfizer) – Approved May 19, 2023

Both vaccines are approved for the prevention of lower respiratory tract disease (LRTD) caused by RSV in adults aged 60 years and older.

Background: What Is RSV Infection?
 
RSV is a common respiratory virus that can infect people of all ages. While most infections cause mild, cold-like symptoms, RSV can lead to severe disease in infants, older adults, and individuals with weakened immune systems.

• Nearly all children experience at least one RSV infection by age two
• Infants younger than six months are at highest risk of severe disease
• Older adults may develop serious complications such as pneumonia or respiratory failure

Common RSV Symptoms

• Runny nose
• Cough
• Wheezing
• Fever
• Shortness of breath

In infants, RSV may also cause:

• Poor feeding
• Lethargy
• Irritability
• Apnea (brief pauses in breathing)

RSV Mortality Risk
Mortality rates vary by age and risk profile:

• Infants under 6 months: ~0.5–1%
• Older adults: ~1–2%

 
How to prevent RSV infection
 
Preventive measures remain important, especially during fall and winter RSV season:

• Frequent handwashing
• Avoiding close contact with sick individuals
• Covering mouth and nose when coughing or sneezing
• Cleaning shared surfaces and children’s toys

Children showing signs of RSV infection should be evaluated promptly by a healthcare provider. The availability of effective vaccines now adds a powerful tool for prevention.
 
Key Differences Between Arexvy and Abrysvo
 
Approved Populations

• Abrysvo (Pfizer)
  • Adults aged 60 and older
  • Pregnant women between 32 and 36 weeks of gestation (to protect newborns)
• Arexvy (GSK)
  • Adults aged 60 and older
  • Not approved for use during pregnancy

In short:

• Older adults may receive either vaccine
• Pregnant women currently have only one option: Abrysvo

 
Ideal Patient Profiles
 
Abrysvo May Be Preferred For:

• Adults aged 60+
• Pregnant women (32–36 weeks)
• Individuals with chronic conditions (e.g., asthma, COPD, heart disease)
• Immunocompromised individuals

Arexvy May Be Preferred For:

• Adults aged 60+
• Individuals with a history of allergic reactions to live attenuated vaccines

These distinctions reflect differences in vaccine technology.
 
RSV Vaccine Manufacturing Technology
 
Arexvy (GSK): Subunit Vaccine
Arexvy is a recombinant subunit vaccine, meaning it contains only a purified RSV protein rather than the whole virus.

• RSV protein produced using recombinant DNA technology
• Manufactured in non-pathogenic expression systems
• Formulated with an adjuvant to enhance immune response
• Cannot cause infection

Abrysvo (Pfizer): Live Attenuated Vaccine
Abrysvo contains a weakened (attenuated) form of RSV.

• Virus is grown in cell culture
• Capable of limited replication to stimulate immunity
• Does not require an adjuvant​​

​Advantages and Disadvantages by Vaccine Type
 
Subunit Vaccines (Arexvy)
Advantages

• Excellent safety profile
• No live virus
• Suitable for many older adults

Limitations

• May require stronger immune stimulation
• Potentially reduced effectiveness in severely immunocompromised individuals

 
Live Attenuated Vaccines (Abrysvo)
Advantages

• Strong and durable immune response
• Often effective with a single dose

Limitations

• Mild infection-like side effects possible
• Caution advised in immunocompromised patients

Cost of RSV Vaccines
 
There is a modest difference in pricing:

• Arexvy (GSK): approximately $200–$295 per dose
• Abrysvo (Pfizer): approximately $180–$270 per dose

Actual out-of-pocket costs vary depending on:

• Pharmacy pricing
• Insurance coverage
• Administration fees (not included in vaccine price)

Patients should contact their insurance provider to confirm coverage.
 
Final Takeaway
 
Both Arexvy and Abrysvo are safe and effective RSV vaccines. The best choice depends on individual factors such as age, pregnancy status, immune health, and medical history.
Patients are encouraged to discuss options with their physician or pharmacist to determine the most appropriate vaccine.

References
CDC source:
(1) Respiratory Syncytial Virus (RSV) Immunizations
 
FDA sources:
(2) Arexvy
(3) Abrysvo
 
Pricing

Uric acid is a metabolic byproduct of purine breakdown. Purines are naturally present in the body and found in foods such as red meat, seafood, and alcohol. Under normal physiological conditions, uric acid dissolves in the bloodstream and is excreted by the kidneys through urine. When uric acid production exceeds elimination, however, it accumulates in the blood, leading to hyperuricemia, a condition associated with multiple adverse health outcomes¹.
 
Uric Acid, Gout, and Kidney Disease
 
Hyperuricemia is a well-established risk factor for gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals in joints. Gout attacks are characterized by intense pain, swelling, redness, and stiffness (1). Elevated uric acid levels can also promote the formation of kidney stones, which may obstruct the urinary tract and lead to severe pain, infection, or long-term kidney damage¹.
 
Beyond Gout: Uric Acid and Metabolic Disease
 
Over the past decade, growing evidence has linked elevated uric acid levels to a broad range of metabolic disorders, including obesity, type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease²–⁵. These conditions share common pathological features such as insulin resistance, chronic low-grade inflammation, oxidative stress, and endothelial dysfunction—key drivers of heart attack, stroke, and chronic kidney disease (2-5).
 
Importantly, uric acid is no longer viewed as a passive bystander. Experimental and clinical studies suggest it may play an active role in the pathogenesis of metabolic disease.
 
Biological Mechanisms Linking Uric Acid to Metabolic Dysfunction
 
Several mechanisms have been proposed to explain how uric acid contributes to metabolic disease (2-5):
 
Inflammation activation
Uric acid can activate the NLRP3 inflammasome, a multiprotein complex that promotes the release of pro-inflammatory cytokines such as interleukin-1β and interleukin-18. These cytokines impair insulin signaling and reduce glucose uptake in muscle and liver tissue (2,3).
 
Oxidative stress and endothelial dysfunction
Elevated uric acid reduces the bioavailability of nitric oxide, a molecule essential for blood vessel dilation and vascular protection. This promotes endothelial dysfunction, raises blood pressure, and accelerates atherosclerotic plaque formation (2,4).
 
Disruption of energy metabolism
Uric acid can inhibit AMP-activated protein kinase (AMPK), a master regulator of cellular energy balance. AMPK inhibition decreases fatty acid oxidation and increases lipogenesis, contributing to hepatic fat accumulation, insulin resistance, and dyslipidemia (2,5).

Activation of the renin–angiotensin–aldosterone system (RAAS)
Uric acid may stimulate RAAS activity, increasing sodium and water reabsorption by the kidneys. This promotes hypertension and edema while simultaneously reducing uric acid excretion—creating a self-reinforcing cycle of hyperuricemia (2,4).
 
Why Isn’t Uric Acid Part of the Comprehensive Metabolic Panel?
 
Given these associations, serum uric acid is widely used as a biomarker in clinical practice—not only for gout, but also as a risk indicator for metabolic disease. Yet, uric acid is not routinely included in the Comprehensive Metabolic Panel (CMP) and is typically ordered only at the discretion of a healthcare provider (6).
 
Arguments commonly cited against its routine inclusion include:

• Cost-effectiveness: Adding uric acid to the CMP may increase testing costs, and the cost–benefit ratio of early detection remains debated.
• Risk of overdiagnosis: Detecting asymptomatic hyperuricemia could lead to unnecessary anxiety or overtreatment.
• Lack of treatment consensus: There is no universal agreement on when or how aggressively to treat elevated uric acid levels in asymptomatic individuals.

 
A Missed Opportunity for Early Prevention?
 
While further research is needed to clarify causality and define optimal uric acid ranges for disease prevention (2-5), an important question remains: How long should we wait for perfect consensus?
For asymptomatic individuals—especially younger patients or those with a family history of metabolic disease—early identification of elevated uric acid could enable low-risk interventions, such as dietary modification, weight management, and lifestyle changes. Delaying measurement until overt disease develops may represent a missed opportunity for prevention.
At present, both patients and clinicians often remain unaware of abnormal uric acid levels simply because the test is not routinely included in standard metabolic screening.
 
Time to Rethink Metabolic Panels
 
Relying solely on provider discretion may not adequately protect asymptomatic patients at risk of future metabolic disease. Government health agencies and professional medical societies should re-evaluate current guidelines and seriously consider including uric acid in metabolic panels, at least for individuals with known risk factors or a family history of metabolic disorders.
Early knowledge empowers prevention—and in the case of uric acid, the evidence increasingly suggests that earlier may be better.