A jab at malaria – WHO, GAVI and UNICEF announce mass vaccine distribution plans

On July 5th, WHO, GAVI and UNICEF announced that 18 million first doses of the malaria vaccine RTS,S/AS01 will be made available to 12 countries in Africa between 2023 and 2025. This is a massive boost in the fight against malaria and in the effort to improve child health. 

Almost half the world’s population is at risk from malaria each year, and in 2021 malaria was responsible for over 600,000 deaths, making it one of the most deadly diseases we face. Most cases of malaria (95%) and fatalities (96%) are seen in sub-Saharan Africa. In 2021, half a million children under 5 in Africa were killed by malaria.

From an economic perspective, malaria is a drain on public health resources (around 40% of public health expenditure of endemic countries goes towards fighting malaria) and endemic regions have a 70% lower ‘per capita’ income, effectively pushing populations even further towards poverty. The eradication of malaria is therefore key in helping to improve the socioeconomic future of many malaria-endemic countries.

RTS,S/AS01 is a vaccine targeting  Plasmodium falciparum (the deadliest of the five malaria parasites that infect humans) and was developed in collaboration with Glaxo Smithkline and PATH Malaria Vaccine Initiative (with funding support from the Gates Foundation). It went into Phase III trials in 2012, and a pilot to provide vaccines to children in Ghana, Kenya and Malawi began in 2019. In the last four years, 4.5 million doses of the vaccine were administered and of these 1.5 million were given to children. Therefore 18 million doses in the next few years is a significant step up.

Ghana, Kenya and Malawi will be given 6.9 million of the 18 million promised vaccine doses to continue their vaccination programmes. 10.535 million doses will be allocated between Benin, Burkina Faso, Burundi, Cameroon, the Democratic Republic of the Congo, Liberia, Sierra Leone and Uganda, and Niger will be given 565k doses (as it will be given a partial supply). These countries will receive the vaccine doses in Q3 of 2023 and implementation is expected to begin in early 2024.

The vaccine has been shown to reduce deadly severe malaria cases by 30%, and bring about a 40% reduction in malaria episodes. The vaccine can and should be used in conjunction with other malaria control measures, such as Insecticide-treated Nets(ITNs). Contrary to the increasing cynicism towards vaccination seen in general across the world, there is a high demand for the vaccine in malaria-endemic countries which is promising in terms of making this vaccine roll out effective. Vaccines will be offered to people and countries following a framework based on priority

Looking beyond the 18 million doses announced this week, it is estimated that in 2026 the global demand for the vaccine would be approximately 40-60 million doses, and by 2030 this figure is estimated to grow to 80 -100 million. This of course requires a step in vaccine production. In the near future, there is a second vaccine R21/Matrix-M that may get pre-approval from the WHO soon, which could help further in reducing the malaria burden in Africa and globally.

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