A joint news release from WHO, UNICEF, and Gavi in November 2023 states that shipments of the first WHO-recommended malaria vaccine arrived in Cameroon with more to arrive on the continent over the coming weeks. RTS,S was recommended by WHO for the prevention of malaria in children in October 2021 and has had a “substantial impact” since implementation in pilot countries. The burden of malaria is highest on the African continent, with approximately 95% of global malaria cases and 96% of related deaths in 2021.
“Nearly every minute, a child under five dies of malaria.”
Alongside the RTS,S vaccine, a second vaccine (R21) is currently under review by WHO for prequalification. Having two malaria vaccines is intended to increase supply in response to the high demand from Africa. The three organisations emphasise that they are working with countries that have expressed interest or confirmed plans to prepare the next steps.
Despite the hope that a broad implementation of vaccination in endemic regions “has the potential to be a gamechanger” for control efforts, the statement highlights that “malaria vaccines are not a standalone solution” and should be introduced in the context of the WHO-recommend package of control measures.
RTS,S shipments begin
The shipment to Cameroon contained 331,200 doses of the RTS,S vaccine, which landed in Yaoundé. This is the first delivery to a country that was not already involved in the malaria vaccine pilot programme, which the statement suggests “signals that scale-up of vaccination” across the “highest-risk areas” of the continent will begin “shortly”.
Over the next few weeks an additional 1.7 million doses will arrive in Burkina Faso, Liberia, Niger, and Sierra Leone. Further countries are expected to receive doses in the coming months.
“This reflects the fact that several countries are now in the final stage of preparations for malaria vaccine introduction into routine immunisation programmes, which should see first doses administered in Q1 2024.”
Incorporating the vaccine into programmes
The joint statement acknowledges that “comprehensive preparations” are needed to introduce any new vaccine into essential immunisation programmes. This includes training of health workers and investment in infrastructure. For the malaria vaccine there is an “added challenge” of a four-dose schedule, which requires “careful planning” for implementation.
MVIP
Since 2019, Ghana, Kenya, and Malawi have been administering the vaccine in a four-dose schedule from around 5 months of age in selected districts. This is part of the pilot programme, the Malaria Vaccine Implementation Programme (MVIP). This programme has enabled the malaria vaccine to reach more than 2 million children in three countries with the effect of a “remarkable 13% drop” in all-cause mortality in children age-eligible for the vaccine.
MVIP is coordinated by WHO, in collaboration with UNICEF and other partners; it is funded by Gavi, the Global Fund, and UNITAID, using doses donated by GSK. Data from the pilot have demonstrated that the vaccine is safe and provide “important evidence” on acceptability and uptake to inform the latest WHO recommendation of the R21 vaccine.
Good news: a gamechanger
David Marlow, Gavi’s CEO, is “proud” that the stakeholders took the decision invest in the vaccine.
“The world needs good news – and this is a good news story.”
Marlow is “excited” to roll out the “historic vaccine” through Gavi’s programmes and to collaborate with partners to ensure it is delivered “alongside other vital measures”. UNICEF’s Executive Director Catherine Russell commented that “introducing vaccines is like adding a star player to the pitch”.
“This could be a real gamechanger in our fight against malaria.”
The “long-anticipated step”, which has been “spearheaded by African leaders”, brings about a “new era” of immunisation and malaria control. Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General, is also excited by this “breakthrough moment” for malaria control, which he describes as a “ray of light in a dark time for so many vulnerable children”.
“But we must not stop here. Together, we must find the will and the resources to bring malaria vaccines to scale, so more children can live longer, healthier lives.”
Dr Matshidiso Moeti, WHO Regional Director for Africa, agreed that this is a “significant advancement” for vaccination in the region.
“The vaccine, which protects children from the severe forms of the disease, is a vital addition to the existing set of malaria prevention tools and will help bolster our efforts to reduce the rising trend in cases.”
A malaria milestone
Dr Robert Lucien Jean-Claude Kargougou is Burkina Faso’s Minister of Health and Public Hygiene. He looks forward to the arrival of the vaccine in the country as a “historic milestone”.
“Malaria is in fact the primary cause for consultations, hospitalisation, and death in our health facilities. Children under 5 pay the heaviest price.”
However, he is hopeful that the introduction of the vaccine into routine immunisation will “reduce the burden” of disease and “save many lives”. Hon Dr Malachie Manaouda, Minister of Public Health of Cameroon, is “committed” to ensuring that the vaccine reaches eligible children, encouraging “all parents” to take advantage of the “life-saving intervention”.
“As we vaccinate children, the government also remains committed to strengthening other prevention and control measures so that we can lower the huge burden of malaria.”
Minister of Health for Liberia, Hon Dr Wilhemina Jallah, is also “committed” to making sure the vaccine reaches “those who need it most”.
“This vaccine has the potential to save many lives and reduce the burden of this disease on our population.”
Executive Director of the Global Fund, Peter Sands, welcomed the news.
“Using this vaccine, appropriately prioritised in the context of existing tools, could help prevent malaria and save tens of thousands of young lives each year.”
Nikolaj Gilbert, President and CEO of PATH, is “thrilled” that the vaccine has arrived in Cameroon and will “soon reach even more children at risk of malaria”.
“All of us at PATH appreciate the efforts by Gavi, UNICEF, and WHO to accelerate access to this life-saving vaccine.”
Dr David Walton, US Global Malaria Coordinator, congratulated the Gavi Secretariat and African Ministries of Health on behalf of the US President’s Malaria Initiative.
‘This moment has been decades in the making and the US has supported malaria vaccine development for decades…we will enthusiastically continue our partnerships with Ministries of Health and national, regional, and global partners to achieve a world in which no child dies from a mosquito bite.”
These malaria vaccines have the potential to transform malaria control in Africa, but what does the future hold for malaria vaccine development? To learn more about this, join us in Santa Clara next week for a session on “next generation malaria VLP vaccines that target vulnerable epitopes” from Professor Bryce Chackerian. If you can’t make it, why not subscribe to our weekly newsletter here?
