On the 6th of October, the World Health Organisation (WHO) announced its approval to use a malaria vaccine, known as RTS,S, or Mosquirix, in children in areas where malaria infection rates are moderate or high, predominantly in sub-Saharan Africa. Malaria remains a persistent threat to global health; the World Economic Forum (WEF) reports that a total of 386,000 people died of malaria in Africa in 2019, of which 274,000 were children under the age of five. The decision to approve “widespread use” of RTS,S in children by the WHO follows thanks to the outcomes of a pilot programme carried out in Ghana, Kenya and Malawi, where over 800,000 children have already been vaccinated.

The pilot study, launched in 2019, demonstrated the strengths of introducing vaccination in children; executing vaccination programmes was attainable and increased the reach of malaria prevention strategies. The WHO reports that more than two-thirds of children who do not have access to insecticide-treated bed nets could benefit from the vaccine in the pilot. The vaccine was also shown to be cost-effective and to have a strong safety profile.

In terms of protection against disease, the BBC reports that the vaccine efficacy is 40% for preventing all malaria cases and 30% for severe cases. While this is a relatively low protection rate, Pedro Alonso, Director of the WHO’s Global Malaria Programme, highlights how even moderate protection can play an essential role in saving many lives given the widespread nature of the disease. Speaking to the BBC, he said, “This is a moderately efficacious vaccine…but saving, preserving, avoiding 30-40% of cases and deaths can bring a major benefit to the population.” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said in a statement, “This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control. Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Managing malaria has proven a challenge, and despite significant research efforts, vaccines with higher efficacy have, so far, not been successfully developed. The scientific journal Nature indicates that both the lower availability of funding for research into malaria treatments given its presence mainly in lower-income countries and the characteristics of the malaria-causing parasite Plasmodium that have historically made it challenging to develop more effective therapies. The creation of vaccinations and their use in combination with methods such as nets is essential over-reliance on anti-malarial drugs, given that the parasite has consistently developed resistance to anti-malarial drugs that are in use.

One vaccine has recently shown promise, as reported by Nature News. A modified version of the RTS,S vaccine, called R21 has undergone initial clinical trials in humans that reported up to 77% efficacy of preventing malaria over a one year period, compared to RTS,S which is 56% effective over a one year period with effectiveness dropping to 36% over four years. Further trialling will be needed to confirm these initial findings, but they are nevertheless promising in an area in great need of effective prevention.