On 6 October 2021, the World Health Organisation (WHO) recommended the widespread use of the world’s first malaria vaccine. They approved its use in areas with moderate to high malaria transmission, such as sub-Saharan Africa. This recommendation is based on encouraging results from a pilot program running in three African countries — Ghana, Kenya and Malawi. Since 2016, it has reached over 800,000 children.
Overall, malaria kills an estimated 500,000 people every year, mostly in sub-Saharan Africa. The new malaria vaccine, called RTS,S, increases children’s immunity to Plasmodium falciparum, the most deadly malaria and the most prevalent in Africa. To date, 2.3 million doses of the vaccine have been administered with promising results, indicating that the vaccine is safe for use. It is also moderately effective, as it has been proven to prevent 40 per cent of malaria cases and 30 per cent of severe cases in clinical trials. While ongoing research for a more effective vaccine is necessary and desirable, with hundreds of millions of cases worldwide, this vaccine still represents a significant step forward. It also capitalises on existing infrastructure designed to deliver immunisations even in remote areas, making distribution feasible.
The RTS,S vaccine is the first vaccine that is effective against a human parasite. Indeed, this development marks a historic breakthrough in searching for a malaria vaccine, which has been in progress for a hundred years. According to a study released in 2020, the vaccine could prevent 5.4 million cases and 23,000 deaths in children younger than five each year if it was made accessible in countries with the highest malaria rates.
“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”
This vaccine is a major scientific development, and its rollout and further research in this field are essential. However, to ensure that the vaccine is accessible to vulnerable populations, Gavi, the global vaccine alliance, needs to invest in it. This poses a significant challenge given the demographic that this disease affects and the timing of the vaccine’s discovery.
Malaria is rare in developed countries. For example, Australia records 700-800 cases per year, with the disease no longer being endemic. This indicates that malaria and poverty are linked, with assumptions that preventative measures and existing combination therapy medications are affordable and feasible for developing countries leading to an underfunding of research into cures.
This vaccine has also been developed at a time when the world is facing strong competing priorities given the ongoing COVID-19 crisis. According to Deepali Patel, who leads malaria vaccine programs at Gavi, “COVID is a big unknown in the room in terms of where capacity is currently in countries, and rolling out COVID-19 vaccines is a huge effort. We’re really going to have to see how the pandemic unfolds next year in terms of when countries will be ready to pick up all of these other priorities.”
Overall, this vaccine should be incorporated into a holistic strategy to combat malaria transmission, like bednets, education, and insecticides to save lives and alleviate human suffering. However, to ensure investment in prevention, treatment and cures, it is necessary to use transnational advocacy networks to reframe malaria as a high priority and prevent a resurgence in cases. This endeavour has great potential in the current global environment, as COVID-19 has thrust health security to the forefront of the global consciousness.