The World Health Organisation (WHO) has welcomed the launch by Gavi, the Vaccine Alliance, of the landmark opportunity for countries to apply for funding to introduce, or further roll-out, the RTS,S/AS01 (RTS,S) malaria vaccine.
International support of nearly $160-million from 2022-2025 will facilitate increased vaccine access to children at high risk of illness and death from malaria, starting with Ghana, Kenya and Malawi, the three African countries that began pilot introduction of the vaccine in 2019, and then expanding to other eligible endemic countries.
Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. In 2020, nearly half a million African children died from malaria – or one child died of malaria every minute.
Since the world’s first malaria vaccine was introduced in 2019, it has been well accepted in African communities after a relatively short period of time. Demand is high even in the context of Covid-19: vaccination performance for the first dose is reaching between 73% to over 90% coverage, depending on the country, with no major disruptions during the pandemic.
To date, about 1,3-million children have benefitted from the vaccine in the three African pilot countries.
“Gavi’s new funding opportunity brings us one step closer to reaching millions more children across Africa with the lifesaving RTS,S malaria vaccine,” says Dr Matshidiso Moeti, WHO regional director for Africa. “Throughout the pandemic, when routine health services faced myriad challenges, parents and caregivers diligently brought their children to clinics and health posts to get the malaria vaccine. They know all too well that lives are being lost to malaria every day and are eager to protect their children from this deadly disease.”
Following WHO’s recommendation in October 2021 for widespread use of the RTS,S malaria vaccine among children in regions with moderate to high Plasmodium falciparum malaria transmission, a number of malaria-endemic countries have expressed interest in adopting the vaccine and are expected to apply for Gavi support to introduce the vaccine.
The RTS,S vaccine works specifically against Plasmodium falciparum, which is the deadliest malaria parasite and the most prevalent on the African continent.
Where the vaccine has been introduced, there has been a substantial drop in children being hospitalized with severe malaria and a drop in child deaths in the age group that is eligible for the vaccine.
Gavi has indicated that the first application deadline in September 2022 is reserved for countries currently piloting the vaccine and for which continuity of the vaccine programme is a priority. A second window open to other eligible malaria-endemic countries will close in January 2023. Countries can already submit expressions of interest during the first funding window for inclusion in this round.
“Malaria has devastated communities for far too long in Africa. We know that initially, supply, will not meet demand, nevertheless, we look forward to working with countries and our partners to introduce and scale this new tool in our fight against malaria, which could save the lives of thousands of children across the continent,” says Thabani Maphosa, MD of country programmes at Gavi. “Gavi is proud to support this vaccine, and we hope this is just the beginning of a broader rollout that will see populations across the continent increasingly protected against this deadly disease.”
Like with many new vaccines, the supply of the malaria vaccine is limited as vaccine production ramps up.
“The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control. It is projected that – at scale – using this vaccine could save tens of thousands of young lives each year, but we will need an increased supply of the vaccine so Africa can reap the benefits of this additional tool for malaria prevention,” says Professor Rose Leke, a malaria disease expert from the University of Yaounde in Cameroon, and co-chair of the expert group that advised WHO on a framework to allocate the currently limited malaria vaccine supply.
Over the next few years, the supply of the RTS,S malaria vaccine will be insufficient to meet the needs of over 25 million children born each year in areas where the vaccine is recommended, according to a WHO-commissioned global market study. Should a second malaria vaccine complete clinical development successfully and be approved for use, the period of constrained supply could be shorter. The demand is estimated to range from 80-million to 100-million doses annually.
In response to the supply situation, WHO has developed, with expert advice, a framework to guide vaccine allocation decisions at global and country levels that ensures children at highest risk across endemic countries are prioritised to receive the vaccine. The framework also aims to ensure that childhood vaccination services started in the three pilot countries continue without disruption, until supply fully meets demand.
“Now is the time for African countries and communities to call out their interest – to donors, health leaders and manufacturers – in early access to this vaccine. Lives are at stake, every day,” adds Dr Moeti. “This situation underlines once again why expanded local production of vaccines is essential for meeting health needs in Africa. We’ve seen encouraging first steps in that direction in recent months, and we are committed to supporting further efforts to expand vaccine production in Africa.”
WHO, Gavi and partners are working to accelerate RTS,S supply by exploring approaches to increase manufacturing capacity, market-shaping and facilitating the development of other first-generation and next-generation malaria vaccines.