Funding opens to expand roll-out of the first-ever malaria vaccine

In 2019, the world’s first malaria vaccine was introduced, and in the past few years, it has been in high demand. The World Health Organisation (WHO) reports that even in the context of COVID-19 the vaccination’s performance (for the first dose) has reached between 73% to over 90% coverage, depending on the country, with no major disruptions despite the pandemic. This has resulted in the immunisation of approximately 1.3 million children in the pilot countries i.e., Ghana, Kenya & Malawi.

Because malaria remains a primary cause of childhood illness and death in sub-Saharan Africa, killing 1 child every minute, the WHO recommended wider routine use of the RTS,S/AS01 malaria vaccine. Although funding has dipped from other organisations, in December 2021 Gavi, the Vaccine Alliance, approved an initial investment of US$ 155.7 million for the 2022–2025 period. They also received additional support through a US$ 56 million investment through a “de-risk” agreement with manufacturer GlaxoSmithKline (GSK) and innovative financing partner MedAccess.

Ghana, Kenya and Malawi were invited to apply by the 13th of September. Other countries with moderate to high transmission of Plasmodium falciparum malaria can submit expressions of interest in advance of the second window at the end of 2022.

Plasmodium falciparum is transmitted through the bite of a female Anopheles mosquito.

Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance said: “The work towards a malaria vaccine has been long and hard… This new tool will allow us to save more lives in countries hit hardest by this killer disease.”

WHO details that, the RTS,S vaccine works specifically against Plasmodium falciparum, which is the most prevalent and deadliest malaria parasite on the continent. The introduction of the vaccine in the test areas has yielded a substantial drop in malaria-related hospitalisation and child deaths in the eligible age group.

“Gavi’s new funding opportunity brings us one step closer to reaching millions more children across Africa with the lifesaving RTS,S malaria vaccine,” said 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.”

Despite these efforts, there will likely be an insufficient supply of the vaccine. In anticipation of this challenge WHO has developed a framework to guide vaccine allocation decisions at global and country levels. The framework will ensure high-risk children across endemic countries are prioritised and that the implemented childhood vaccination services continue without disruption until supply fully meets demand.

“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,” explained Dr. Moeti.

Funding drops and efficacy concerns

On the other hand, the Bill and Melinda Gates Foundation, arguably the vaccine’s biggest backer, will not be financially supporting the vaccine moving forward. Philip Welkhoff, the Gates Foundation’s director of malaria programmes, told the Associated Press (AP) that it has “a much lower efficacy than we would like.” This is in reference to the approximately 30 percent effectiveness of the vaccine and the requirement for four doses to achieve it.

On the front line against malaria: Army medical researchers in Kenya mark World Malaria Day 2010
Photo by Rick Scavetta, U.S. Army Africa Public Affairs/ Flickr

He explained that after spending more than $200m and several decades getting the vaccine to market, the shot is relatively expensive and logistically challenging to deliver.

“If we’re trying to save as many lives with our existing funding, that cost-effectiveness matters,” he said.

They also noted the supply barriers i.e., for the 25 million children born each year WHO estimates at least 100 million doses would be needed annually but GSK says it can only produce about 15 million doses per year until 2028.

“All the money in the world” would not alleviate the vaccine’s short-term supply constraints, said Welkhoff, however, he added, “We’re supporting the roll-out via the Gavi funding, but we decided we would not dedicate additional direct funding to extend the supply of the vaccine.”

There are fears that the Foundation’s decision could detour other donors and partners from supporting the vaccine or disincentivise those working on alternative versions. But for now, the vaccine, even with its limitations, is helping save lives that would be lost as researchers and funders spend valuable time striving for perfection.

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