On Wednesday, the World Health Organisation (WHO) recommended the widespread use of the only approved vaccine against malaria, and said it should be widely given to African children.
Malaria kills more than 400,000 people a year, most of them under the age of five.
The RTS,S malaria vaccine – or Mosquirix – has been developed by British pharmaceutical giant GSK, and its roll-out marks a major advance against a disease that evades the immune system.
Children in sub-Saharan Africa and in other regions with moderate to high levels of malaria transmission are to receive the vaccine.
How deadly is malaria?
Malaria is a preventable disease caused by parasites transmitted to people by the bites of infected mosquitoes. Symptoms include fever, vomiting and fatigue.
It killed 386,000 Africans in 2019, according to a WHO estimate, compared with 212,000 confirmed deaths from Covid-19 in the past 18 months.
WHO says 94% of malaria cases and deaths occur in Africa, a continent of 1.3 billion people.
What has been happening?
Since 2019, 2.3 million doses of Mosquirix have been administered to infants in Ghana, Kenya and Malawi in a large-scale pilot programme coordinated by the WHO. The majority of those whom the disease kills are aged under five.
That programme followed a decade of clinical trials in seven African countries.
So far, Mosquirix is the only approved vaccine. The European Union’s drugs regulator gave it the go-ahead in 2015, saying its benefits outweighed the risks
How does it work?
The jab requires four doses to be given to children aged five months and older.
The vaccine’s effectiveness at preventing severe cases of malaria in children is only around 30%. But health experts say that used in combination with other preventative measures – including bed nets and spraying – the vaccine could save “millions” of lives.
GSK said that when the jab is given in combination with seasonal administration of antimalarial drugs, the vaccine “lowers clinical episodes of malaria, hospital admissions with severe malaria, and deaths by around 70%”.
Another vaccine against malaria, developed by scientists at the University of Oxford and called R21/Matrix-M, showed up to 77% efficacy in a year-long study involving 450 children in Burkina Faso, researchers said in April, but it is still in the trial stages.
Experts said the challenge now would be mobilising financing for production and distribution of the vaccine to some of the world’s poorest countries.
GSK has to date committed to produce 15 million doses of Mosquirix annually, in addition to the 10 million doses donated to the WHO pilot programmes, up to 2028 at no more than 5% above the cost of production.
A study led by the WHO this year projected demand for a malaria vaccine would be 50 to 110 million doses per year by 2030 if it is deployed in areas with moderate to high transmission of the disease.
The Gavi vaccine alliance, a global public-private partnership, will consider in December whether and how to finance the vaccination programme.
What are people saying?
WHO director-general Tedros Adhanom Ghebreyesus:
“This is a vaccine developed in Africa by African scientists and we’re very proud.
“Using this vaccine in addition to existing tools to prevent malaria could save tens of thousands of young lives each year.”
Ashley Birkett, who leads global malaria vaccine work at Path, a non-profit global health organisation that has funded the development of the vaccine with GSK and the three-country pilot:
“This is how we fight malaria, layering imperfect tools on top of each other.”
Thomas Breuer, chief global health officer of GSK:
“This long-awaited landmark decision can reinvigorate the fight against malaria in the region at a time when progress on malaria control has stalled.”
Gavi chief executive Dr Seth Berkley:
“Today marks a historic achievement in our fight against malaria.
“The vaccine is an important additional tool to help control this disease alongside other interventions, such as bed nets, and especially when delivered seasonally in combination with antimalarial medication.”
Professor Sir Brian Greenwood, from the London School of Hygiene and Tropical Medicine, who has played a pivotal role in malaria vaccination trials and research since the inception of the jab:
“With malaria still a major cause of death, especially among children in Africa, this decision has the potential to save millions of young lives.
“The RTS,S vaccine does not provide complete protection, but this decision is testament to the global health community’s drive and vision to find a way forward.”
Dr. Rose Jalong’o, a vaccinology specialist at the Kenyan health ministry:
“I suffered from malaria as a child and during my internship, and during my clinical years I attended to children in hospital because of severe malaria who needed blood transfusion and unfortunately some of them died.
“It’s a disease I have grown up with and, seeing all this in my lifetime, it’s an exciting time.”