Malaria Vaccine Rollout by WHO and Gavi to Proceed Despite Limited Efficacy
A healthcare worker gives a child a dose of the malaria vaccine, RTS,S.

“It’s better to reduce the number of children affected than not to do anything at all”

The World Health Organization (WHO) and Gavi, the Vaccine Alliance are planning to go ahead with the mass rollout of the RTS,S/AS01 (RTS,S) malaria vaccine, starting with three countries in Africa — Ghana, Kenya and Malawi — despite the Bill and Melinda Gates Foundation’s withdrawal of more direct support for increased malaria vaccinations because its efficacy was limited.

In a June interview with Health Policy Watch, Philip Welkhoff, who directs the foundation’s malaria program, said the foundation preferred to invest in classical malaria control measures, like bednets, rather than the vaccine.

According to WHO, however, researchers observed a 30% reduction in severe malaria infections, a 21% reduction in hospitalizations, and a 10% reduction in mortality, in the areas of Ghana, Kenya and Malawi where the vaccine recently was piloted on some 800,000 infants and children aged 5–17 months  And those reductions are significant. 

In October 2021, the vaccine was approved by WHO in a historic first, shortly after the results of the three-country pilot were reported.  

Thabani Maphosa, managing director of country programmes at Gavi, the Vaccine Alliance

Thabani Maphosa, managing director of country programmes at Gavi, told a WHO press briefing on Thursday the malaria vaccine’s ability to protect some children justifies the investment in its rollout even though there are debates regarding the degree of its benefits.

“It is better to be protected and to reduce the number of children that are affected than not to do anything at all,” he said.

Maphosa said Gavi and WHO would make US$ 160 million in funds available to support the wider rollout of the vaccine between this year and 2025, first targeting children in the three African nations that began piloting the vaccine three years ago. He said the rollout would then expand to other eligible endemic countries.

 The two organizations also are working with others to improve the vaccine supply, since that is the real problem, not the funding.

A ‘Lifesaving’ Vaccine

Dr Matshidiso Moeti, WHO’s Regional Director for Africa, described the vaccine as “lifesaving.” Rose Leke, a malaria disease expert and professor at Cameroon’s University of Yaounde, said the vaccine is needed now more than ever.

After recent decades of progress, we now see that malaria is getting worse in many places, and this threatens our well being and future potential. And, really, this is unacceptable,” Leke, a co-chair of the expert group that advised WHO on a framework to allocate the currently limited malaria vaccine supply, told the press briefing. She described the vaccine as an opportunity to strengthen malaria control.

Rose Leke, a malaria disease expert and professor at Cameroon’s University of Yaounde

Welkhoff said during the June 2021 interview that the foundation would not prioritize the rollout of the malaria vaccine in its 2022 call to countries for proposals to fund malaria control projects.

Instead, he said, the foundation’s US$140 million contribution will go to country projects that prioritize traditional infection control measures, such as mosquito nets, access to antimalarial drugs, and improvements in diagnostics and health systems. The malaria vaccines’s limited effectiveness highlights a gap that still needs to be filled by researchers, according to Welkhoff.

“It is a remarkable technical accomplishment but is only partially effective and the effect goes away after a period of time,” he said.

Moet, on the other hand, noted that in the pilot countries where more than 1.3 million children have been vaccinated, there has been an almost 30% drop in hospitalizations of children with severe malaria. 

“They’ve also seen, after two years in areas where the vaccine was piloted, an almost 10% reduction in child deaths in the age group that is eligible for the vaccine,” she said.

Welkhoff, however, told Health Policy Watch the foundation wants to prioritize new measures like research and development and mass introduction of new generation drugs and insecticide treated nets (ITNs) that can beat fast-developing mosquito and parasite resistance to the drugs and chemicals currently in use.

“We want to start introducing and scaling up these [new] nets,” he said.  “We are [also] starting to see the beginnings of drug resistance in parts of Africa to the Artemisinin combination therapies (ACTs). So this is going to need funding, to make sure that we don’t lose these drugs that each year save so many lives.”

Image Credits: WHO/M. Nieuwenhof.

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