As the Kigali Summit unfolds, Adrian Hill, director of Oxford University’s Jenner Institute, describes the great strides made in malaria control, and the contribution new malaria vaccines can make, including one designed at the Jenner Institute. He spoke to Health Policy Watch just ahead of this week’s meeting by heads of Commonwealth nations, which galvanized support for the fight against malaria and neglected tropical diseases.

Leaders of Commonwealth nations meeting in Rwanda’s capital have pledged more than US$4 billion towards global efforts to accelerate the fight against malaria and other neglected tropical diseases.

The heads of state also committed to redouble efforts on climate change and the COVID-19 pandemic, which continue to affect the lives of the 2.5 billion people in the 54 nations belonging to the Commonwealth association of one-time territories of the British Empire.

Thursday’s Summit on Malaria and NTDs, taking place on the sidelines of the broader Commonwealth meeting, also saw the signing the Kigali Declaration on neglected tropical diseases (NTDs), a political statement meant to galvanize support for some of the UN’s top health goals by 2030.

“Only through continued country ownership, political commitment, accountability and great partnership can we ensure progress is accelerated over the coming months,” the leaders concluded in their outcome statement.

Forty nations were certified malaria-free between 1955 and 2021, the World Health Organization (WHO) says. And while global efforts to fight malaria prevented an estimated 10.6 million deaths and 1.7 billion cases from 2000 to 2020, the disease still resulted in as many as 627,000 deaths and 241 million cases in 2020.

Ahead of the summit hosted by Rwanda’s President Paul Kagame, Health Policy Watch interviewed Adrian Hill, a professor of vaccinology and director of Oxford University’s Jenner Institute, which works on designing and developing vaccines for infectious diseases prevalent in developing countries. His answers have been edited for brevity and clarity.

Health Policy Watch: How will the Kigali Summit boost malaria control?

Adrian Hill:This key meeting could not have come at a better time for boosting the state of malaria control in Africa. The power of vaccines has been demonstrated strikingly by the response to the COVID-19 pandemic ─ well-illustrated by the Oxford-AstraZeneca-Serum Institute vaccine. And now vaccines for malaria that could have a huge impact on malaria control and save hundreds of thousands of lives a year will be available from next year. The challenge for the summit is to ensure that more lives are not lost because the world has failed to support the purchase and distribution of new malaria vaccines.

HPW: Why is it important to focus on the development of a malaria vaccine?

AH. Malaria is the biggest infectious killer of children from six months to five years of age in Africa. There are over 620,000 deaths from malaria a year, according to the latest WHO figures and this has been increasing. New interventions are crucial to reduce this unacceptable death rate and now malaria vaccination is at hand for the first time.

HPW: What progress is being made to develop an effective, affordable and accessible malaria vaccine?

AH: There are two malaria vaccines that are close to licensure and should be available for use next year (2023). The older one is RTS,S/AS01, from GSK, that will be available at a scale of maybe 9-10 million doses. The other is the newer R21/MM that will be available, also next year, and was designed and developed by Oxford University with the Serum Institute of India. Importantly, this can be provided next year at a scale of 200 million doses a year, enough to vaccinate the 40 million children born each year in areas of Africa with high transmission of malaria and a high risk of death.

HPW: What progress has been made in the fight against malaria and NTDs in the last two decades?

AH: In 2000, there were about 1 million deaths each year globally from malaria. But with the improved use of bed nets, insecticides and chemoprevention drugs, deaths fell to about 500,000 people by 2015. Death rates are rising again, however, as these older types of interventions appear to be losing effectiveness. Fortunately, new malaria vaccines are becoming available from 2023 and one of these vaccines (R21/MM) appears more effective than any of these older interventions. However, the best approach will be to use all these interventions in parallel.

HPW: Why is it important to scale up tools to eliminate malaria?

AH: The cost of malaria controls each year is now about US$3 billion. Adding the R21 vaccine will add about half a billion dollars to this cost, but this should be very cost effective. Importantly, adding new vaccines to other interventions should allow malaria to be eliminated in some countries very soon and eventually eradicated globally. Elimination and then eradication of malaria will reduce and then remove the costs of malaria control.

HPW: Why has it been so difficult to come up with a malaria vaccine?

AH: The RTS,S vaccine has not received regulatory approval as yet. It is just a WHO policy recommendation, but this should happen soon. And importantly, R21/MM should provide about 10-20-fold more doses and a less expensive vaccine. These two vaccines have emerged from over 140 candidates tested in clinical trials as the most effective to date. This reflects the great technical difficulty of making a vaccine against protozoan parasites, like malaria, which have thousands of genes, suppress natural immunity, and require exceptionally potent vaccines to provide protective efficacy. There are no licensed vaccines today against any parasite disease.

HPW: What about the successful malaria vaccine trial with which you have been involved?

AH: The WHO has specified that a malaria vaccine should aim to show high efficacy of at least 75% over two years of follow-up. R21/MM, designed at Oxford University’ s Jenner Institute as part of a 30-year programme of vaccine research, is the only vaccine to demonstrate that level of efficacy in African children, the most important population to protect and the most vulnerable to malaria disease and death.

Image Credits: US Centers for Disease Control and Prevention, World Health Organization .