RTS,S is the first vaccine recommended for use to prevent malaria in children. The malaria vaccine is safe and effective and provides substantial public health impact. If implemented broadly, the vaccine could save tens of thousands of lives each year.
- Pilot introductions of the malaria vaccine through national immunization programmes in Ghana, Kenya and Malawi have resulted in substantial reduction in deadly severe malaria – a drop in child hospitalizations and reduction in child deaths.
- The vaccine is estimated to save 1 life for every 200 children vaccinated.
- A large phase 3 trial (2009-2014) showed that malaria cases dropped by over half in the first year after vaccination and a 40% reduction in malaria episodes after 4 years of follow up.
- A more recent trial (2017-2020) of the vaccine provided just prior to the peak (rainy) malaria season in areas with highly seasonal malaria found malaria vaccine efficacy similar to efficacy of Seasonal Malaria Chemoprevention (SMC), shown to prevent around 75% of malaria cases.
- This malaria vaccine is needed now more than ever: in 2021, nearly half a million African children died from malaria – or 1 child died of malaria every minute.
- By using a tailored mix of WHO-recommended malaria control interventions – including the malaria vaccine – countries can achieve optimal impact in reducing malaria illness and deaths among children living in areas of moderate to high malaria transmission.
Message 2: (reach and benefits of the ongoing pilots)
More than 1.2 million children have been reached with at least one dose of vaccine through the ongoing pilot introductions. More than three years on, the pilots continue to benefit children at risk and demonstrate the strong community acceptance of the vaccine and how the vaccine increases access to malaria prevention.
- The pilot introductions have shown that the vaccine is well accepted in African communities and demand for the malaria vaccine is high, even when additional visits to vaccination clinics are required.
- The vaccine increases access to malaria prevention: the vaccine reaches about 80% of children through the established immunization platform and, because of this high uptake, is reaching children who are not using other forms of prevention such as insecticide-treated nets.
Furthermore, the introduction of the malaria vaccine did not result in a decline in the use of other malaria interventions, including insecticide-treated nets.
- The pilots will continue through 2023 to help us understand the added value of the 4th vaccine dose, and to measure the impact of vaccine introduction on lives saved.
- The WHO-coordinated pilot programme is made possible by an unprecedented collaboration between in-country and international partners – the Ministries of Health of Ghana, Kenya and Malawi; in-country evaluation partners; PATH, GSK, UNICEF and others; and the funding bodies of Gavi, the Global Fund and Unitaid.
Message 3 (high demand, increasing supply to optimize impact )
There is unprecedented demand for the malaria vaccine, and soon many more children will benefit from the protection. However there is considerable work to do to increase supply so Africa can reap the benefits of this new malaria prevention tool.
- All 3 pilot countries will continue and expand malaria vaccination for the longer-term.
Malawi launched expansion of malaria vaccine delivery in areas of the pilots that have not yet received the vaccine (November 2022), and Ghana and Kenya will expand delivery in these areas in the coming weeks.
- A total of 28 countries in Africa plan to apply for Gavi funding support to rollout the malaria vaccine as part of their national malaria control strategies (and 13 countries applied for Gavi funding in the January 2023 round). Phased introduction in additional countries will begin as early as late 2023.
- Supply, although limited in the short term, has been secured for wider malaria vaccine use. The initially limited supply will be allocated to children living in areas of highest need across endemic countries, with phased expansion to other areas as supply increases.
WHO and partners Gavi, UNICEF and PATH and others continue to work to increase vaccine supply and reduce costs as rapidly as possible.
A second malaria vaccine may be coming forward which, if approved, could increase supply and access – WHO looks forward to reviewing data from the ongoing phase 3 trial on R21/Matrix-M (R21) vaccine to understand the vaccine’s safety and efficacy in different malaria transmission settings (seasonal and year-round).
Reactive Q and A
- What about the RTS,S vaccine’s level of efficacy? Is this too low?
The first malaria vaccine, RTS,S, is having high impact in routine use. Pilot introductions reaching more than 1.2 million children have resulted in substantial reduction in deadly severe malaria – a drop in child hospitalizations and reduction in child deaths. A large phase 3 trial conducted between 2009 and 2014 showed that malaria cases dropped by over half in the first year after vaccination and a 40% reduction in malaria episodes after 4 years of follow up. If the vaccine is introduced broadly across Africa, this level of efficacy will translate to millions of malaria cases prevented and tens of thousands of children’s lives saved.
We need this vaccine now more than ever: more than half a million children die of malaria each year in the Africa region. This additional malaria prevention delivered on the existing immunization platform (which reaches about 80% of children in malaria-endemic countries) can substantially reduce severe malaria illness and save lives, resulting in more children growing up healthier, and more families remaining intact.
2. What about affordability of the vaccine compared to other less expensive malaria control interventions?
The current vaccine price (about $10/dose for the next 3 years) is an initial price that is expected to drop as supply of the vaccine increases. Increasing supply and reducing vaccine price are priorities for WHO, Gavi and partners.
More immediately, Gavi has approved (December 2022) an exceptional time-limited approach for malaria vaccine co-financing to facilitate affordability and support uptake. Many of the malaria-endemic countries pay $.020/dose but not all. Specifics of the revised policy differ depending on the country’s co-financing grouping by Gavi; however, affordability of the vaccine increases for all Gavi-eligible countries. (see Gavi for more specifics).
It is important to note that the current vaccine price is within the range that is estimated to be cost-effective for use in areas of moderate to high malaria transmission.