New lifesaving malaria vaccines need to be available now

From the article:

Right now, enough material to make 20 million doses of a lifesaving malaria vaccine is sitting on a shelf in India, expected to go unused until mid-2024. Extrapolating from estimates by researchers at Imperial College London, these doses—enough for 5 million children—could save more than 31,000 lives, at a cost of a little more than $3,000 per life. But current plans by the World Health Organization to distribute the vaccine are unclear and have been criticized as lacking urgency.

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Luckily, the new vaccine, R21, is much easier and cheaper to produce. The Serum Institute of India, which is the world’s largest vaccine manufacturer, estimates that it already has the capacity to manufacture more than 100 million doses per year and that this capacity will double by 2025. By one estimate, for every million children vaccinated with R21, 1.9 million cases of malaria will be prevented (since people are often infected multiple times) and more than 6,000 lives will be saved.

In other words, over the next year, if the Serum Institute of India alone can produce and supply 120 million initial doses, the world could potentially vaccinate 40 million children, saving roughly 240,000 of them from a painful death.

As it stands, we will not be deploying 120 million doses in the next year, or even a sizable fraction thereof. The WHO estimated that R21 delivery will start around mid-2024, and the most recent public forecasts are that fewer than 20 million doses will be delivered next year.

WHO, to its credit, has stated to the Financial Times that it “agree[s] that everything should be done to expedite” the use of malaria vaccines. For R21, WHO already utilized some of the available options to move things faster toward recommendation ahead of the conclusion of phase 3 trials. This strategic ingenuity has saved the world some years of a painful wait. The WHO deserves praise for the hard work it’s done already to accelerate this vaccine.

However, there’s another mechanism that could expedite the process—and it’s one that WHO has used recently. Because COVID-19 was deemed a public health emergency, a faster deployment route was used during the pandemic: emergency use listing (EUL). More than 1 billion doses of COVID-19 vaccines have been delivered in Africa over the past two years. As it stands for malaria and R21, no similar commitment has been made to distribute all available doses of R21 at COVID-speed.

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For COVID-19 vaccines, EUL was available because the pandemic was undeniably an emergency. Given the staggering scale of deaths of children in sub-Saharan Africa every year, shouldn’t we also be treating malaria vaccine deployment as an emergency?

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For many, especially in the global north, malaria may not feel like an emergency, but it was an emergency for me and my mother when I contracted it as a child, and it will be an emergency to the millions and millions of children who will be infected next year.

Some African countries have already taken the initiative to approve the R21 malaria vaccine for use. Ghana, Burkina Faso, and Nigeria all made the decision to license the vaccine prior to approval from WHO.

Global health institutions need to support these countries by facilitating the rapid distribution of this vaccine and creating a public plan to vaccinate 40 million children before 2025. As Adrian Hill, the University of Oxford scientist whose work was key in developing R21, succinctly asked: “Why would you allow children to die instead of distributing the vaccine?”