First 18 million doses of malaria vaccine distributed to 12 African countries

Clive Tatenda Makumbe

In the next two years, 18 million doses of the groundbreaking malaria vaccine will be distributed among twelve African countries from various regions. The implementation of this initiative is a significant progress in the battle against a major contributor to mortality in the region.

The distribution of the malaria vaccine has been decided based on the principles outlined in the Framework for allocation of limited vaccine supply. This prioritizes providing doses to areas with the highest need, where children face the greatest risk of malaria illness and death.

Starting from 2019, the countries of Ghana, Kenya, and Malawi have successfully provided the malaria vaccine through the collaborative effort of the Malaria Vaccine Implementation Programme (MVIP). This initiative is led by the World Health Organization (WHO) and supported financially by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, as well as Unitaid. Since 2019, over 1. 7 million children in Ghana, Kenya, and Malawi have received the RTS,S/AS01 vaccine. This vaccine has proven to be both safe and successful, leading to a significant decrease in severe malaria cases and a decline in child mortality rates. The malaria vaccine has piqued the interest of more than 28 African countries.

Besides Ghana, Kenya, and Malawi, the initial allocation of 18 million doses will allow nine additional countries, such as Benin, Burkina Faso, Burundi, Cameroon, the Democratic Republic of the Congo, Liberia, Niger, Sierra Leone, and Uganda, to incorporate the vaccine into their regular immunization programs for the first time. This distribution process utilizes the vaccine doses that Gavi, Vaccine Alliance has received through UNICEF. Countries are anticipated to receive the initial vaccine supply by the end of 2023, and they are expected to commence its distribution in early 2024.

“This vaccine has the potential to be very impactful in the fight against malaria, and when broadly deployed alongside other interventions, it can prevent tens of thousands of future deaths every year,” said Thabani Maphosa, Managing Director of Country Programmes Delivery at Gavi, the Vaccine Alliance. “While we work with manufacturers to help ramp up supply, we need to make sure the doses that we do have are used as effectively as possible, which means applying all the learnings from our pilot programmes as we broaden out to a new total of 12 countries.”

Malaria continues to be a major health threat in Africa, causing the deaths of almost 500,000 children under the age of 5 annually. It also represents the majority of both malaria cases and fatalities worldwide, with around 95% of cases and 96% of deaths occurring in Africa in 2021.

“Nearly every minute, a child under 5 years old dies of malaria,” said UNICEF Associate Director of Immunization Ephrem T Lemango. “For a long time, these deaths have been preventable and treatable; but the roll-out of this vaccine will give children, especially in Africa, an even better chance at surviving. As supply increases, we hope even more children can benefit from this life-saving advancement.”

“The malaria vaccine is a breakthrough to improve child health and child survival; and families and communities, rightly, want this vaccine for their children. This first allocation of malaria vaccine doses is prioritised for children at highest risk of dying of malaria,” said Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals. “The high demand for the vaccine and the strong reach of childhood immunisation will increase equity in access to malaria prevention and save many young lives. We will work tirelessly to increase supply until all children at risk have access.”

As the new vaccine was initially in short supply, the World Health Organization (WHO) sought the expertise of advisors, primarily from Africa where malaria is most prevalent, to create a Framework for distributing the limited doses. This Framework aimed to determine the locations where the limited vaccine supply would be allocated initially. The Framework is built upon ethical values and a sense of unity, and it suggests that the distribution of vaccines should initially prioritize areas with the highest level of necessity.

The group responsible for implementing the framework principles included representatives from various organizations such as Africa CDC, UNICEF, WHO, and the Gavi Secretariat, along with members from civil society and independent advisors. The Senior Leadership Endorsement Group of Gavi, WHO, and UNICEF reviewed and supported the group’s recommendations, as stated in the First malaria vaccine supply allocations: explanation of process and outcomes document.

The global need for malaria vaccines is projected to reach 40-60 million doses annually by 2026, and further rise to 80-100 million doses per year by 2030. The GSK-developed RTS,S/AS01 vaccine, soon to be distributed by Bharat Biotech, could be joined by a second vaccine, R21/Matrix-M, created by Oxford University and produced by Serum Institute of India (SII), which may also receive WHO prequalification in the near future. Gavi has recently provided a detailed plan to enhance its supply in order to meet the growing demand.