Malaria Vaccine Introduction: An incredible new opportunity for integrated health and immunization services
October 8th, 2021 | viewpoint
On October 6, the World Health Organization made the historic announcement that it recommends widespread use of the RTS,S/AS01 malaria vaccine in areas with moderate-to- high malaria transmission. The findings from the malaria vaccine pilots in Ghana, Kenya, and Malawi are encouraging, with data showing a 30 percent reduction in severe malaria. Although the vaccine efficacy is not high, it is a wonderful opportunity to reduce morbidity and mortality from malaria in early years of life—while infants’ immune systems mature. Of course, vaccination must be conducted through a multi-pronged strategy, as part of a set of preventive interventions.
It will take some years for these vaccines to be available for wide-scale use, given early supply limitations and approval processes with Gavi and local national regulatory authorities. Advance market commitments will be needed for pricing; production and supply forecasting based on realistic demand estimates (in economic terminology); and an equity balance (to ensure that wealthier countries do not initially get all of the supply and that Gavi is positioned to help its countries introduce the vaccines).
Gavi resources alone will not be sufficient nor expedient, particularly for lower-income countries. Despite the important work of Gavi, COVAX, and other dedicated partners, challenges to availability and uptake of human papillomavirus and COVID-19 vaccines show that broader engagement and commitments are needed to scale and speed up vaccination with other services, particularly to improve equity of service delivery for the most at-risk populations.
Impact, which is feasible with malaria vaccination, will require commitment of and resources from The Global Fund and other partners to contextualize malaria vaccine introduction as a fundamental component of holistic approaches to malaria prevention and control. Vaccination must be paired with existing interventions such as insecticide-treated bednets, prophylactics, and mosquito abatement. For the vaccine to reduce childhood illness and death, a long-term donor partnership will be needed to fund production and availability (and work with countries for uptake and sustainability), as the Bill & Melinda Gates Foundation has done for the pneumococcal conjugate and rotavirus vaccines.
The success of the new malaria vaccine will be highly dependent on immunization programs that reach the highest-risk communities every year and integrated prevention and control strategies—with established resource commitments that are 5–10 years and beyond. The malaria vaccine announcement is an exciting and real opportunity for integration. The onus is on The Global Fund, Gavi, and other partners to link their resources and ensure partnerships with countries and civil society organizations to meet subnational program operational needs across malaria interventions. Infants need to be reached with vaccination and health services via at least five contacts before 11 months of age and additional contacts in the second year of life. Coordination is critical to reduce silos and proactively support implementation for these preventive health services.
Written by Lora Shimp
