RTS,S Malaria Vaccine, a Promising Tool in the Fight Against Malaria

In October 2021, WHO recommended the RTS,S vaccine to prevent malaria among children in areas of moderate to high transmission in sub-Saharan Africa. A few months later, Gavi – the Vaccine Alliance approved an investment to support the introduction of the malaria vaccine in Gavi-eligible countries. The RTS,S vaccine is designed to be administered in three doses to children starting at five months, with a fourth dose 12 months after the third. Given that this is the first vaccine of its kind, demand is expected to be 80-100 million doses per year. However, supply is expected to reach only 15 million doses in the short term. Governments should immediately consider several operational points, including for coordination with other malaria interventions, to prepare for implementation.

Prioritize endemic areas for vulnerable populations

Given severe supply challenges, malaria vaccines should be prioritized for endemic areas and the most vulnerable and high-risk populations (e.g., children who are not able to regularly access health services or who live in dense high transmission areas). Ministries of Healths’ Expanded Programme on Immunization (EPIs) should collaborate with National Malaria Control Programs (NMCPs) and communicable and infectious disease partners to align resources and operations. An NMCP is responsible for malaria control interventions and can provide insight into how to reach vulnerable populations. As the vaccine is designed to be used in addition to other malaria control measures, the NMCPs and EPIs can promote linkages with other partners, such as the Global Fund, Gavi, and organizations supporting bednets and other malaria control and prevention efforts, particularly at the community level.

Consider operational requirements for vaccine rollout

Ministries of health (MOH) and EPIs can prepare for supply, funding, and programming needs in anticipation of introducing malaria vaccination. MOH must compile and assess evidence with their National Immunization Technical Advisory Groups to advise and prepare policy to introduce malaria vaccination as part of the preventive and public health system. Additionally, each country’s national regulatory authority should be positioned to expeditiously approve the vaccine for use.
Governments need to consider the funding requirements for a comprehensive and sustainable vaccine rollout. To secure local funding beyond donor (e.g., Gavi and Global Fund) commitments, broader engagement will be required. These funds should cover procurement of the vaccine and supply chain and delivery needs, cold chain capacity, training and monitoring at community level, and the development and resourcing of communications activities. While preparing malaria vaccine rollout, EPIs should also consider which populations are most at risk and prioritize the most effective approaches to reach them, linked with updating their national immunization plans.

Communicate about the vaccine early

Communication programs should be prioritized when planning RTS,S vaccine introduction. Messages should be informative, easy to understand, disseminated to remote and mobile populations, and incorporate learning with other global and country malaria prevention and control measures. They should educate the community on vaccine availability and health benefits, and stress the importance of returning for the complete schedule (i.e., through the fourth dose [something that was observed as a challenge during the vaccine introduction demonstration in Malawi]).

JSI’s support for vaccine introduction globally

Lifecourse vaccination is being emphasized with newer vaccines, and the addition of the RTS,S vaccine will further support these expanded schedules. JSI has supported many countries in assessing the challenges and considerations, developing implementation plans, and introducing vaccines worldwide. This has included providing technical assistance for HPV, meningitis A, measles second dose, and COVID-19 vaccine introduction in over 20 countries. Each of these vaccines was introduced outside the traditional childhood vaccination schedule (i.e., beyond 0–11-month-olds).

JSI also has improved the quality and use of immunization data at community levels to reduce inequities and increase vaccination coverage. With MOH colleagues in Zimbabwe, JSI has implemented the My Village My Home data-tracking tool, which helps village leaders to collaborate with health facilities to monitor the progress of childhood immunizations. This learning has been adapted from India, Ethiopia, Malawi, and several other countries.

Although there is still time before widespread introduction of the RTS,S vaccine, governments should consider the financial and programmatic requirements for implementation now. JSI is excited to continue to assist countries with tremendous opportunity to reduce child morbidity and mortality from malaria.

Written by Emily Kitts