It’s been several decades in the making, but a malaria vaccine has finally won approval for general use. The World Health Organization’s recent recommendation for widespread use of the RTS, S/AS01 malaria vaccine is among the most promising public health developments in recent times. It provides a new tool for families to protect their young children from the ever-present dangers of Malaria.
The WHO recommendation is based on the advice of its global advisory bodies on immunization and on Malaria. The vaccine is recommended for use among children in sub-Saharan Africa and other regions with moderate to high transmission of Plasmodium falciparum, the most dangerous form of Malaria.
The recommendation also comes at a crucial time in the fight against Malaria. Tools like insecticide-treated bed nets, indoor residual spraying, and seasonal malaria chemoprevention have reduced the Malaria burden. But progress in some countries has stalled in recent years. Malaria is still one of the leading causes of childhood illness and death in sub-Saharan Africa. More than 260,000 African children under the age of five die from the disease annually. RTS, S/AS01, which has been shown to reduce Malaria illness and deaths among children at risk, has the potential to save tens of thousands of children’s lives in Africa every year.
Before the WHO recommendation, RTS, S/AS01 was piloted in Ghana, Kenya, and Malawi, reaching more than 830,000 children since 2019. Ministries of health in the three pilot countries implemented the programme as part of their routine childhood immunization services, with support from PATH, GSK (the vaccine developer), and UNICEF.
The pilot programme allowed us to understand how the four-dose vaccine can be best integrated into routine vaccine systems. It also helped us understand the effects of vaccination on child survival and its safety profile when used in everyday settings. Much has been learned from the pilots. They have shown that the Malaria vaccine can be rolled out through routine childhood immunization programs and extend the reach of Malaria prevention tools. All three pilot countries saw high uptake of the vaccine. In the areas it was deployed, life-threatening severe Malaria fell by 30 percent.
The vaccine provides an added layer of protection when combined with other interventions. The layering of Malaria prevention tools in vaccinating areas resulted in over 90 percent of children benefitting from at least one preventive intervention. As with all Malaria control tools, the impact is most significant when multiple tools are used together—each one adding its benefits to the others.
Global partners are now putting processes in place to facilitate the widespread use of the vaccine. Short-term, the international community will need to make funding decisions for vaccine procurement and broader rollout. Sub-Saharan countries also need to follow their internal processes to decide whether and how to roll out the vaccine as part of a tailored mix of Malaria control tools for maximum effect. The WHO landmark announcement presents an excellent opportunity for countries like Uganda to accelerate progress in Malaria prevention and control.
