Will Global Supply of New Malaria Vaccines meet the African Demand?

The discovery and development of new innovations and scientific breakthroughs cannot be the sole measure of their success. The extent to which they reach the most vulnerable and the most in-need is perhaps the most important measure of their success. Ghana's approval of a new malaria vaccine has the potential to transform the story of communicable diseases in Africa. Realizing this potential depends on how quickly global production can ramp up to secure the necessary supplies to meet demand, including through the local manufacturing of vaccines on the African continent.

A second malaria vaccine, R21, was announced this week. It is an improvement over the first, less efficacious malaria vaccine that was introduced in 2021 - the RTS,S vaccine. The R21 vaccine was approved for use by the Ghana FDA after local clinical trials demonstrated high efficacy and safety. Nigeria has also granted provisional approval. Other African countries like Burkina Faso, Tanzania, Kenya, Mali are awaiting the publication of data from their clinical trials. Meanwhile, the World Health Organization is reviewing these data to consider whether to prequalify the vaccine for wider use globally.

Malaria has been with us since time immemorial. Today, malaria is associated primarily with the African continent (we record 95% - 234million - of the world’s annual recorded cases of malaria). However, malaria was widely prevalent in other parts of the world, including southern parts of the United States and Western Europe, before urbanization, stronger health systems, and insecticide use helped them to eliminate the disease. A little-known fact is that the American Centers for Disease Control – one of the world’s leading institutions for public health – has its roots as the malaria control unit of the United States. Then named the Communicable Disease Center, it was established in 1946 to control malaria, which was most prevalent in Atlanta and surrounding areas of the American South.

Despite a long history of immunization and advances in vaccine science, the world has never had a vaccine for malaria, one of the oldest known infectious diseases and one whose impact on human health and population exceeds that of any other infectious pathogen. For decades, it had been said that a vaccine against malaria was a scientific challenge due to the complexity of the life cycle of the malaria causing parasites. Additionally, the genome of malaria parasites has the potential to produce thousands of different antigens – the proteins that are typically replicated in vaccines to train the body to develop an immune response against the infection.

The political and market dynamics in which vaccines are produced is fraught with complexity. The COVID-19 pandemic provided painfully stark clarity of this. The level of resolve and investment to push the boundaries of what is possible in order to develop a scientific breakthrough, fast track the regulatory approvals, and scale up production of millions of doses can have as much to do with geopolitics and purchasing power as it has to do with the bounds of our scientific or technical abilities.

About fifteen years ago, efforts intensified to accelerate the pace of innovation through partnerships between academia, philanthropy, and private biopharma companies to develop vaccines for neglected diseases like malaria and tuberculosis. Thirty years into malaria vaccine research, there is finally some light. In a space of just two years, we have seen two malaria vaccines become available. This is a game-changing and a history-defining moment, not just for public health, but also for the prospects of seeing children survive,thrive, and improve their cognitive development, educational, and economic outlook.

This is only the beginning. The availability of an innovation or new medical tool does not make it immediately available and affordable for those who need it the most. When the first malaria vaccine became available and was approved for use in several African countries, may countries still contended with the issue of global supply, which was insufficient to meet the demand. While the first RTS,S vaccine was endorsed for use by the World Health Organization in 2022, supply projections (based on production capabilities) anticipated that global supply would only meet demand between 2026 and 2028. African demand for a malaria vaccine is expected to be between 80 and 100 million doses annually.

It is hoped that the new R21 vaccine – developed at theJenner Institute at the University of Oxford and manufactured by the Serum Institute of India - could be manufactured at greater scale, and at a more modest cost. Allowing technology transfer to enable African manufacturers to manufacture and supply this vaccine is going to be critical for improving the reliability of supply for African communities.

African countries have made tremendous progress in dramatically reducing the cases and deaths from malaria over the last twenty years. However, Africa is now contending with an increase in the emergence of resistance by the parasite to the treatments, while mosquitoes are also resisting the insecticides used to prevent malaria. On top of this, the climate change is reintroducing malaria into geographies where it was previously controlled.    

Investing ininnovation for better tools as well as for rapidly scaling up supply is critical,and it must be fueled by the same sense of urgency with which the world developed, produced, and deployed a COVID-19 vaccine. Because each year that we contemplate, and wade through global public health bureaucracy, and lament the complexities of science and market failures, is another year where we lose half a million African children to malaria.