Malaria vaccines provide new hope in fight against the disease 

This article was first published in October 2021, was updated in September 2022, and again on 14 April 2023 and 21 April 2023.

In a groundbreaking first, Ghana approved a new malaria vaccine for use in young children on 13 April.

And now Nigeria, Africa's most populous nation, has provisionally approved use of the vaccine less than a week later.

In 2019, 386,000 Africans died from malaria, of which 274,000 were children under five, according to the World Health Organization (WHO).

In 2021, the WHO approved a malaria vaccine for children for the first time, after a successful pilot scheme in three African countries: Ghana, Kenya and Malawi.

RTS,S – or Mosquirix – is a vaccine developed by British drugmaker GlaxoSmithKline, which acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa.

WHO Director-General Dr Tedros Adhanom Ghebreyesus called it a "historic moment" and a "breakthrough for science, child health and malaria control".

“Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year,” he added.

Mosquirix has paved the way for a more potent R21 vaccine developed by the University of Oxford, with evidence showing vaccine effectiveness at as much as 80%. Combined with a manufacturing advantage, the malaria vaccine has been described as having "world-changing" potential.

Ghana is the first country to officially approve the use of the new R21 vaccine. Its Food and Drugs Authority, which has seen data from a recent trial, has approved the vaccine's use in children aged between five months to three years old.

And now provisional approval for the vaccine has been granted by Nigeria's National Agency for Food and Drug Administration and Control. It's the country most affected by malaria, accounting for over 30% of global malaria deaths, according to the WHO.

"We expect R21 to make a major impact on malaria mortality in children in the coming years, and in the longer term [it] will contribute to [the] overall final goal of malaria eradication and elimination," Professor Adrian Hill, director of the Jenner Institute at the University of Oxford, where the vaccine was invented, told the BBC.

Talking in 2021, the World Economic Forum's Head, Shaping the Future of Health and Healthcare, Shyam Bishen, said: “Malaria is one of the biggest infectious diseases which kills close to half a million people every year. A more effective malaria vaccine with 80% efficacy which can be produced on a larger scale at an affordable price would be a great tool in our fight against this deadly vector-borne disease."

Bishen continued, “Along with other malaria-fighting measures, this vaccine could help save tens of thousands of lives every year. We also need to make sure there are investments and resources available for further development and delivery to those who need it most, such as communities in Africa and Southeast Asia”.

The WHO's Global Malaria Programme Director, Dr Pedro Alonso, explained the vaccine breakthrough to Science in 5. That interview spotlights how the latest developments could address some of the biggest challenges in efficacy, manufacturing and rollout.

"We are at a historical point in time. A first malaria vaccine is being recommended for broad-scale use among children in Africa to help prevent malaria in this group.

"The vaccine reaches this stage at a critical point in time in our fight against malaria. Malaria is probably the largest killer of humans along history. We have seen unprecedented progress this century, which resulted in 7 million deaths averted...

"But the stark truth is that for the past four or five years, progress has plateaued. We still have more than 200 million malaria cases in people living in malaria-endemic countries every year. We have more than 400,000 deaths due to malaria every year - and the brunt of the disease and death is carried by African children."

"It's a vaccine developed in Africa, with strong engagement of African scientists and aimed to prevent malaria disease and death among African children.

"The malaria vaccine has now been used among 800,000 children as part of our pilot implementation programmes and builds on phase 3 trial data that has been examined by the European Medicines Agency, that issued a positive recommendation.

"We are reassured on the good safety profile of this vaccine. It is a safe and efficacious vaccine that can contribute to saving lives and preventing disease."

"We've found over the past two-and-a-half years of rolling out the malaria vaccine in the pilot programmes, there's very strong demand, very good acceptability by the populations and, even in the face of COVID-19, we reached very high levels of coverage within a short period of time.

"That speaks of the fundamental value and acceptance of vaccines in general and of a malaria vaccine, particularly in Africa.

"There are a number of steps we still need to go through. The funding to secure the supply of this vaccine to African countries still needs to be worked out, but we are optimistic.

"We cannot imagine a situation where international solidarity will not generate the financial resources to allow this vaccine to reach those that need it.

"In the face of COVID-19, the resilience of health systems and particularly of vaccine delivery mechanisms in Africa gives us hope that this vaccine will be able to reach those ultimate beneficiaries – young children."