In 2021, there were an estimated 247 million cases of malaria and more than 600,000 deaths from the disease worldwide, according to the World Health Organization (WHO).

World Health Organization. Malaria. 2024.

More than 90% of those cases and related deaths occurred in sub-Saharan Africa, with children under 5 years of age seeing the highest risk.

Harris E. Africa’s first routine malaria vaccination campaign begins. JAMA. February 7, 2024.

Njie P, et al. Cameroon starts world-first malaria mass vaccine rollout. BBC News. January 22, 2024.

 

That same year, the WHO approved RTS,S, the world’s first malaria vaccine. Between 2019 and November 2023, a pilot vaccine administration in Ghana, Kenya, and Malawi reached more than 2 million children, and led to a 13% drop in mortality among age-eligible children during the pilot, according to UNICEF.

UNICEF Press Releases. Shipments to African countries herald final steps toward broader vaccination against malaria. November 22, 2023.

 

Now, amid hope and an already high demand, the vaccine is poised for a much broader distribution.

In February, the vaccine was launched in Burkina Faso. Through the WHO’s Regional Office for Africa’s Accelerated Malaria Vaccines Introduction and Rollout in Africa (AMVIRA), it’s expected that the vaccine will roll out in an additional 19 African countries in 2024.

World Health Organization Regional Office for Africa. Nearly 10,000 children vaccinated as malaria vaccine rollout in Africa expands. February 9, 2024.

 

“Malaria is one of the major health challenges our region faces,” said Matshidiso Moeti, the WHO’s Regional Director for Africa, in a press release. “The wider rollout of the malaria vaccine marks a significant milestone in advancing the fight against this deadly disease.”

International funding has provided nearly $160 million for the 2022–2025 vaccine rollout.

United Nations Africa Renewal. Historic funding to expand roll-out of first-ever malaria vaccine in Africa. July 21, 2022.

 

 

Vaccine efficacy

 

The RTS,S vaccine has an estimated efficacy rate of at least 36%, which is relatively low, considering vaccines typically need an efficacy of at least 50% for WHO approval.

Njie P, et al. Cameroon starts world-first malaria mass vaccine rollout. BBC News. January 22, 2024.

World Health Organization. Vaccine efficacy, effectiveness and protection. July 14, 2021.

However, many medics and other health professionals in regions heavily impacted by malaria still see the RTS,S vaccine as a vital new tool in the fight against the disease.

 

A study conducted by researchers in the United Kingdom found that when combined with previously available preventive measures, such as mosquito nets and malaria medications, the RTS,S vaccine has the potential to offer children up to 90% protection.

Dicko A, et al. Seasonal vaccination with RTS,S/AS01E vaccine with or without seasonal malaria chemoprevention in children up to the age of 5 years in Burkina Faso and Mali: a double-blind, randomised, controlled, phase 3 trial. Lancet Infect Dis. 2024;24(1):75-86.

 

 

Concerns about RTS,S

 

There have also been some concerns regarding the multiple required doses of the RTS,S vaccine. The four doses required for the RTS,S protocol will be required at different times than other standard childhood vaccines. This means that families will need to attend more medical visits—a challenge for some families without appropriate support in place.

Zafar A. Routine malaria vaccines start to roll out to protect children in Africa. CBC News. January 23, 2024.

 

Additionally, vaccine hesitancy could prevent some parents from bringing their child for the vaccine.

Public education campaigns that emphasize the safety and benefits of the malaria vaccine will likely be crucial in Cameroon and other countries where the vaccine is needed.

Njie P, et al. Cameroon starts world-first malaria mass vaccine rollout. BBC News. January 22, 2024.

 

Despite these concerns, there is already high demand for the vaccine. Currently, it’s expected that only about 18 million doses of RTS,S will be available for allocation before 2025. Demand for the vaccine already far exceeds this number.

Njie P, et al. Cameroon starts world-first malaria mass vaccine rollout. BBC News. January 22, 2024.

 

 

A second vaccine

 

Another WHO-approved vaccine, R21/Matrix-M, might help with this demand. The R21 vaccine, approved in October 2023, was developed by Oxford University in collaboration with the Serum Institute of India.

World Health Organization. WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization. October 2, 2023.

CBC. Routine malaria vaccines start to roll out to protect children in Africa. January 22, 2023.

The vaccine, which has an estimated efficacy 66%, is expected to roll out in Africa later this year. 

 

Public health experts are hopeful that having two available vaccines will help increase the overall supply of doses and allow medical professionals to vaccinate more children at a faster rate.

Zafar A. Routine malaria vaccines start to roll out to protect children in Africa. CBC News. January 23, 2024.

 

 

Managing malaria 

 

Through modern medical advancements, the global burden of malaria has been declining. As recently as 2000, there were 897,000 malaria deaths globally.

World Health Organization. Malaria. 2024.

At that time, the global incidence rate of malaria was 82.3 per 1,000. By 2020, the rate was 59.4. The entire continent of Europe has been malaria-free since 2015. China and El Salvador were both certified malaria-free in 2021.

 

However, there have also been setbacks. Urban mosquito populations have shown resistance to insecticides and standard malaria medications, and the COVID-19 pandemic slowed down key malaria prevention and treatment measures. The WHO estimates that more than 14 million additional cases of malaria can be attributed to service disruptions during COVID-19.

World Health Organization. Malaria. 2024.

 

For example, some current antibiotics have been found beneficial as a treatment, and chemotherapy medications have also been used successfully in some cases.

Pandey S, et al. Drug development strategies for malaria: with the hope for new antimalarial drug discovery—an Update. Adv Med. 2023; 2023:5060665.

 

The WHO has banned the use of single antimalarial medications as a treatment option, but it’s now common to use two or more antimalarial drugs together to avoid resistance. 

The WHO also recommends the use of non-medical modalities to control mosquitoes and prevent the spread of malaria, including the use of new types of insecticide-treated mosquito nets, baits that attract mosquitos, repellant sprays, and genetic engineering of mosquitoes.

World Health Organization. WHO urges increased implementation of recommended tools to combat malaria. April 25, 2023.

 

Genetically engineered mosquitoes are a malaria prevention option that involves mosquitoes specifically bred to produce malaria-fighting antibodies. The mosquitos can then spread the antibodies in a fast and sustainable manner.

Brumfiel G. Mosquitoes spread malaria. These researchers want them to fight it instead. NPR. July 20, 2023.