The fight against malaria hit a major milestone last fall when the World Health Organization (WHO) authorized the world’s first malaria vaccine. Now, the vaccine rollout is ready for an expansion after receiving nearly $160 million in international support to spend over the next three years.

The WHO and Gavi, the Vaccine Alliance, are urging countries to apply for a share of the funding to support their malaria vaccine rollouts. So far, the vaccine, known as RTS,S, has been administered in three pilot countries — Ghana, Kenya, and Malawi. In these areas, there has been a “substantial drop” in child hospitalizations for malaria as well as a decline in child deaths, according to the WHO.

Despite these accomplishments, the malaria vaccine has attracted concerns around its evaluation process and efficacy rate. The WHO used an “implied consent” process in the vaccine rollout, meaning recipients were not informed they were participating in a study, a decision experts consider a “serious breach of international ethical standards.”

Nevertheless, the nearly $160 million in funding opens the door for more countries where malaria is endemic to protect their residents from the deadly disease. To learn more about the expanded rollout and its potential impact, Global Citizen interviewed Stephen Sosler, head of vaccine programs at Gavi.

Global Citizen: Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. In 2020, nearly half a million African children under age 5 died from the mosquito-borne disease. How will this expanded vaccine rollout impact the situation on the ground in Africa?

Stephen Sosler: Alongside existing control interventions and protections, the vaccine rollout could help drive down child mortality in Africa — the continent that bears the heaviest malaria burden. As production scales up over the coming years, the vaccine could help prevent millions of cases of malaria, save tens of thousands of lives, and help to ensure a brighter future for the African continent.

So far, the three pilot countries — Ghana, Kenya, and Malawi — have received the malaria vaccine. They, along with other endemic countries, will be able to apply for a share of the $160 million to support their vaccine rollouts. What does the timeline look like for the application process and subsequent vaccine distribution?

Stephen Sosler: As of July, countries can now submit applications or expressions of interest for funding and support to roll out the vaccine, which means we are one step closer to the world’s first-ever mass vaccination against malaria. While there will be vaccine supply constraints initially, Gavi, UNICEF, WHO, and other partners will work together with countries to plan implementation, with the aspiration to make the first doses and support available for rollout as soon as late 2023 or early 2024. 

Vaccine hesitancy and anti-vaccine sentiments have been on the rise around the world. How has the malaria vaccine uptake been so far in the three pilot countries?

Stephen Sosler: While supply was very limited in the pilot program, there was a great level of enthusiasm, and we are seeing significant demand in the countries served by Gavi. African countries played a critical role in the WHO’s recommendation of the RTS,S malaria vaccine for widespread use. The recommendation was based on data gathered through the Malaria Vaccine Implementation Program, which took place in Ghana, Kenya, and Malawi over a two-year period, and a clinical trial around the seasonal delivery of the vaccine in Mali and Burkina Faso. 

We are still in the early stages of the malaria vaccine rollout. What challenges do you expect in the near future and how do you plan to address them?

Stephen Sosler: The WHO’s Malaria Vaccine Global Market Study projects likely supply constraints over the initial years of rollout, which will have implications on available Gavi support and the access and allocation of vaccines. Gavi is devising and implementing a market-shaping roadmap aimed at increasing supply and accelerating these timelines. 

As manufacturing ramps up over time, and new malaria vaccines enter the market, we expect that volumes will increase and, with the necessary investments, more children will be able to access this vaccine. The RTS,S vaccine is an important additional tool to control malaria in Africa — alongside other interventions — and we look forward to working with global malaria stakeholders to ensure that countries are able to implement it in the fight against the deadly disease.

This interview was lightly edited for clarity.

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