Cheap malaria vaccine receives WHO go-ahead for global roll-out

The R21/Matrix-M vaccine could help reduce the 500,000 malaria-associated deaths that occur each year.

The vaccine was developed by researchers from the University of Oxford, the Serum Institute of India and drugmaker Novavax. It is expected to become available by 2024, at a cost of between $2 and $4 per dose. 

R21 is the second malaria vaccine to receive WHO approval. The first one – known as RTS,S – was developed by GSK and has been sold under the brand Mosquirix since 2022. However, the difficulty in producing doses of RTS,S has made pharmaceutical firms unable to meet the high demand for the vaccine – presenting R21 as an equally effective but cheaper alternative.

“As a malaria researcher, I used to dream of the day we would have a safe and effective vaccine against malaria. Now we have two,” said Dr Tedros Adhanom Ghebreyesus, director-general of the WHO.

“Almost exactly two years ago, WHO recommended the broad use of the world’s first malaria vaccine called RTS,S. Today, it gives me great pleasure to announce that WHO is recommending a second vaccine called R21/Matrix-M to prevent malaria in children at risk of the disease.”

Each year, more than 200 million people fall sick with malaria and more than half a million of these infections lead to death, creating an acute need for an affordable vaccine. However, the complexity of the disease’s transmission has made it difficult to develop a vaccine.

Due to these challenges, WHO set its criteria for an effective vaccine at 75 per cent efficacy rate. In trials, R21 prevented between 68 and 75 per cent of recipients from contracting malaria. However, the vaccine achieved levels of protection of between 75 to 79 per cent in infants – the population at highest risk of dying from malaria. 

This means the effectiveness of the two malaria vaccines was “very similar” with no evidence that one was better than the other.

Hanna Nohynek, chair of WHO’s Strategic Advisory Group of Experts on Immunisation, said the addition of a second malaria vaccine was “expected to close the gap between supply and demand, and has the potential to save tens of thousands of lives each year”.  

“The vaccine is easily deployable, cost-effective and affordable, ready for distribution in areas where it is needed most, with the potential to save hundreds of thousands of lives a year,” said Sir Adrian Hill, who led the team developing the vaccine at Oxford University’s Jenner Institute.

The Serum Institute of India said it could develop 100 million doses of R21 each year, which it hopes to double over the next two years. Moreover, its CEO, Adar Poonawalla, has confirmed the Institute has already produced more than 20 million doses in anticipation of WHO’s recommendation.

“We will ramp it up as per what the demand requirements are,” he said. “We hope that by the end of 2024, there will be zero mismatch of demand and supply, with our supply coming into the system.”

The R21 vaccine took 30 years to develop. The feat has been achieved by the same lab that was able to design an effective Covid-19 vaccine in under 12 months. 

In addition to vaccine breakthroughs, researchers have also been working on new ways of detecting the disease. In August, researchers from University College London Hospital presented an artificial intelligence (AI) system to detect malaria in travellers and, last year, University of Queensland researchers developed a chemical-free, needle-free tool to detect malaria through the skin using infrared light.

The roll-out of both the RTS,S and R21 vaccines is expected as soon as next year, with at least 28 countries in Africa having presented plans to introduce a WHO-recommended malaria vaccine as part of their national immunisation programmes.