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23 October 2015
GENEVA - Today's recommendations by two advisory bodies to the World Health Organization, the Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC), for use of the RTS,S malaria vaccine are a step toward making the vaccine available in countries with a heavy malaria burden as well as an opportunity to assess its likely real world impact.
They have called for pilot implementations of the vaccine in three to five settings in sub-Saharan Africa. This follows an earlier four-year trial of the vaccine that found it safe and effective, providing 39 percent efficacy at preventing clinical cases of malaria.
Replicating that success rate in a non-clinical setting poses challenges. The RTS,S vaccine requires four doses and the last dose is critical for sustaining the protective effect of the vaccine. The first three doses of the vaccine will be administered to children between 5 and 9 months of age and the fourth dose is given around the second birthday. This is partially outside the existing immunization schedule in which most vaccines are administered to infants 6 to 14 weeks after birth, potentially posing logistical challenges to health systems in low-income countries. Further assessing the feasibility of providing these vaccinations and the resulting impact is therefore a prudent approach.
While additional studies could demonstrate RTS,S's utility in the malaria control toolkit, global efforts must continue to expand access to proven methods of malaria control. The RTS,S vaccine could complement - not replace - existing proven and cost-effective methods, such as insecticide-treated mosquito nets and spraying. Tools such as insecticide-treated mosquito nets have significantly reduced the burden of malaria, more than halving the number under-five deaths since 2000. Despite such progress, there are still more than 200 million cases of malaria worldwide each year, resulting in 438,000 deaths, the vast majority of them African children.
It is now for the World Health Organization to confirm its recommendations on the first-ever malaria vaccine based on the recommendations received from SAGE/MPAC. The boards of Gavi and the Global Fund will review the WHO's recommendation to determine next steps.
Gavi and the Global Fund are continuing to work together to plan for the possible use of a malaria vaccine, if recommended by WHO and if the Gavi and Global Fund boards decide to support the vaccine in conjunction with other proven malaria interventions, as part of an integrated approach towards malaria control. Both organisations are working in close coordination with the Global Malaria Programme at the WHO, other technical and donor partners and implementing countries.