Vaccination and malaria elimination

In October 2023, the World Health Organization (WHO) recommended a new vaccine, R21/Matrix-M, developed by The University of Oxford and the Serum Institute of India, for the prevention of malaria in children. This marks the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine developed by GlaxoSmithKline (GSK), which received WHO approval in 2021. Both vaccines have demonstrated safety and efficacy in preventing malaria in children.

However, the necessity of vaccines in the Asia Pacific region is debatable, given that countries like China, Sri Lanka, and the Maldives have achieved malaria elimination without relying on vaccines, instead employing established strategies such as early diagnosis, treatment, and vector control. While vaccines are a welcome development, they come with unique challenges. The R21/MM vaccine is primarily designed to reduce Plasmodium falciparum malaria mortality in young African children, potentially limiting its effectiveness in regions where Plasmodium vivax is prevalent (such as Asia). Additionally, while Serum Institute of India has the capacity to produce more than 200 million doses of the R21/ MM vaccine annually, the production capacity for RTS,S/AS01 is limited, with only 18 million initial doses allocated to 12 countries for 2023–25.

Though optimistic about the success of Oxford’s R21/MM vaccine, East Asia Forum, which is the academic research network of the East Asian Bureau of Economic Research (EABER) says that Oxford’s R21/MM could be a historic breakthrough for children in Africa, but it may have limited impacts on the elimination of malaria in the Asia Pacific. Asia is capable of reaching this goal, but it needs tools suited to its fundamentally different malaria problem.

In areas where limited accessibility hinders regular surveillance and vector control, vaccines could serve as another critical tool. While no single tool will be a silver bullet, vaccines are vital weapons in our arsenal as we strive to put an end to the world’s oldest fever, stated APLMA.