A new malaria vaccine developed by Oxford scientists is instrumental to preventing half a million deaths a year.

At least, that’s what the scientists and the World Health Organisation – which this week endorsed the new drug for use in all countries – are hoping.

Is this for real? If so, it would – in tandem with long-standing measures such as bed nets – prevent just about all child deaths from malaria in Africa. About 620,000 people died from malaria in Africa in 2021.

The new drug – the second vaccine to be endorsed by the WHO in just two years – is being hailed as a breakthrough.

But we’ve heard this sort of talk before.

Still, there’s a lot riding on the vaccine’s success. Reducing case numbers and deaths has been stalled for eight years. So there’s a measure of desperation at play here.

A tale of two vaccines

In 2021, there were two upbeat vaccine stories. Firstly, here and abroad, people were receiving their initial round of COVID-19 shots.

Secondly, and less celebrated outside of Africa, the World Health Organisation approved the first-ever vaccine for malaria. The WHO described the vaccine as “groundbreaking”.

Wow! Were two rampaging killers about to be vanquished – or at least brought under a good measure of control – within a matter of months?

COVID’s precedent

You may recall the COVID vaccine rollout was plagued with problems and a dark irony.

Overall, the jabs had impressive efficacy and did their job well, bringing down serious illness, and allowing the country to be opened up again. But this had the unfortunate consequence of deaths spiking and continuing to spike, such that COVID-19 is now the third-biggest killer in Australia.

The relative success of the COVID vaccines – which weren’t perfect – provided hope to malaria researchers that a vaccine, even one with a less than impressive profile, might at least do some good. And save some children’s lives.

After all, progress against malaria had pretty much stalled since 2015.

So what happened?

Scientists had tried for decades without success to develop a vaccine against malaria.

In fact, the first vaccine to get WHO approval – known as Mosquirix – was developed back in 1987 by GlaxoSmithKline (GSK).

It was designed to help protect children aged six weeks to 17 months against malaria caused by the parasite Plasmodium falciparum. This is the deadliest malaria parasite globally and the most prevalent in Africa

More than three decades went by – and nearly half a million children, under the age of five, had died from the disease each and every year. That is, more than 15 million small children have died in that time.

Why did it take so long?

A lack of funding is the short version. But there were other serious issues.

Mosquirix was only about 30 per cent effective. It was better than nothing and remains endorsed by the WHO.

But it required up to four doses, which reportedly presented a colossal logistics issue in sub-Saharan Africa, where malaria reigns supreme.

And its efficacy was short-lived, a matter of months.

The WHO gave its endorsement in October 21, calling the deployment of a decades-old vaccine an “historic moment”.

In July 2022, the Gates Foundation pulled its direct funding.

Why pull the funding?

The foundation said it had spent more than US$200 million and several decades getting Mosquirix to market.

It was relatively expensive and the logistic challenges didn’t help either.

Mostly, though, it seems the biggest problem, according to a report from AP at the time, the vaccine had “a much lower efficacy than we would like”.

And there wasn’t sufficient supply

According to a Reuters report, from July 2022, drugmaker GSK  committed to producing up to 15 million doses a year, up until 2028. But a source close to the rollout told Reuters it was unlikely to make more than a few million doses a year before 2026.

GSK said more funds were needed from international donors if the company were to meet demand.

The WHO said 100 million doses a year were required to meaningfully lower the impact of malaria in Africa.

Some scientists were stunned by the Gates Foundation’s abandonment of the vaccine rollout. As Julian Rayner, director of the Cambridge Institute for Medical Research, said at the time: “It’s an imperfect vaccine, but it will still stop hundreds of thousands of children from dying.”

The foundation said it would put its money into proven strategies, such as bed nets.

A new vaccine, a new hope

The new malaria vaccine, called R21/Matrix-M is also designed specifically for the protection of small children. And it appears to solve some of the problems that plagued Mosquirix.

The WHO’s approval is based on preclinical and Phase III clinical trial data (which is under peer review).

According to a report from WHO, the vaccine has “high efficacy when given just before the high transmission season”.

In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to four to five months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75 per cent during the 12 months following a 3-dose series.

A fourth dose given a year after the third maintained efficacy.

Mathematical modelling estimates indicate the public health impact of the R21 vaccine “is expected to be high in a wide range of malaria transmission settings, including low transmission settings”.

It also appears to be cost effective at US$2-US$4 per dose.

And supply might meet demand

The Serum Institute of India will manufacture the R21 vaccine. It boasts an “established capacity for producing 100 million doses annually”.

This would meet the WHO’s estimated requirements.

WHO Director General Tedros Adhanom Ghebreyesus said in a statement:

“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.

“Demand for the (Mosquirix) vaccine far exceeds supply, so this second vaccine is a vital additional tool to protect more children faster, and to bring us closer to our vision of a malaria-free future.”