Malaria vaccination: hurdles to reach high-risk children

Abstract

Ensuring that malaria vaccines deliver maximum public health impact is non-trivial. Drawing on current research, this article examines hurdles that malaria immunization may face to reach high-risk children and explores the policy implications. The analysis finds health system related risks with the potential to reduce the ability of malaria vaccines to provide equitable protection. Deployment of effective frameworks to tackle these risks so as to strengthen within-country equity and progress tracking should be entangled with the deployment of the vaccines. To capture more comprehensively disease- and system-related risks to child health and survival, vaccine allocation criteria should expand their data and indicator breadth. Factoring molecular, clinical, and epidemiological features of antimalarial drug resistance into vaccine allocation frameworks is critical to effectively reflect current and future risks to malaria control interventions. It is proposed that approximately 6–15 children would need to be vaccinated to prevent a malaria adverse outcome. Vaccine purchasing and delivery costs may overwhelm endemic countries’ health systems given the sizeable number needed to vaccinate, the population of at-risk children, and limited government financing of the health sector. Innovations in health financing are pivotal to ensuring the cost-effectiveness and sustainability of immunization programs aiming to attain and maintain universal and equitable protection.

Leveraging malaria vaccines and mRNA technology to tackle the global inequity in pharmaceutical research and production towards disease elimination

“…Reliance on imported medicines has traditionally been a major weakness of malaria control efforts in Africa. About 96–95.4% and 75.7–74.5% of global malaria deaths in 2021–2022 occurred in the WHO African Region (AFR) and among children younger than 5 years (U5) in the region, respectively [ 7 , 12 , 13 ]. Yet the continent has to import medicines to protect itself against the disease.…”

“…Sustainability is paramount. Otherwise, if AFR continues to neglect its HE, then even to fight against malaria (a preventable and curable disease whose approximately 3/4 of attributable deaths globally occur in its U5 [ 7 ]) the continent may have to continue relying on imported medicines and technology. Given the complexity of the biology of P. falciparum [ 54 , 55 ], even the mRNA technology transfer, on its own, not coupled with a solid investment in HE on the continent and institutional strengthening, may not be the panacea for meager R&D, at least not as expected.…”