Vaccines are a glimmer of hope against malaria, but the battle has only just begun

By the time you reach the end of this article, three children will have died from malaria – a disease that casts a dark shadow over nearly half of the world’s population, claiming victims predominantly in the most vulnerable corners of our world.

In the quest for a vaccine, scientists have faced a Herculean challenge. The malaria parasite is a cunning shapeshifter, adept at evading the human immune system. Moreover, successfully distributing the vaccine at scale in some of the world’s most disadvantaged communities will require overcoming considerable logistical barriers.

After three decades of stagnation, we’re now witnessing a pivotal moment with the approval of two vaccines primed for global distribution – RTS,S and R21/Matrix-M. The latter emerged from a unique collaboration, uniting the brightest minds of Oxford’s Jenner Institute with India’s Serum Institute, the world’s largest vaccine manufacturer.

The vaccines offer a beacon of hope. But will they be enough to turn the tide?

This World Malaria Day, we asked the architects behind the R21/Matrix-M vaccine to give us their take on the road ahead.

Professor Sir Adrian Hill

Professor of Vaccinology and Director of the Jenner Institute at Oxford University

After decades of development, last year marked a historic moment for us, when the World Health Organisation approved R21 – the first malaria vaccine to meet the WHO’s stringent 75% efficacy threshold. While this data is incredibly promising, we are facing a formidable challenge when it comes to scaling-up production to meet demand, as well as ensuring fair and widespread distribution.

While there is a wide range of vaccines currently administered to children in Africa to shield against a myriad of deadly diseases, malaria presents a uniquely complex case. Unlike many existing routine immunisations, maximising effectiveness requires multiple doses and customised regimens involving a four-dose schedule. Storing vaccines at the right temperature can also be a substantial logistical challenge, making the thermostability of R21 a real benefit.

Overcoming these barriers requires innovative solutions and a concerted effort from governments, NGOs, and the private sector – which is why our long-standing partnership with the Serum Institute of India has been so integral to the development of R21, as we knew that any very effective vaccine with major impact also had to be ‘fit for purpose’ when it came to meeting manufacturing and distribution requirements. Looking ahead though, we know our mission is far from over. It’s evident that next-generation vaccines are imperative – which is why our partnership is set to continue. 

Currently, our development programme and efforts at Oxford University are continuing at pace, with new candidates which target all three stages of the parasite’s life cycle undergoing trials in Africa. Development of such a combination vaccine will further enhance effectiveness and integrate a transmission-blocking vaccine which will be pivotal for the ultimate goal of malaria eradication.

However, it is also important we acknowledge that while vaccines are a critical tool in the fight against malaria, they are not a panacea. Insecticide-treated bed nets, vector control programs, and surveillance efforts must be sustained and augmented to complement vaccination efforts – especially as climate patterns threaten to worsen malaria and other vector-borne diseases like dengue and chikungunya.

Adar Poonawalla

CEO, Serum Institute of India

The approval of R21 signifies historic progress – but the journey to malaria eradication doesn’t end there. With decades of experience operating in the world’s most deprived regions, we are acutely aware of the complex challenges that lie ahead. Developing and manufacturing an effective vaccine is a huge scientific feat, but this is only the first step. Without a comprehensive and streamlined delivery process which gets vaccines directly into children’s arms, millions more will die from this devastating disease.

Achieving widespread vaccination coverage demands creative solutions and a bold approach, including the ability and willingness to take risks. As manufacturing is progressing at pace, the next pressing challenge to address is distribution – which will demand a concerted effort from both governments, NGOs and industry working together. Our

longstanding collaborations and relationships with crucial global health stakeholders including Gavi, and governments provide invaluable insights into population challenges, infrastructural environments, and local dynamics which is optimising our distribution approach.

There is no doubt that after decades of stagnation it is encouraging to be standing on the precipice of progress, but it’s important we continue to move at speed. As the Center for Disease Control notes, malaria’s grip on economies perpetuates a cycle of poverty, burdening households and straining public healthcare spending.

Now is the time for the global community to come together and mobilise resources; we need a whole system approach ensuring healthcare workers are trained, communities are primed, and the infrastructure is in place to deliver this vaccine directly to those needing it most.

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