MALARIA
VACCINES

Over the last century, the quest to control and eliminate malaria—a debilitating, deadly, and costly disease transmitted by mosquitoes—has challenged governments, international organizations, and public health researchers.

Substantial investments in research and development have led to new diagnostic tools and treatments that have successfully reduced the number of deaths from malaria since the early 2000s.

However, prolonged illness, absenteeism, and economic losses associated with malaria infection remain significant, particularly in sub-Saharan Africa, where more than 90 percent of malaria cases are reported.

Climate change and natural disasters are placing greater numbers of people at risk of exposure to malaria. Meanwhile, drug resistance and conflict make it challenging for vulnerable populations to access effective diagnosis and treatment.

New vaccines that can help prevent malaria infection for the most vulnerable populations promise to be game changers in the fight against this public health challenge.

Malaria’s Impact in
Sub-Saharan Africa
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Pregnant women are also vulnerable to malaria. Women who are infected while pregnant can experience miscarriage, severe anemia, and death. Malaria also poses risks to the developing fetus, including low birth weight and premature birth.

In regions where malaria is endemic, people may acquire some immunity due to repeated exposure and experience fewer debilitating symptoms over time. However, there is evidence that malnutrition and HIV infection can also make people infected with malaria susceptible to more severe illness. This makes malaria a special health concern where the three conditions coincide.

Malaria infections also have a financial impact. They are costly to households when children miss school and family members must forego income-generating activities to care for sick relatives.

Malaria is also costly to governments. A recent study estimated that reducing malaria by 90 percent by 2030 could increase the GDP of the countries in sub-Saharan Africa with the highest malaria burden by $16 billion a year.

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Unpacking Malaria
Prevention
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Until relatively recently, preventing malaria depended on controlling people’s exposure to mosquitos. Several species of the biting females in the Anopheles mosquito family are responsible for transmitting malaria-causing parasites. The Anopheles gambiae mosquito has been historically responsible for the majority of malaria cases on the African continent.

These mosquitoes frequent freshwater environments, primarily in rural areas. When they bite a person to ingest blood, they can transmit the Plasmodium falciparum parasite, responsible for most severe malaria cases.

However, in recent years, the Anopheles stephensi mosquito, originally from South Asia, has become more adapted to urban environments. It has been reported in several African cities. Anopheles stephensi can transmit not only Plasmodium falciparum, but also Plasmodium vivax, another strain of the malaria-causing parasite. The increasing presence of Anopheles stephensi mosquitoes in metropolitan areas has led to concerns that urban populations with little immunity to malaria may be vulnerable to severe outbreaks if the invasive mosquitoes are not eliminated.

Beyond urbanization and the arrival of new mosquito species, climate change is also making new areas suitable for transmission of the disease. Warmer temperatures, erratic weather patterns, and flooding caused by intense rainfall in some regions will continue to change environments and raise the risk of malaria transmission in new landscapes.

In recent years, two vaccines that prevent malaria have been introduced in sub-Saharan Africa. These vaccines offer the promise of preventing infection and are most significant for young children and pregnant women, for whom malaria can be especially dangerous.

With future vaccines to protect against infection with tuberculosis and, potentially, HIV in the R&D pipeline, the lessons learned from the effort to scale up malaria vaccines will be critical for broader approaches to global health security. 

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Eradication Efforts &
Global Collaboration
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Malaria was eradicated from the United States in 1951.

Following this successful campaign, efforts to eradicate malaria in parts of Latin America and Asia were undertaken by WHO, the U.S. government, and philanthropic organizations such as the Rockefeller Foundation’s International Health Division in the middle of the twentieth century.

However, early approaches had limitations and generally overlooked the African continent, where a significant number of cases were reported.

To correct this, the international community adopted the Millennium Development Goals and recommitted to halting and reversing the incidence of malaria by 2015.

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Current Challenges in a
Post-pandemic World
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The disruption of health services and diversion of resources, such as financing and staff, to outbreak response during Covid-19 led to an increase in malaria cases and deaths during the first years of this decade. The number of reported malaria cases in 2022 was 5 million higher than in 2021, and 20 million higher than in 2019.

In the post-pandemic period, new malaria-transmitting vectors and the expanding range of mosquito habitats due to climate change are driving a shifting epidemiological landscape in Africa. However, there are other factors making an impact as well:

These challenges to traditional malaria prevention make widespread distribution and access to the new malaria vaccines of paramount importance.

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Evolution of Malaria
Vaccine Options
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The vaccines can reduce the number of cases by about three-fourths and reduce the risk of severe complications, as well as death. 

They are designed to be delivered prior to the season of highest transmission and used in combination with other prevention methods.

The new prevention tools have demonstrated proof of concept and stimulated further research to develop even more effective options. Work is being done to create a vaccine for pregnant women, for whom malaria infection can be especially dangerous.

However, it will be several years before there is adequate supply to meet the needs of all malaria-endemic countries with a low-cost vaccine. The challenge now is to ensure high-burden countries can purchase sufficient vaccines and make them available to the populations who can benefit the most.

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Bilateral & Multilateral Coordination to
Prevent Malaria
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In 2021, the board of Gavi, the Vaccine Alliance, approved plans to support eligible countries in adding malaria vaccines to routine immunization programs. 

Launched in 2000 as a public-private partnership to ensure timely access to new and underutilized vaccines for low- and lower-middle-income countries, Gavi supports countries’ routine immunization programs, as well as special campaigns, such as for Covid-19, Ebola, and mpox, among others.

For the malaria vaccines, Gavi works with UNICEF to procure the WHO-prequalified doses in bulk at a low cost and then provides them to eligible countries at a fraction of the price. The lowest-income countries pay just $0.20 per dose to start. Those transitioning away from Gavi support pay more over time, depending on their economic status. Gavi is also working with suppliers to increase manufacturing to ensure availability of vaccines to meet the anticipated demand.

In 2023, Gavi allocated 18 million doses of RTS,S to 12 countries in sub-Saharan Africa that had expressed interest in the vaccine, including Ghana, Kenya, and Malawi, where the MVIP pilots had taken place. In January 2024, Cameroon became the first country to provide RTS,S through the country’s national immunization program.

In May 2024, the Central African Republic, with support from Gavi and UNICEF, began delivering the R21 vaccine to children through routine immunization programs.

To date, 20 countries in sub-Saharan Africa have indicated plans to introduce malaria vaccines into routine immunizations programs.

Gavi estimates that nearly 100 million doses per year will be needed by 2030.

In preparing for the launch of the Africa Vaccine Manufacturing Accelerator in June 2024, Gavi signaled that regional production of one or more malaria vaccines will be a priority for the “innovative financing instrument.”

The addition of vaccines to the malaria prevention tool kit represents an important step in the effort to protect child health and prepare for the health impacts of a changing climate. It also represents a new opportunity for organizations like the Global Fund and Gavi to cooperate. Gavi can support a key prevention option, while the Global Fund continues to provide financing for malaria diagnostics and treatment.

With both organizations planning to seek renewed funding, aligning efforts regarding malaria can demonstrate collaboration and cost-effectiveness for donors and implementing countries alike.

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The Future of
Elimination Efforts
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Long-term research and investments in new technologies to prevent, diagnose, and treat malaria have successfully lowered the number of deaths over the past quarter century.

The introduction of new malaria vaccines promises to accelerate progress in improving health outcomes for children under the age of five who are the most vulnerable to severe illness and death.

 Yet at the precise moment when new, game-changing tools are available, urbanization, climate change, and the introduction of new malaria-transmitting mosquito species on the African continent threaten to destabilize these fragile gains.

As a key funder of global malaria programs, the United States has an important role to play in ensuring countries can access the new vaccines as part of a comprehensive approach to malaria. U.S. support for malaria initiatives will contribute to broader efforts to prevent outbreaks, strengthen laboratories, and carry out disease surveillance, as outlined in the 2024 U.S. Government Global Health Security Strategy.

To protect the children and women in sub-Saharan Africa and beyond who face the greatest threat from malaria, the international health community must rise to the challenge of ensuring equitable access to vaccines for all.