Ghana has pioneered in the global health sector by becoming the inaugural nation to authorize a notably potent malaria vaccine, which was developed at Oxford University in the United Kingdom. This vaccine, known as R21/Matrix-M, has remarkably surpassed the World Health Organization's (WHO) efficacy target of 75%. Ghana's Food and Drugs Authority has given the green light for its use in children between 5 to 36 months old, who are most vulnerable to fatalities from malaria1.
Adrian Hill, director of the Jenner Institute, which is a segment of the Nuffield Department of Medicine at Oxford University, has articulated that this significant development is the fruit of three decades of exhaustive malaria vaccine research conducted at Oxford University. The research was aimed at creating a highly effective vaccine that could be mass-produced and delivered to the nations where it is most desperately needed.
Despite this achievement, the battle against malaria, a mosquito-borne disease, is intricate and remains far from over. Malaria claimed approximately 619,000 lives in 2021, with the majority of fatalities being children in sub-Saharan Africa, according to the WHO. In Ghana, a nation where malaria is endemic and perennial, an estimated 5.3 million cases and 12,500 deaths were recorded. Therefore, this vaccine is important but not the ultimate solution in this complex fight.
The R21 vaccine is still undergoing phase 3 trials, and the WHO has not yet recommended it for broad use. Preliminary trials have demonstrated efficacy levels of 77%, which has been maintained even after a single booster dose administered a year later. Until the WHO endorses the R21 vaccine, the amount of international funding available for it remains uncertain.
In contrast, the RTS,S vaccine, which the WHO recommended for use in 2021, has more modest efficacy levels. The R21 vaccine is being produced by the Serum Institute of India, a biotechnology behemoth. The institute has the capacity to manufacture more than 200 million doses of the R21 vaccine annually, thereby potentially making a significant impact in the global fight against malaria.
Adar Poonawalla, CEO of the Serum Institute, has expressed that the approval of the vaccine by Ghanaian authorities marks a critical milestone in combating malaria. The process of creating an effective vaccine against malaria has been a century-long scientific endeavor that has seen about 140 vaccine candidates. The R21 vaccine, originating from Oxford University, is set to be the second approved for widespread use.
However, before the R21 vaccine can be widely distributed, there are several key considerations. Agencies such as Gavi, the vaccine alliance, require the vaccine to be deemed safe, effective, and quality assured by the WHO pre-qualification program. The cost-effectiveness of R21 compared to other malaria interventions, such as insecticide-treated nets or indoor residual spraying, that haven't been fully deployed across endemic countries, is still uncertain.
Nonetheless, the approval of the R21 vaccine in Ghana represents a glimmer of hope in the struggle against malaria. This struggle has been impeded by challenges such as insecticide resistance, which is reducing the effectiveness of bed-nets, parasitic resistance to commonly used drugs, and the emergence in Africa of an insecticide-resistant mosquito that thrives in urban environments1.