World Health Organization (WHO) issued a recommendation for the use of the R21/Matrix-M vaccine as a preventive measure against malaria in children.

This recommendation comes after thorough deliberation and endorsement by the WHO Director-General, following the counsel of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Group (MPAG) during their regular biannual meeting held from September 25th to 29th.

Notably, this marks the second malaria vaccine recommended by the WHO, following the RTS,S/AS01 vaccine, which received WHO endorsement in 2021. Both vaccines have demonstrated their safety and efficacy in preventing malaria in children. When implemented on a broad scale, they are expected to have a significant positive impact on public health. Malaria, primarily transmitted through mosquito bites, poses a considerable threat to children in the African Region, where nearly half a million children succumb to the disease annually.

While the demand for malaria vaccines is substantial, the availability of the RTS,S vaccine remains limited. The inclusion of the R21 vaccine in the list of WHO-recommended malaria vaccines is expected to substantially enhance vaccine supply, ensuring that all children residing in malaria-prone areas can benefit from protection against the disease.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, expressed his optimism, stating, "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 RTS,S 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."

Dr. Matshidiso Moeti, WHO Regional Director for Africa, emphasized the significance of this recommendation for the continent, saying, "This second vaccine holds real potential to close the huge demand-and-supply gap. Delivered to scale and rolled out widely, the two vaccines can help bolster malaria prevention and control efforts and save hundreds of thousands of young lives in Africa from this deadly disease."

Key Attributes of the R21 Malaria Vaccine:

• High efficacy when administered just before the high malaria transmission season, reducing symptomatic cases of malaria by 75% in areas with seasonal transmission.
• Demonstrates good efficacy (66%) during the 12 months following the initial 3 doses.
• Expected to have a substantial public health impact in a variety of malaria transmission settings, including low transmission areas.
• Cost-effective, with estimated prices ranging from US$2 to US$4 per dose.
• Safety profile affirmed through clinical trials, with ongoing safety monitoring.
• It's worth noting that the R21 and RTS,S vaccines have not been directly compared in clinical trials. The choice between the two vaccines in a given country will be influenced by programmatic considerations, vaccine supply, and affordability.

The next steps for the R21/Matrix-M vaccine include completing the ongoing WHO prequalification process to facilitate international procurement and broader distribution. Approximately 28 African countries are planning to introduce WHO-recommended malaria vaccines as part of their national immunization programs. Gavi, the Vaccine Alliance, has approved technical and financial support for vaccine rollout in 18 countries. The RTS,S vaccine is scheduled for introduction in some African nations in early 2024, while the R21 malaria vaccine is expected to become available to countries in mid-2024.

In addition to the recommendation for the R21/Matrix-M vaccine, WHO also issued recommendations related to dengue and meningitis vaccines, as well as immunization schedules and products for COVID-19. The recommendations aim to address various public health challenges and advance global immunization efforts.