Public health

The P. vivax malaria parasite caused an estimated 6.9 million cases of malaria in 2022. Complete treatment requires elimination of the parasite from the blood as well as the liver. This treatment is known a ‘radical cure’.

However, doctors are wary of prescribing the most effective treatments because the treatments can cause severe anaemia in patients who are deficient in the enzyme glucose-6 phosphate dehydrogenase (G6PD). This affects 400 million people worldwide.

The World Health Organization (WHO) recommends conducting a G6PD deficiency test prior to treatment of P. vivax malaria patients, to guide treatment decisions. But many countries have not adopted this recommendation meaning point of care G6PD tests are not widely available.

In places with no access to G6PD testing, patients are usually prescribed longer courses of primaquine with lower dosing. However, patients often stop taking the pills when they start to feel better and this can lead to reinfection because the parasite persists in their liver.

Market situation

G6PD testing is required for countries to be able to roll-out tafenoquine, a new, more effective treatment for P. vivax malaria.

However, widespread adoption of G6PD testing has been limited due to inconsistent supply, low affordability, and the absence of cost-effectiveness, operational, and feasibility studies. In turn, commercial sustainability of the product has been threatened by the relatively small market size, uncertain demand, and complexity of producing and commercialising testing equipment. This caused some suppliers to exit the market.

At the time, SD Biosensor’s STANDARD G6PD Test was the only quantitative point-of-care G6PD test on the market. Demand visibility was critical to sustaining production levels and supporting the commercial feasibility of the product, while high-burden priority countries finalised studies, and rolled-out G6PD testing in accordance with WHO recommendations.

Lives changed

Estimates for treatment eligibility were derived from projections by Watson et al. Estimates of treatment outcomes were derived from a 2020 meta-analysis by Rodrigo et al.

Money saved

Impact was based on actual price reductions for G6PD tests over the course of the volume guarantee.

Markets shaped

We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact.

Public health

Malaria is a life-threatening illness caused by parasites transmitted to people bitten by infected female Anopheles mosquitos.

The World Health Organization (WHO) estimates that malaria claimed 601,000 lives in 2021. Africa is disproportionately affected by malaria, accounting for approximately 95% of the cases and 96% of the deaths worldwide in 2021; nearly 80% of those deaths were in children under five.

Although existing interventions have helped to reduce malaria deaths significantly since 2000, a vaccine adds an important complementary tool for malaria control efforts.

Before GSK and partners developed RTS,S, the world had never had a malaria vaccine. The RTS,S vaccine was developed specifically to tackle P. falciparum malaria in Africa.

Market situation

RTS,S received a positive medical opinion from the European Medicines Agency in 2015. At the time of signing this agreement, the vaccine was being piloted in routine immunisation programmes through the World Health Organization’s Malaria Vaccine Implementation Programme (MVIP). Interim data from the pilots was expected in late 2021, which would enable WHO to issue a recommendation for wider use. GSK committed to produce the vaccines required for the MVIP but was unable to promise further production until there was certainty on vaccine roll-out and demand. This required a recommendation for use from WHO and funding commitments from Gavi.

Because the vaccine was to be given as part of routine immunisation for children – rather than campaigns for adults – there was no other viable market for the vaccine. A halt in manufacturing would have resulted in millions of children not having access to the vaccine while production was restarted and scaled up.

All development impact estimates were dependent on the exact timing of WHO’s policy decision and Gavi’s funding decision. We projected impact across various timelines between 2021 and 2028 to ensure we captured the full range of potential impact.

Lives changed

Inputs used to estimate expected additional children vaccinated through the accelerated access to RTS,S include timing of key policy and funding decisions, expected production schedules, and projected demand following a Gavi decision. Deaths and cases averted are estimated using modelling published by Penny et al. in 2016 and assume available vaccine doses will be used to fully vaccinate fewer children rather than partially vaccinate a greater number.

Money saved

Impact is estimated based on the additional costs associated with a stop-and-start production scenario, which was used to calculate an average price per dose for projected doses purchased between 2021 and 2028 across various timelines.

Markets shaped

We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact.

Public health

Malaria is a life-threatening illness caused by parasites transmitted to people bitten by infected female Anopheles mosquitos. The World Health Organization (WHO) estimates that malaria claimed 567,000 lives in 2019. Africa is disproportionately affected by malaria, accounting for approximately 95% of the cases and 96% of the deaths worldwide in that same year; 80% of those deaths were in children under five.

Insecticide-treated nets (ITNs) help prevent the spread of malaria by providing a physical barrier between mosquitos and sleeping people. However, growing resistance among mosquitos to pyrethroids – the main insecticide class used in standard ITNs – is hindering progress. According to WHO, 78 of the 88 malaria-endemic countries, covering all regions of sub-Saharan Africa, reported mosquito resistance to at least one of the four commonly-used insecticide classes in the period 2010-2019. Millions more people are at risk as standard nets become less effective in high resistance areas.

Market situation

While the price of standard nets has reduced substantially over the past decade, next-generation nets are more expensive. Despite its benefits, uptake of this new net was expected to be slow due to market-related barriers, including slow prioritisation, adoption uncertainty, and higher prices related to production. Many countries were cautious about buying next-generation nets as data from randomised controlled trials in Tanzania and Benin were being collected ahead of publication in 2022 and 2023 respectively.

In 2018, BASF’s Interceptor^® G2 net was the only dual-active ingredient net using pyrethroid and chlorfenapyr, a new class of insecticide in public health. This made a volume guarantee the ideal instrument to address the high-price low-volume dynamic and support accelerated introduction of the nets ahead of expected growth in the market for dual-active ingredient nets.

Lives changed

Impact was based on projections developed by malaria modelling experts at Imperial College London. The figures provided by Imperial represent the impact of switching from standard long-lasting insecticide-treated nets to Interceptor^® G2 nets within the countries where the nets are distributed.

Money saved

The price of individual nets varies by size. Impact was estimated based on actual price reductions for an average-sized net over the course of the volume guarantee.

Markets shaped

We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact. To quantify change against a baseline, we used publicly available indicators as proxies for market-wide change.