Public health

On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. COVID-19 remains the most widespread public health crisis in more than a century. By the end of 2021, more than 5.4 million COVID-19 deaths had been officially reported worldwide, although WHO estimates that the true death toll was substantially higher.

Unprecedented scientific, industrial, and political collaboration saw COVID-19 vaccines developed in record time. The vaccines were highly effective at preventing severe disease and protecting lives.

But by the end of 2021, just 33% of people in Africa had received a first dose and 98 countries had missed the target set by WHO of vaccinating 40% of their populations.

Market situation

COVID-19 vaccine distribution was fraught with inequality. While high-income countries quickly secured deals for billions of doses, lower-resource countries struggled to access the shots.

COVAX is a global partnership set up to ensure equitable access to COVID-19 vaccines. The COVAX Advance Market Commitment (AMC) pooled donor funding to enable 92 of the world’s lowest-income countries to receive COVID-19 vaccine free of charge. COVAX aimed to supply these doses as soon as possible.

As supply projections improved in mid-2021, COVAX announced a new Cost-Sharing Mechanism to enable AMC countries to self-finance additional doses. This would help countries to meet national vaccination targets and help them get back on track towards the WHO’s 40% target.

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

Africa accounts for around 17% of the world’s population and around 25% of global vaccine demand, yet more than 98% of vaccines used on the continent are imported. This dependence on overseas manufacturing leaves countries vulnerable to disruptions in global supply chains and limits regional resilience during health emergencies.

Strengthening vaccine manufacturing in Africa is a priority for governments, donors and global health organisations, since the COVID-19 pandemic exposed the risks of relying heavily on imported products.

Market situation

Vaccine manufacturing in Africa remains a small and emerging industry. African manufacturers must compete with large global suppliers that have established production facilities, lower costs and the ability to manufacture at scale. This makes it harder for individual African suppliers to secure the long-term finance needed to expand, and harder for the wider industry to develop the breadth of capabilities required for resilient regional supply.

Much of Africa’s current vaccine manufacturing is focused on fill and finish, with fewer manufacturers covering a broader manufacturing spectrum. Building end-to-end capability, including drug substance production, can take many years and requires significant investment, technology transfer and specialist expertise.