RTS,S malaria vaccine

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 619,000 lives in 2021. Africa is disproportionately affected by malaria, accounting for approximately 95% of the cases and deaths worldwide. 80% of malaria deaths in Africa are in children under five.

Although existing interventions have helped to reduce malaria deaths significantly over the past 15 years, 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.