R21/Matrix-M vaccine: optimising supply, maximising impact
Authors: Chukwudi A Nnaji, Uchenna A Amaechi, Charles S Wiysonge
Journal: The Lancet (2024)

Following decades of extensive research and development, a second malaria vaccine, the R21/Matrix-M vaccine, has been recommended by WHO.1WHOWHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization.https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunizationDate: Oct 2, 2023Date accessed: October 30, 2023Google Scholar The recommendation comes at a crucial time when progress has stalled over the past decade due to a host of factors, including parasite resistance and persisting suboptimal access to preventive interventions, diagnostics, and therapeutics, with service disruptions by the COVID-19 pandemic posing additional constraints.2Noor AM Alonso PL The message on malaria is clear: progress has stalled.Lancet. 2022; 3991777 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar The addition of the new vaccine to the arsenal of malaria control and elimination tools offers a glimmer of hope and creates an impetus for expediting current efforts. It is hoped that the R21/Matrix-M vaccine, when prequalified, will help address the access gaps resulting from the limited supply of the RTS,S/ASO1 vaccine. Available and projected supplies of both vaccine options are however unlikely to be sufficient to meet current demand. It is estimated that 40–60 million doses will be needed to meet demand by 2026, increasing to 80–100 million doses annually by 2030.3Gavi, the Vaccine AllianceGavi outlines plans to build sustainable supply of malaria vaccines.https://www.gavi.org/news/media-room/gavi-outlines-plans-build-sustainable-supply-malaria-vaccinesDate: April 25, 2023Date accessed: October 30, 2023Google Scholar To reach all at-risk children younger than 5 years, demand could rise even further, considering growing birth cohorts in sub-Saharan Africa and potential deployment in pre-elimination and elimination settings. Anticipated supply of the R21/Matrix-M vaccine from the Serum Institute of India and the recent agreement between UNICEF and Serum Life Sciences to secure additional supplies are both positive steps.4UNICEFUNICEF signs deal to deliver new malaria vaccine in breakthrough for child survival.https://www.unicef.org/press-releases/unicef-signs-deal-deliver-new-malaria-vaccine-breakthrough-child-survivalDate: Oct 12, 2023Date accessed: October 30, 2023Google Scholar However, expanding the number of manufacturers further can help to prevent the risks associated with having a limited pool of producers, such as inadequate or interrupted global supply, should there be unanticipated disruptions (as was evident with the COVID-19 pandemic). Moreover, enabling vaccine manufacturing in the African continent could have the added advantage of lowering production costs in the medium to long term and could also boost global supply to reach populations in essential need of protection from the devasting burden of malaria. Reducing costs of vaccine production is particularly crucial, given the dire economic situations in many countries bearing the highest burden of malaria—which could ultimately mean less fiscal space for such countries to mobilise and allocate resources to meet broader vaccine financing and co-financing obligations. Existing vaccine manufacturing infrastructure could be leveraged to manufacture the R21/Matrix-M malaria vaccine through timely and effective technology transfer. This effort would require having the full range of technical, regulatory, and legal mechanisms that are essential to ensure a successful vaccine technology transfer. In our view, these are urgent considerations and a perfect opportunity for efforts at the global, regional, and national levels to enable a timely and effective expansion of manufacturing capacity to boost vaccine supply. Expanding vaccine manufacturing could also create prospects for lowering costs and fostering cost-efficient deployment of approved vaccines for malaria and other priority vaccine-preventable diseases. This could also be an opportunity for galvanising the proposed African Vaccine Manufacturing Accelerator—a financing instrument which aims to catalyse vaccine manufacturing in Africa.5Africa Centres for Disease Control and PreventionAfrica CDC & Gavi, the Vaccine Alliance host the first manufacturers marketplace for vaccine manufacturing African Union member states. News release.https://africacdc.org/news-item/africa-cdc-gavi-the-vaccine-alliance-host-the-first-manufacturers-marketplace-for-vaccine-manufacturing-african-union-member-statesDate: Oct 1, 2023Date accessed: October 30, 2023Google Scholar We believe such initiatives could play a vital role in consolidating current efforts and accelerating progress towards actualising the 2030 global targets to move the world closer to a malaria-free future. We declare no competing interests. The views and opinions expressed here are those of the authors only and do not necessarily represent those of their affiliated institutions.