Six questions for a supply expert: Michaela Briedova on supplying the malaria vaccine
Learn more about UNICEF’s work to procure and deliver this life-saving vaccine.
On World Malaria Day, we speak to Michaela Briedova, Contracts Specialist, Vaccine Centre, UNICEF Supply Division, about the major developments in malaria vaccines, UNICEF’s role in vaccine procurement and supply, and what countries with a severe burden of malaria can expect in the coming years as vaccine supplies increase.
The RTS,S malaria vaccine is the first vaccine recommended by the World Health Organization (WHO) for use against a human parasitic disease of any kind.
In 2021, nearly half a million children died from malaria in Africa alone. Despite the devastating toll this disease takes on young lives, it has taken over 35 years to get to this point. This is partly because of the technical complexity of developing a vaccine against a parasite, combined with a lack of prioritization and funding for malaria research.
If implemented broadly, the malaria vaccine has the potential to be one of the most impactful vaccines ever due to the high malaria burden affecting primarily young children in sub-Saharan Africa. Its addition to the existing arsenal of malaria control tools could result in millions of malaria cases averted and tens of thousands of children’s lives saved every year.
The vaccine was launched in 2019 with a series of pilot introductions in Ghana, Kenya and Malawi, where nearly 1.5 million children were reached with at least one dose. In October 2021, WHO recommended the widespread use of the malaria vaccine in countries with moderate to high P. falciparum malaria transmission. This recommendation, together with the funding decision from Gavi, the Vaccine Alliance, has generated a lot of enthusiasm about this addition to the malaria toolkit. UNICEF has secured access to 18 million doses of RTS,S malaria vaccine from 2023-2025, which is the projected maximum production capacity for this vaccine. Earlier this year, twelve countries submitted applications for Gavi support to introduce the vaccine, with further application rounds underway throughout 2023.
It is clear that the demand is very high and far surpasses the supply that is expected to become available. To allocate this limited supply equitably for children living in areas of greatest need, WHO led the development of the Framework for Allocation of Limited Malaria Vaccine Supply. By 2026-2027, the supply situation is expected to significantly improve. As production capacity ramps up and new malaria vaccines receive regulatory approval, we expect to see greater volumes of vaccines and lower prices that can be sustained by countries in the long term.
It is important to understand that this vaccine is in addition to and not a substitute for any of the existing malaria prevention tools, such as long-lasting insecticidal nets (LLINs), malaria rapid diagnostic tests and malaria medicine. There is no silver bullet when it comes to malaria control and we must use all the tools available to reduce the burden of this disease and save children’s lives. The pilots demonstrated that the introduction of the malaria vaccine did not result in a decline in the use of other malaria interventions, including LLINs. They also showed that more children who were not using other forms of prevention such as LLINs could be reached with vaccination.
The WHO policy recommendation and Gavi funding ignited a sense of urgency to get the much-awaited malaria vaccine to the children who need it as fast as possible. However, as is the case for other new vaccines when first introduced, the projected RTS,S vaccine production capacity is initially limited and far below the demand. For this vaccine to reach its potential and generate the impact seen through the pilot implementation, we need more malaria vaccines and a healthy malaria vaccine market.
Throughout 2022, we have engaged closely with Gavi and other partners to develop the first market shaping roadmap for the malaria vaccine. We need innovation and the development of new, improved malaria vaccines with increased efficacy, in addition to having more vaccines available at lower prices. Through flexible contracting, close collaboration with industry and the deployment of special contracting tools, UNICEF will ensure that any additional supply can be contracted for supply without delay.
This is a fast-evolving environment and there is a possibility that an additional vaccine, R21/Matrix-M malaria vaccine, currently in Phase III trials, could reach the market as early as 2024. This would bring us one step closer to a healthier malaria vaccine market and more children being reached with this life-saving tool.
As UNICEF procures vaccines for 45 per cent of the world’s children, we have a unique role and opportunity to leverage our partnerships and engagement with industry to bring new vaccines, including the malaria vaccine to children as fast as they reach the market. We work to ensure that new vaccines will be affordable for countries and sustainable for manufacturers in the long term.
Within UNICEF, we have a strong team with expertise in immunization, new vaccine introductions, malaria programming, south-south cooperation, as well as supply and logistics. We collaborate with multiple donors and stakeholders who have worked on malaria programming for decades. We also have new partners and stakeholders joining this scope of work. UNICEF can ensure that we maximize this collective experience and expertise while capitalizing on new opportunities to deliver vaccines for children within accelerated timelines and ultimately save lives.
UNICEF has engaged closely with governments, policy makers, partners and stakeholders to ensure that the WHO policy recommendation, Gavi programme support, the supply situation and next steps are well understood.
While I have been the focal point for the supply of malaria vaccine for the last two and a half years, I have benefitted from the expertise and experience of colleagues who have supported other new vaccine introductions and those who have been part of the malaria vaccine development for many years before me. It is a real privilege to be able to see the malaria vaccine supply taking shape towards finally reaching children.
It is also a privilege to be part of the conversations on the future of the malaria vaccine market. Connecting the dots between the pilot implementation, the tender, contract negotiations, and the future malaria vaccine market and contributing to the conversations on supply challenges is very rewarding.
There is a lot of hard work ahead of us to ensure that the vaccine supply reaches countries without delay and through engagement with industry and developers, we secure access to more vaccine as it becomes available, at prices that are sustainable in the long term. Our procurement strategy is designed to ensure that we can react quickly to the changes in market dynamics in the coming years.