Authors

A Hill¹;  ¹ Jenner Institute, University of Oxford, UK

Discussion

Malaria remains a major cause of mortality in children in sub-Saharan Africa with a total of over 600,000 deaths and 200 million clinical cases globally each year. Technically it has been very difficult to design effective anti-parasitic vaccines, over 140 distinct malaria candidate vaccine have reached clinical trials, and last year none were in programmatic deployment. A new nanoparticle-in adjuvant vaccine, R21 in Matrix-M^TM adjuvant, has been designed by the Jenner Institute at the University of Oxford and initial clinical testing showed efficacy in a controlled human infection model. From 2017, in partnership with the Serum Institute of India, an accelerated programme of vaccine development in African children included a phase IIb trial at Nanoro, Burkina Faso which showed unprecedented efficacy of >75%. In a recently reported phase III trial in 4800 children across four countries in sub-Saharan Africa (Lancet 10426: 533-544, 2024) good safety was documented and high level efficacy was confirmed. Immunological analyses have identified likely immune correlates of protective efficacy. This vaccine has now received initial regulatory and policy approvals and plans for its deployment, scale up, wider use and potential impact will be discussed. In parallel, the RTS,S/AS01 vaccine from GSK is also set for roll out at a smaller scale this year and several blood-stage and transmission-blocking vaccines are showing promise in African trials.