Avoiding Another Lost Decade on Malaria Vaccines

After decades of research and development, two new malaria vaccines entered routine administration this year, and are projected to save 180,000 children’s lives by 2030. But under current plans, roughly 2.5 million children will die of malaria unvaccinated over the same period. What’s stopping a faster rollout? Money is the obvious answer. Nigeria, home to a third of global malaria deaths, has a total health budget of $10 per capita, and qualifies for only limited international assistance to purchase a vaccine that costs more than $15 per child for even the generic R21 variety. Poorer countries like the Democratic Republic of Congo have received highly subsidized vaccines, but will struggle to ensure take-up for a four-dose regimen without additional expenditure on community outreach and cold-chain management. Despite these financing challenges, malaria vaccines appear highly cost effective, at around $4,200 per life saved, rivaling some of the best buys in global health. While policymakers must weigh malaria spending against other disease priorities, the advent of vaccines implies malaria can absorb more resources while maintaining higher cost effectiveness than ever before. The most ambitious rollout would exceed the malaria budget of Gavi, the Vaccine Alliance, by $2 to $3 billion over the next five years.