As the World Health Organization announces the next step in its rollout of the world’s first authorized malaria vaccine in three African countries, concerns about its value have come from an unlikely source: the Bill and Melinda Gates Foundation, arguably the vaccine’s biggest backer. WHO endorsed the vaccine last fall as a “ historic ” breakthrough in the fight against malaria, but the Gates Foundation told The Associated Press this week it will no longer financially support the shot. Some scientists say they’re mystified by that decision, warning it could leave millions of African children at risk of dying from malaria as well as undermine future efforts to solve intractable problems in public health. The vaccine, sold by GlaxoSmithKline as Mosquirix, is about 30% effective and requires four doses. The malaria vaccine has “a much lower efficacy than we would like,” Philip Welkhoff, the Gates Foundation’s director of malaria programs, told the AP. Explaining its decision to end support after spending more than $200 million and several decades getting the vaccine to market, he said the shot is relatively expensive and logistically challenging to deliver. “If we’re trying to save as many lives with our existing funding, that cost-effectiveness matters,” he said. The Gates Foundation’s decision to pivot away from supporting the rollout of the vaccine in Africa was made years ago after detailed deliberations, including whether the foundation’s money would be better spent on other malaria vaccines, treatments or production capacity, Welkhoff said. Some of the resources that might have gone into getting the vaccine to countries have been redirected to buy new insecticidal nets, for example. “It’s not the greatest vaccine in the world, but there are ways of using it that could have a big impact,” said Alister Craig, dean of biological sciences at Liverpool School of Tropical Medicine. The world is struggling to contain the spike in malaria seen since the coronavirus pandemic disrupted efforts to stop the parasitic disease, which killed more than 620,000 people in 2020 and caused 241 million cases, mainly in children under 5 in Africa, Craig said. “It’s not like we have a lot of other alternatives,” Craig said. “There could be another vaccine approved in about five years, but that’s a lot of lives lost if we wait until then,” he said, referring to a shot being developed by Oxford University. BioNTech, creator of the Pfizer COVID-19 vaccine, plans to apply the messenger RNA technology it used for the coronavirus to malaria, but that project is in its infancy. Another big obstacle is availability; GSK says it can only produce about 15 million doses per year until 2028. WHO estimates that to protect the 25 million children born in Africa every year, at least 100 million doses every year might be needed. Although there are plans to transfer the technology to an Indian drugmaker, it will be years before any doses are produced. “All the money in the world” wouldn’t alleviate the vaccine’s short-term supply constraints, said Welkhoff, of the Gates Foundation. He noted that the Gates Foundation continues to support vaccines alliance Gavi, which is investing nearly $156 million into making the shot initially available in three African countries: Ghana, Kenya and Malawi. “We’re supporting the roll-out via the Gavi funding, but we decided we would not dedicate additional […]

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