Mosquirix: The WHO-backed, game-changing vaccine that can lead the fight against malaria

The World Health Organization on Wednesday endorsed Mosquirix, the trade name for RTS,S/ASO1 (RTS.S), as the first only vaccine to have displayed a capability of reducing significantly malaria and severe malaria in young children in Africa.

The vaccine acts against the deadliest malaria parasite — P. falciparum — most prevalent in Africa. Over a four-year clinical trial, Mosquirix prevented approximately 40% malaria cases among children who received four doses.

Mosquirix is the first anti-malaria vaccine to complete clinical development. The European Medical Agency has also given positive scientific opinion for the vaccine.

Three national health ministries have already introduced Mosquirix through their childhood immunisation programmes, becoming the first malaria vaccine to achieve this feat. The governments of Kenya, Ghana, and Malawi have inoculated 800,000 children who are benefiting from vaccine’s added protection as part of a pilot programme.

Recent clinical evidence suggests that the vaccine’s strategic delivery just prior to the high-transmission season in areas where malaria is seasonal can optimise its impact and significantly reduce mortality, especially when combined with other recommended interventions.

A fatal disease caused by parasites transmitted through infected female Anopheles mosquitoes, malaria is preventable and also curable.

Still, an estimated 229 million malaria cases were reported worldwide in 2019, with the number of deaths estimated at 409,000.

Children below five are most vulnerable to malaria, accounting for 274,000 or 67% of global deaths in 2019.

In 2019, India recorded an estimated 5.6 million cases, according to WHO data.

How can the vaccine help?
WHO has recommended the use of Mosquirix following advice from its two global advisory bodies, one for malaria and the other for immunisation.

The global health body has recommended that the RTS,S/AS01 vaccine be used to prevent P. falciparum malaria in children in regions of moderate-to-high transmission.

The vaccine should be provided in four doses from five months to reduce the disease and its burden.

The next steps will include funding decisions for broader rollout in countries where malaria is endemic, and country-wise decision-making on adopting Mosquirix as part of national malaria control measures.

Countries that eliminated malaria
The malaria elimination net across the world is widening, with many countries moving towards a ‘zero malaria’ goal. Twenty-seven countries reported fewer than 100 indigenous cases in 2009, up from six in 2000.

Countries that achieve a minimum of three consecutive years with zero indigenous cases can apply with WHO for malaria elimination certification. The WHO Director-General has certified 11 countries as malaria-free over the past two decades — the United Arab Emirates in 2007, Morocco and Turkmenistan in 2010, Armenia in 2011, Kyrgyzstan and Sri Lanka in 2016, Uzbekistan and Paraguay in 2018, Algeria and Argentina in 2019, and El Salvador in 2021.