UNICEF and Gavi Urged to Boost Malaria Vaccine Orders

Malaria vaccine manufacturers have urged the United Nations Children’s Fund (UNICEF) and the global vaccine alliance Gavi to order more vaccines to reduce costs and strengthen a historic but challenging battle to combat one of Africa’s most deadly illnesses.

However, multilateral organizations have warned that expanding supply will not alleviate the logistical challenges faced by the world’s first malaria immunization program, which began in January.

On Monday, the Serum Institute of India, the world’s largest vaccine maker, announced that it could produce four times the number of doses ordered by Unicef and Gavi.

“[R21] will make a huge impact in saving children’s lives in Africa,” Adar Poonawalla, Serum’s CEO, told the Financial Times. However, he noted that the business was losing money on every jab and that more orders were required to break even and the Malaria vaccine campaign to succeed.

In an interview at Serum’s offices in Pune, Poonawalla stated that if funders do not support Gavi, the organization may not receive the desired coverage. He stated that Serum was planning to send 100 million doses to Sub-Saharan Africa over the next four years despite having the capability for 100 million shots per year.

Bharat Biotech, a Hyderabad-based vaccine manufacturer that will take over production of British pharmaceutical company GSK’s malaria vaccine in 2028, said it required more advance orders from Unicef and Gavi to ramp up production.

“If they don’t indicate well ahead of time that they need ‘x’ million of doses of product at a certain timeline, it’s difficult for us to make an at-risk investment and have the product available on time,” Krishna Ella, executive chair of Bharat Biotech. However, government and industry executives stated that international organizations will gradually increase immunization efforts.

According to Mary Hamel, chief of the WHO malaria vaccine implementation project, GSK provided 18 million doses in the program’s first three years, which was “substantially lower” than international bodies anticipated.

Thomas Breuer, GSK’s chief global health officer, stated that, despite the low numbers, not all of the 3.5 million malaria vaccine doses delivered in 2023, at a pilot stage before the general launch, were utilized.

Countries Receiving Malaria Vaccines

According to Andrew Jones, deputy director of immunization supply at Unicef, the vaccine’s intricate dosing regimen — which requires four jabs within the first two years of a child’s life — caused planning delays, “hence the doses not being fully used last year”. “Supply is not the issue now: the key is getting countries ready and trying to deliver to all countries that have made a request,” Jones stated.

Gavi’s chief program officer, Aurélia Nguyen, stated that all available doses had been used and that the R21 supply would support a wider rollout. When asked about the calls for larger orders, Nguyen said Gavi attempted to balance moving rapidly enough to have a visible health impact while ensuring the vaccine program was not “poorly implemented or sets countries up for fiscal issues”.

Nguyen added that eight countries have received malaria vaccines since the campaign’s launch in January, and seven more are scheduled to receive them this year. Serum said it sent its first batch of 43,200 R21 pills to the Central African Republic on Monday.

Serum’s ability to generate vast quantities should assist in meeting the high demand: In January, Gavi predicted that Africa would require 80-100 million doses per year by 2030.

However, Jenny Hill, an epidemiologist at the Liverpool School of Tropical Medicine, believes that increased supply will not overcome the first logistical issues. “You need a cold chain [temperature-controlled logistics], skilled people, effective communication tactics, and follow-up with children after all four doses.

“It’s extremely difficult to recover from a bad start,” Hill explained. The GSK jab costs €9.30 per dosage, making it the most expensive vaccine funded by Gavi, whereas Serum provides the R21 vaccine for around $4.

The WHO believes both jabs are equally effective, and Poonawalla stated that while the price Serum charged was now lower than its costs, it will decline as production expands.

However, he reminded Gavi that larger orders would require more funding. “Even if you made a dairy farm here . . . you make more money,” he stated, adding: “At some point, donors who donate to Gavi would have to look at substantially increasing the envelope.”

GSK manufactures its jab in Belgium. Breuer said he expected pricing to decline after Bharat Biotech took over production, and GSK was looking into whether its Malaria vaccine could be supplied in fewer doses.

Ella stated that the Indian company aimed for an annual capacity of 40 million doses but declined to disclose on pricing. Nguyen stated that Gavi would urge producers to lower their pricing while it asked donors to increase their support for its next funding cycle, which begins in 2026.

The vaccination alliance won $21.3 billion for the 2021-25 cycle. “It’s a really important part of our ask to our sovereign donors and others to make sure that this programme has the viability that is very much needed,” Nguyen added.