Reductions in funding will hit administration of malaria vaccines at the local level in endemic areas, with implications for increased cases and deaths, experts said at a press briefing on malaria sponsored by the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Malaria remains a deadly threat in many areas of Africa, and the development of a safe and effective vaccine has been “a holy grail,” said William Moss, MD, professor of epidemiology and international health at the Johns Hopkins Bloomberg School of Public Health and deputy director of the Johns Hopkins Malaria Research Institute in Baltimore, in the briefing.

Currently available vaccines have had significant public health benefits, especially when children aged 5-7 years received four doses, Moss said in the briefing. However, current changes in the funding structure and decreases in available funding threaten to slow progress in these areas, he said.

“Malaria vaccines are the latest major tool in our toolbox to fight malaria, and many countries in high-burden areas of sub-Saharan Africa have introduced a malaria vaccine over the past 2 years,” Moss told Medscape Medical News. “These vaccines are critical because of stalled progress in reducing malaria cases and deaths with our current tools, in part because increasing insecticide resistance limits the effectiveness of vector control strategies, and the reduced sensitivity of rapid diagnostic tests in some areas limits our ability to rapidly diagnose and treat children with malaria,” he said. “Funding cuts for global malaria vaccination, alongside cuts to other malaria control programs, can lead to an increase in cases and deaths,” he said.

Current threats to global progress against malaria, which include antimalarial drug resistance and mosquito resistance to the insecticides used on bed nets in endemic areas, were also outlined in the briefing by Jane M. Carlton, PhD, director of the Johns Hopkins Malaria Research Institute and a professor of microbiology and immunology. She also noted the downsizing of the US Agency for International Development’s President’s Malaria Initiative and less funding than expected from Gavi, the Vaccine Alliance.

Gavi’s membership, according to its website, includes “partner country and donor governments, WHO [World Health Organization], UNICEF [United Nations International Children’s Emergency Fund], the World Bank, the vaccine industry, technical agencies, civil society, the Gates Foundation, and other private sector partners.”

Using Resources Wisely

Current estimates are that 13% of Gavi’s funding came from the US, Moss told Medscape Medical News. Countries other than the US, such as the UK, also cut support for Gavi and other foreign assistance programs, and Gavi is approximately $2.5-$2.9 billion short of its $11.9 billion goal for 2026-2030, Moss said.

“Local health organizations facing resource constraints will need to use their available resources more efficiently,” said Moss. This may involve prioritizing the most vulnerable children and communities and ensuring minimal waste of precious commodities, he added. Newly developed dual-active ingredient long-lasting insecticidal nets will help, but effective malaria control requires a multipronged approach, he emphasized.

Barriers and Next Steps

“Barriers to vaccination can be classified as those related to access and those related to demand,” Moss said. Access to the R21 vaccine, the newest malaria vaccine, approved by the WHO in 2023, remains a challenge in some areas, he noted. In addition, some countries with a high malaria burden have yet to introduce any vaccine, and even those that have introduced it face challenges with limited access for the at-risk population, he said.

In general, demand is high for malaria vaccines in communities with a high malaria burden, Moss told Medscape Medical News. However, one key challenge specific to malaria vaccines is the need for a four-dose administration schedule that differs from the current vaccine schedule for other routine childhood immunizations and requires additional visits to health facilities, he said.

The current malaria vaccines are good, but not ideal; an ideal vaccine would be more effective with fewer doses and would target multiple parasite stages, Moss told Medscape Medical News. In the meantime, more research is needed to optimize existing malaria vaccines in part by examining the dosing schedule of the current malaria vaccines in different transmission settings and understanding local barriers and facilitators to high vaccine uptake, he said.

More information on the status of malaria vaccine introductions worldwide and on malaria is available through VIEW-hub, an open-access data visualization tool developed and maintained by the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.

Carlton and Moss disclosed having no relevant financial conflicts of interest.