The R21/Matrix-M vaccine has been suggested by the World Health Organization (WHO) for the treatment of pediatric malaria. The recommendation was approved by the WHO Director-General during its normal biannual meeting, which took place from September 25–29. It was based on the recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Group (MPAG).
Along with the immunization schedule and COVID-19 product recommendations, WHO also made recommendations based on SAGE's advise for new vaccines against dengue and meningitis. Important vaccination programmatic recommendations from WHO were also made on polio, IA2030, and restarting the immunization campaign.
Following the RTS,S/AS01 vaccine, which was endorsed by WHO in 2021, the R21 vaccine is the second malaria vaccine the organization has approved. It is proven that both vaccines are secure.
Key features of the R21 malaria vaccine:
The updated WHO malaria vaccine recommendation is informed by evidence from an ongoing R21 vaccine clinical trial and other studies, which showed:
High efficacy when given just before the high transmission season: In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to 4 or 5 months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75% during the 12 months following a 3-dose series. A fourth dose given a year after the third maintained efficacy. This high efficacy is similar to the efficacy demonstrated when RTS,S is given seasonally.
Good efficacy when given in an age-based schedule: The vaccine showed good efficacy (66%) during the 12 months following the first 3 doses. A fourth dose a year after the third maintained efficacy.
High impact: Mathematical modelling estimates indicate the public health impact of the R21 vaccine is expected to be high in a wide range of malaria transmission settings, including low transmission settings.
Cost effectiveness: At prices of US$ 2 – US$ 4 per dose, the cost-effectiveness of the R21 vaccine would be comparable with other recommended malaria interventions and other childhood vaccines.
Similarity of R21 and RTS,S vaccines: The two WHO-recommended vaccines, R21 and RTS,S, have not been tested in a head-to-head trial. There is no evidence to date showing one vaccine performs better than the other. The choice of product to be used in a country should be based on programmatic characteristics, vaccine supply, and vaccine affordability
Safety: The R21 vaccine was shown to be safe in clinical trials. As with other new vaccines, safety monitoring will continue.
Next steps for the second recommended malaria vaccine, R21/Matrix-M, include completing the ongoing WHO prequalification which would enable international procurement of the vaccine for broader rollout.
At least 28 countries in Africa plan to introduce a WHO-recommended malaria vaccine as part of their national immunization programmes. Gavi, the Vaccine Alliance has approved providing technical and financial support to roll out malaria vaccines to 18 countries. The RTS,S vaccine will be rolled out in some African countries in early 2024, and the R21 malaria vaccine is expected to become available to countries mid-2024. ;
Dengue recommendations
Due to climate change and urbanization, dengue poses a serious threat to public health in endemic nations and is expected to spread further in terms of both incidence and geographic reach.
In baseline seropositive children (4–16 years old) in endemic countries, the Takeda live-attenuated quadrivalent dengue vaccine (TAK–003) has shown efficacy against all four serotypes of the virus, as well as against serotypes 1 and 2 in baseline seronegative children.
To optimize the public health impact and reduce any potential danger to seronegative people, SAGE advised that the vaccine be introduced in areas with high dengue disease burden and high transmission intensity.
Children between the ages of 6 and 16 should start receiving the vaccine, according to SAGE. Between these ages,
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