After years of research, the RTS,S/AS01 (RTS,S) malaria vaccine is the first new tool in the fight against malaria in more than 15 years. “The importance of this step cannot be overstated,” says Professor David Schellenberg, Professor of Malaria and International Health at London School of Hygiene & Tropical Medicine. “Given the enormous burden of malaria on the world and the lack of new tools to deal with it, this is a really important step.”

Whilst excitement for the vaccine is understandable, it is certainly not a miracle cure. Clinical trials show the vaccine has an efficacy of around 50 per cent at best, which is modest in comparison to most other vaccinations.

Schellenberg is keen to point out that administering vaccines within the highly monitored environment of a clinical trial is also very different from the reality in the field. More research is needed to assess the feasibility and impact of the vaccine when used in ‘real life’, before it becomes widely available.

One of the major considerations is the fact that, unlike most other vaccines that require one to three doses, RTS,S requires infants and young children to receive four doses: the first three doses at monthly intervals and a fourth dose 18 months later. This poses a number of challenges in communities where the majority of healthcare is administered through private or informal settings.

A pilot implementation of RTS,S is currently being planned for children aged 5-7 months in a number of sub-Saharan African countries. The outcome of this project, which will take roughly four years, will enable the World Health Organisation to make recommendations on a larger roll out of the vaccine. Another consideration is the cost of the vaccine and GSK, the manufacturers of RTS,S, need to find the most cost-effective way to provide it on a large scale.

“Whatever the results, the vaccine won’t be prioritised over other methods to prevent malaria,” states Schellenberg. The current methods of using insecticide-treated mosquito nets and indoor spraying, alongside rapid diagnostic testing and anti-malarial drugs, whilst not perfect, are certainly working. The addition of a malaria vaccine will strengthen the arsenal of tools to fight what remains the world’s most deadly disease.

“We can do an awful lot more to improve our malaria response and having new tools is essential,” concludes Schellenberg. “This disease is preventable and we must do better. It doesn’t have to be like this.”