Malaria vaccines for children: and now there are two

In 2021, nearly half of the world's population lived at risk from malaria, with over 600 000 deaths annually, of which over 95% occur in the WHO African region and 80% of these in children younger than 5 years.1 WHO recommends several preventive and curative interventions that, when used together, can greatly reduce malaria illness and death, including effective vector control, chemoprevention, and prompt diagnosis and treatment, and since October, 2021 malaria vaccines, the first of which is RTS,S/AS01.2 Malaria, specifically Plasmodium falciparum, is the first human parasite for which vaccination has proved possible. R21/Matrix-M is formulated with a saponin-based adjuvant, Matrix-M, which is distinct from the AS01 adjuvant of RTS,S. In the phase 3 trial4 of R21/Matrix-M reported in The Lancet, 5477 children aged 5–36 months in five sites in four sub-Saharan African countries were to be screened; 4878 children received the first dose of vaccine and 3103 children in the R21/Matrix-M group and 1541 children in the control group were included in the modified per-protocol analysis (2412 [51·9%] were male and 2232 [48·1%] were female; mean age 19 [SD 9·0] months). The malaria vaccine community also has the benefit of a strategic framework in the form of the malaria vaccine technology roadmap, and agreement on the priority use cases, and preferred product characteristics for these use cases.10 WHO prioritises the use of malaria vaccines in moderate-to-high transmission settings because this is where the impact will be greatest.2 In these areas, it will be important to ensure that the malaria vaccines are integrated into the existing package of WHO-recommended high-impact measures for malaria control.