Footnotes for "Why GiveWell funded the rollout of the malaria vaccine"

[1] "The estimated deaths in 2021 were 619 000, a slight decline compared with 2020." World Health Organization, World malaria report 2022, p. 17

"The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2021 the Region was home to about 95% of all malaria cases and 96% of deaths. Children under 5 years of age accounted for about 80% of all malaria deaths in the Region." World Health Organization, "Malaria," 2023

"Malaria is a life-threatening disease spread to humans by some types of mosquitoes. It is mostly found in tropical countries. It is preventable and curable." World Health Organization, "Malaria," 2023

[2] "In October 2021, on the advice of two WHO global advisory bodies, one for immunization and the other for malaria, the Organization made this recommendation. WHO recommends the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO." World Health Organization, "Q&A on RTS,S malaria vaccine," 2023.

[3] See our estimates of the numbers of children treated in our cost-effectiveness model for this grant here.

[4] "Vaccinations began in the 3 pilot countries in 2019: in Malawi on 23 April, in Ghana on 30 April, and in Kenya on 13 September." World Health Organization, "Malaria: The malaria vaccine implementation programme (MVIP)," 2020

"WHO is working with PATH and GSK on the vaccine pilot programme through a collaboration agreement. PATH provides technical and project management support and is leading studies on health care utilization and the economics of vaccine implementation." World Health Organization, "Malaria: The malaria vaccine implementation programme (MVIP)," 2020

[5] "It is important at this stage to learn how best to introduce the malaria vaccine into routine immunization systems, and to evaluate that introduction. To do this, some districts/sub-counties within the selected areas will have the opportunity to introduce the vaccine into their immunization schedules at the start of the programme, while other districts will not receive the vaccine until a later date, should there be a WHO recommendation for wider use. Assignment of areas into those that receive the vaccine and those that do not has been through a process called “randomization”, based on chance using a computer programme.

Introducing the vaccine into some areas, while delaying it in others, is also important for understanding the public health usefulness of the vaccine and will provide key information on whether the vaccine should be introduced throughout the pilot countries and more broadly across Africa." World Health Organization, "Malaria: The malaria vaccine implementation programme (MVIP)," 2020

[6] Gavi, the Vaccine Alliance is a public–private global health partnership that provides support to increase access to immunization in poor countries.

[7] "If GiveWell didn’t fund this opportunity, the most likely scenario is that access to these vaccines would be available only through the standard process of these countries applying for support through Gavi’s malaria vaccination program. The earliest rollout through Gavi processes would be by the end of 2023." GiveWell's non-verbatim summary of a conversation with PATH and WHO, January 5, 2022

[8] "GSK is donating up to 10 million doses of RTS,S vaccine for use in the pilot and is leading additional studies to continue monitoring the vaccine’s safety and effectiveness in routine use." World Health Organization, "Malaria: The malaria vaccine implementation programme (MVIP)," 2020

[9] "The limited potential alternative use of donated doses if they weren’t used to expand vaccine access within the pilot comparison areas. As part of the Malaria Vaccine Implementation Programme (MVIP), there was an agreement that GSK would provide up to 10 million doses. It is generally understood that these doses should be used for the pilot comparison areas." GiveWell's non-verbatim summary of a conversation with PATH and WHO, January 5, 2022

[10] "If GiveWell didn’t fund this opportunity, the most likely scenario is that access to these vaccines would be available only through the standard process of these countries applying for support through Gavi’s malaria vaccination program. The earliest rollout through Gavi processes would be by the end of 2023.

With GiveWell funding, the expansion to pilot comparison areas could be in the third or fourth quarter of 2022." GiveWell's non-verbatim summary of a conversation with PATH and WHO, January 5, 2022

[11] Technical assistance is a broad category, but generally refers to programs that focus on helping governments implement an intervention, rather than programs that implement an intervention directly.

See expected grant activities here.

[12] Malawi began expanded implementation in November 2022, Ghana in February 2023, and Kenya in March 2023. Sally Ethelston, Director, Resource Mobilization and Outreach, Malaria Vaccines, PATH, emails to GiveWell, February 23, 2023 and March 7, 2023 (unpublished)

[13] "WHO advises countries to use a tailored mix of recommended malaria control interventions – including the malaria vaccine – to increase impact in reducing malaria illness and deaths among children living in areas of moderate to high malaria transmission." World Health Organization, "Q&A on RTS,S malaria vaccine," 2023.

"For malaria, WHO has recommended a range of interventions - namely, vector control, chemoprevention, diagnostic testing and treatment - to reduce transmission and prevent morbidity and mortality." World Health Organization, "Guidelines for Malaria - 14 March 2023"

"Malaria vector control interventions recommended for large-scale deployment are: i) ITNs [insecticide-treated nets] that are prequalified by WHO, which in many settings continue to be pyrethroid-only long-lasting insecticidal nets (LLINs)" World Health Organization, "Guidelines for Malaria - 14 March 2023"

[14] Thus the study’s findings will only apply to perennial transmission environments.

[15] "An important advantage of R21/MM relates to its potential for large-scale manufacturing, which will be critical for the supply of hundreds of millions of doses of vaccine required annually for each birth cohort of children in malaria endemic regions of Africa…. The saponin adjuvant, MM, lacks the monophosphoryl lipid A adjuvant component, which is found in other adjuvants and is less complex to manufacture, and this enables large-scale and low-cost supply of R21/MM." Datoo et al. 2021

[16] "The malaria vaccine market faces considerable supply constraints in the short term and potentially into the medium term, with initial supply expected to fall substantially short of demand." Gavi, the Vaccine Alliance, Market Shaping Roadmap: Malaria Vaccines, p. 2