# Initial thoughts on malaria vaccine approval

The World Health Organization (WHO) recently recommended the widespread use of the malaria vaccine RTS,S/AS011We’ll use “RTS,S” as shorthand in this post. for children. It provides an additional, effective tool to fight malaria. This is great news!

We’ve been following this vaccine’s development for years and, in the last few months, have been speaking with organizations involved in its development and potential wider rollout.

Our work on RTS,S (and other malaria vaccines) is ongoing, and we might significantly update our views in the near future. But because we’ve been following its progress, we’re sharing some initial thoughts.

## In brief

• This vaccine is a promising addition to the set of tools available to fight malaria, but it’s not a panacea. We expect long-lasting insecticide-treated nets (LLINs) and seasonal malaria chemoprevention (SMC)—interventions provided through two of the programs we currently recommend—to continue to be important in the fight against malaria in the near term.2
• The parts of the WHO news release that we have bolded indicate that RTS,S should be used with existing malaria control interventions:
• “WHO Director-General Dr Tedros Adhanom Ghebreyesus [said,] ‘Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.'”
• “WHO recommends that in the context of comprehensive malaria control 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.”
• Similarly, Gavi’s news release states: “The vaccine will be a complementary malaria control tool to be added to the core package of WHO-recommended measures for malaria prevention. This includes the routine use of insecticide-treated bed nets, indoor spraying with insecticides, malaria chemoprevention strategies, and the timely use of malaria testing and treatment.”

• Simple comparisons of potential costs and effectiveness of RTS,S and SMC suggest that SMC could be more cost-effective (see below). But there are lots of unknowns about RTS,S that could change that.
• We are actively looking into whether there are promising funding opportunities in this space.
• So:
• For the time being, this news does not affect our recommendations to donors. We do not know of a current option for individuals to donate to scale up RTS,S. We continue to believe that LLIN distribution and SMC are highly cost-effective, and some of the best giving opportunities available for donors who want to prevent deaths from malaria today.
• We aren’t sure whether we’ll recommend funding of RTS,S in the future. That will depend on how cost-effective we estimate particular opportunities to be, which depends on the answers to the open questions listed below.