Help Needed in Push for a Rapid Malaria Vaccine Rollout

By joshcmorrison @ 2023-10-20T19:30 (+92)

Nathan asked on the forum last week: "Should we push for a rapid malaria vaccine rollout?" Lo and behold, it looks like the answer is yes. (Thanks, Nathan!)

We at 1Day Sooner have been scoping a campaign for how best to do this and we badly need help in the next few weeks, particularly with research on vaccine deployment mechanisms. If you're interested, please email me at josh@1daysooner.org

As context, R21 is a recently approved malaria vaccine that is probably more effective and definitely easier to manufacture than the (slightly less recently approved) RTS,S vaccine. In 2022, GiveWell gave PATH $5 million with the goal of accelerating RTS,S deployment in areas covered by the grant by one year. My understanding is that the pace of RTS,S vaccine production is about 10 million doses/year and R21 is about 100 million, so (at a very very rough order of magnitude), the potential R21 opportunity is probably about 10x the value of that GW PATH grant. 

One advocacy target that looks potentially promising is to persuade WHO to treat prequalification of R21 with a similar process and urgency as was used for the COVID vaccines, thus enabling GAVI to purchase the vaccines (which I understand GAVI cannot do without prequalification).  But to be effective we will need to better understand processes at GAVI and African nations, and we will also need to develop a better model of estimated impact and a way to be useful on malaria deployment decisions longterm (including via adult vaccination campaigns).

To learn more some useful sources are:

NickLaing @ 2023-10-21T21:15 (+10)

Nice initiative I completely aggree

My poorly informed and very uncertain hot take is the WHO cautious estimates on roll-out might be as much about logistics and capacity than it is about caution or laziness. I find it hard to believe with pressure from the vaccine inventors and others, that the WHO won't pre-qualify the thing very soon.

The kind of somewhat tricky logistics I'm talking about might be that 
1. This vaccine has a slightly unusual 4 dose schedule which will need integration into standard country vaccination schefules.

2. A whole lot of money will have to be freed up for the actual rollout. Donors fund logistics of the rollouts too, not just the doses. This money might simply not be available right now.

3.  Rollouts will need to be set up in a way that real-life efficacy can be followed up, so before vaccination gets started there will have to be a plan as to how to measure before and after prevalence/incidence/severe malaria etc which will not be easy in many places

4. There are also RTS,S rollouts to take into account which will complicate matters in some countries.

This isn't quite as simple as just getting doses of covid vaccines on the ground and jabbing as many people as possible.

From your financial times article

"Harris said the timeline was a “conservative estimate” based on “the many moving parts and work of partners required to make this happen”, including for pre-qualification, a separate, confidential, WHO-led process that she said was “well on the way” to completion.

“We are working — and have been well before this announcement — to do our utmost to get this vaccine to children much earlier . . . ideally well before the timeline” announced on Monday, she said, adding that “safety, quality and trust” must not be compromised in the rollout."

If this really the case I'm not sure how much advocating to WHO would really help at the moment. I like your idea of understanding GAVI and country processes here.

Weaver @ 2023-10-23T15:30 (+2)

I love to see things like this spun up. As African countries are the primary recipient of this kind of vaccine I would expect that (It makes sense to me) we have to think about the big problems.

Logistics:

Let's assume that there are no cultural issues and everyone was able to communicate fairly, right? Now you're dealing with the tyranny of distance and the last mile problem. Not only that, but you're dealing with the last mile problem four times and that is just getting the vaccine to where it needs to be. I'm going to go out on a limb here and state that the vaccine cold chain which is common in some vaccines may weigh in. 

In brief: If a vaccine needs to be kept at a certain temperature to administer it, then there had to be a chain of custody that is refrigerated. Now imagine that you have to truck vaccines 1000 km from the capital of Tanzania to the northern reaches.

Secondarily you have the problem of setting up health clinics where recipients will show up FOUR times. I wish this was already a once and done, but hey if we can eliminate Malaria in my lifetime? I'll call up several thousand friends.

Cultural and Language Barriers:

Assuming you have solved the first problem, then you run into the issue that some people may be avoidant to the vaccine or you need to translate the material into Somali or another smaller language. This is where I'm going to go into recommendations and recommend that we pair this with a messaging campaign on the most used platform in that country. This will be highly specific, but say if Nigeria is mostly on the radio, then a few radio spots about the rollout would go a long way.

Recommendation:

There are already aid orgs and EA orgs inside of Africa with good talent that we can reach out to for some on the ground assistance setting this up. LEEP(https://leadelimination.org/) may already have a network of trusted agents in country that you can lean upon and Family Empowerment Media(https://www.familyempowermentmedia.org/) does messaging already. I would start by asking those two if they could help start this.

Additionally it would benefit the local economy to produce the vaccines in Africa, this would also solve some of the cultural issues since it's made there. This would solve some of the logistical issues with getting the vaccine there, but not all.