Technical Exchange 2024

This year's Technical Exchange focused on the new malaria vaccines and ways to scale-up work. For decades, the malaria community waited for a safe and effective malaria vaccine. In October 2021, WHO finally recommended the first malaria vaccine for children (RTS,S/ASO1) and two years later, a second vaccine (R21) was approved. Both malaria vaccines can prevent around 75% of malaria episodes when given seasonally in areas of highly seasonal transmission and in combination with malaria chemoprevention. While the malaria vaccines represent an important complementary tool to counter the malaria resurgence in moderate-to-high transmission settings, their real-world effectiveness also depends on achieving a high coverage and on the implementation of complementary interventions.

Group picture from the Technical Exchange 2024. Photo Credits: Swiss Malaria Group

Keynote addresses

This year's Technical Exchange focused on the new malaria vaccines and ways to scale them up. Participants learned about successes, and challenges in the rollout of malaria vaccines through three keynote addresses by:

• Prof. Blaise Genton, Honorary Professor, Unisanté - Overview of the two malaria vaccines and new developments
• Dr. Adidja Amani, Regional New Vaccines Introduction Medical Officer, WHO AFRO - Overview on the current progress, successes, and challenges in the rollout of malaria vaccines
• Dr. Christian Auer, Public Health Specialist, Swiss TPH - Insights from implementing the RTS,S malaria vaccine

Technical Exchange in the Novartis Pavilion in Basel. Photo Credits: Swiss Malaria Group

Dr. Adidja Amani sharing her insights on the vaccine implementation. Photo Credits: Swiss Malaria Group

Group Discussions

In the discussion rounds, participants of the Technical Exchange discussed the following questions:

Table 1: Experience from implementation

• What have you experienced during malaria vaccine implementation?
• What were successes / positive experiences?
• What were challenges / negative experiences?
• (How) can we contribute to success?

Table 2: Evidence gaps around vaccine implementation

• What evidence gaps to support vaccine rollout are you aware of?
• What can we contribute to overcome these evidence gaps?

Group discussion summary:

Among the group present, there was a lack of hands-on experience with the rollout of the malaria vaccine implementation. However, all participants acknowledged that their current work was related to health systems functions that are also critical for malaria vaccine rollout and that it was highly likely that the rollout would sooner or later happen in areas or programs they were involved in.

While – both within the group and more broadly – there are still many unknowns about the effective large-scale malaria implementation, participants of the Technical Exchange (TE) were impressed to see the progress of the rollout presented by Dr. Adidja Amani and to feel the enthusiasm it inspired.

At the same time, it is useful to acknowledge gaps to decide how to further strengthen the fight against malaria. Overall, the need for a thorough contextualization was stressed: to increase coverage of the vaccines, their rollout and the logistics need to be tailored to each country. This includes considering challenges posed, for example, by natural disasters, or conflict rendering some areas more fragile than others. Both might hinder access to affected communities, weaken or disrupt health systems and cause people to flee, effectively interrupting a possible rollout.

Challenges also evolve around acceptance of the vaccine among the communities affected by malaria. Misinformation cause reactions ranging from skepticism to complete rejection of vaccines all over the world. Therefore, information and communication on what the vaccine can and cannot achieve are key to make sure that affected communities embrace the vaccine rollout while at the same time not neglecting other malaria control measures.

Moreover, for a sustainable rollout, not only communities but also health authorities need to be committed and equipped: health systems need to be strong (or strengthened), health workers informed and trained. Malaria vaccines come on top of other childhood immunization and health programs and might thus cause additional pressure on health systems and staff. This needs to be mitigated and financed to ensure a successful rollout.

Finally, we need to acknowledge that vaccines are not a silver bullet. In light of their limited efficacy, they must be seen as complementing other interventions. Communities and implementors need to continue promoting effective combinations of preventative and curative malaria interventions.

The importance of sustainable funding for all available malaria interventions therefore remains unchanged. To ensure the optimal use of malaria vaccines, we need investments to strengthen health systems and it remains essential to identify the most effective combination of preventive and curative interventions for each given setting in order to progress towards malaria elimination. Thorough post-rollout monitoring of implementation successes and challenges is necessary to inform malaria programs of effective implementation strategies and the role vaccines can play in any given context.