'It is a true honour...': Adar Poonawalla, flags off first R21 malaria vaccine shipment from India to Africa with Eric Garcetti

Adar Poonawalla, CEO of Serum Institute of India and Eric Garcetti, the US Ambassador to India, flagged off the first consignment of R21 vaccines against malaria to Africa on May 20. 

Sharing the development, Poonawalla in a post on X (formally Twitter), wrote, "It is a true honour to be part of this momentous occasion, borne from persistence, patience and passion. Thanks to our long-term collaboration with @uniofoxford, @novavax, @gavi, @UNICEF, @WHO and @USAmbIndia, we were able to flag off our first consignment of the R21 vaccines to Africa, that will save countless lives in our fight against this deadly disease."

In 2023, the World Health Organization (WHO) recommended a new vaccine, R21/Matrix-M, for the prevention of malaria in children. The R21/Matrix-M vaccine is developed in collaboration with the University of Oxford and Novavax.

Sharing photos of the flagging off ceremony on X, Ambassador Garcetti wrote, "#USIndiaHealth partnership exemplifies the transformative power of innovation. I am thrilled to witness firsthand the groundbreaking work towards a malaria vaccine at @SerumInstIndia and to witness the first shipment to be crated and bound for malaria endemic countries. This collaboration between the U.S. and India exemplifies our commitment to addressing global health challenges. Together, we are one step closer to a malaria free world."

The initial consignment is heading to the Central African Republic (CAR), with subsequent deliveries planned for South Sudan and the Democratic Republic of Congo in the coming days. Of the 1,63,800 doses allocated for CAR, 43,200 doses will be dispatched today from SII's facility. To date, SII has produced 25 million doses of the vaccine, with the capacity to scale up to 100 million doses annually, according to a India Today report.

The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Malaria, a mosquito-borne disease, places a particularly high burden on children in the African Region, where nearly half a million children die from the disease each year.

Key features of R21 vaccine 

High efficacy when given just before the high transmission season: In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to 4 or 5 months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75% during the 12 months following a 3-dose series. A fourth dose given a year after the third maintained efficacy. This high efficacy is similar to the efficacy demonstrated when RTS,S is given seasonally.  

Good efficacy when given in an age-based schedule: The vaccine showed good efficacy (66%) during the 12 months following the first 3 doses. A fourth dose a year after the third maintained efficacy.  

High impact: Mathematical modelling estimates indicate the public health impact of the R21 vaccine is expected to be high in a wide range of malaria transmission settings, including low transmission settings. 

Cost effectiveness: At prices of $2-4 per dose, the cost-effectiveness of the R21 vaccine would be comparable with other recommended malaria interventions and other childhood vaccines. 

Similarity of R21 and RTS,S vaccines: The two WHO-recommended vaccines, R21 and RTS,S, have not been tested in a head-to-head trial. There is no evidence to date showing one vaccine performs better than the other. The choice of product to be used in a country should be based on programmatic characteristics, vaccine supply, and vaccine affordability

Safety: The R21 vaccine was shown to be safe in clinical trials. As with other new vaccines, safety monitoring will continue.