Malaria vaccine makers call for more orders to drive down costs

Malaria vaccine makers have called on UN children’s agency Unicef and global vaccine alliance Gavi to order more of the jabs in order to drive down their cost and bolster a historic but challenged campaign to combat one of Africa’s most destructive diseases.

However, the multilateral organisations have warned that increasing supplies will not solve the logistical difficulties faced by the world’s first vaccination campaign against malaria, which was launched in January.

The Serum Institute of India, which is the world’s biggest manufacturer of vaccines and on Monday shipped its first doses of the R21 malaria vaccine developed by the University of Oxford, said it could produce four times as many doses as had been ordered by Unicef and Gavi.

“[R21] will make a huge impact in saving children’s lives in Africa,” Adar Poonawalla, Serum’s chief executive, told the Financial Times, but added the company was losing money on every jab and that it needed more orders for it to break even and for the vaccination campaign to succeed.

“There is so much demand . . . but if donors don’t step up and support Gavi on this, then we may not see the coverage that we want,” Poonawalla said in an interview at Serum’s headquarters in the Indian city of Pune.

He said Serum was set to provide 100mn doses to sub-Saharan Africa over the next four years, despite having capacity for 100mn jabs per year.

Bharat Biotech, a Hyderabad-based vaccine maker that will take over production of British pharmaceutical group GSK’s malaria vaccine from 2028, said it needed more advance orders from Unicef and Gavi in order to build up production.

“If they don’t indicate well ahead of time that they need ‘x’ million of doses of product at a certain timeline, it’s difficult for us to make an at-risk investment and have the product available on time,” said Krishna Ella, Bharat Biotech executive chair.

However, officials and industry leaders said international bodies would continue with their gradual ramp-up of immunisation efforts.

GSK was providing an initial 18mn doses in the first three years of the programme, “substantially lower” than international bodies anticipated, according to Mary Hamel, head of the WHO malaria vaccine implementation programme.

Thomas Breuer, chief global health officer at GSK, said despite the low numbers, not all the 3.5mn malaria vaccine doses it provided in 2023, in a pilot stage before the mass rollout, were actually used.

Andrew Jones, deputy director of immunisation supplies at Unicef, said the complicated dosing schedule of the vaccine — which requires four jabs within the first two years of a child’s life — had led to planning delays, “hence the doses not being fully used last year”.

“Supply is not the issue now: the key is getting countries ready and trying to deliver to all countries that have made a request,” Jones said.

Aurélia Nguyen, chief programme officer at Gavi, said all available doses were now being used and the R21 supply would support a wider rollout.

Asked about the calls for bigger orders, Nguyen said Gavi was trying to strike a balance between moving quickly enough to have a clear health impact while ensuring the vaccine programme was not “poorly implemented or sets countries up for fiscal issues”.

Eight countries had received malaria vaccines since the campaign was launched in January, with seven more to receive them this year, Nguyen said. Serum said it shipped its first batch of 43,200 R21 doses to the Central African Republic on Monday.

Serum’s ability to produce in large quantities should help meet high demand: Gavi forecast in January that Africa would need 80mn-100mn doses per year by 2030.

But Jenny Hill, an epidemiologist at the Liverpool School of Tropical Medicine, said more supply would not solve early logistical challenges.

“You need a cold chain [temperature-controlled logistics], trained staff, good communication strategies and following up with children for all four doses. Starting badly is very difficult to correct,” Hill said.

The GSK jab costs €9.30 per dose, making it the most expensive vaccine Gavi helps fund, while Serum is providing the R21 vaccine at about $4 a dose. The WHO thinks both jabs are equally effective and Poonawalla said that while the price Serum charged was currently below its costs, it would fall as production increased.

But he warned Gavi would need to be able to fund bigger orders. “Even if you made a dairy farm here . . . you make more money,” he said, adding: “At some point, donors who donate to Gavi would have to look at substantially increasing the envelope.”

GSK is producing its jab from Belgium. Breuer said he expected prices to fall when Bharat Biotech took over production and that GSK was exploring whether its vaccine could be delivered in fewer doses. Ella said the Indian company was targeting annual capacity of 40mn doses, but did not comment on pricing.

Nguyen said Gavi would push producers to cut their prices as it asked donors to increase their backing for its next funding cycle, beginning in 2026. The vaccine alliance received $21.3bn for its 2021-25 cycle.

“It’s a really important part of our ask to our sovereign donors and others to make sure that this programme has the viability that is very much needed,” said Nguyen.