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Bangui, Central African Republic — 24 May 2024 — UNICEF delivered over 43,000 doses of the R21/Matrix-M malaria vaccine by air to Bangui today, with more than 120,000 additional doses to follow in the coming days. The Central African Republic became the first country in the world to receive the R21 malaria vaccine for use in routine childhood immunization, marking another step forward in preventing a disease that kills nearly half a million children under five each year in Africa.
The shipment represents the operational debut of the second malaria vaccine recommended by the World Health Organization. R21/Matrix-M, developed at the University of Oxford and manufactured by the Serum Institute of India with the Matrix-M adjuvant supplied by Novavax, received WHO recommendation in October 2023 and WHO prequalification in December 2023. That prequalification unlocked procurement by UNICEF and Gavi, the Vaccine Alliance, enabling the large-scale rollout now underway.
Two Vaccines, One Goal
With both R21/Matrix-M and the earlier RTS,S/AS01 vaccine now recommended and available, the global health community says the longstanding gap between vaccine demand and supply has closed. The RTS,S vaccine was piloted in Ghana, Kenya, and Malawi over four years, reaching more than 2 million children and demonstrating a 13% reduction in all-cause mortality in the areas where it was introduced.
Around 4.33 million doses of RTS,S had already been delivered to eight countries — Benin, Burkina Faso, Cameroon, Ghana, Kenya, Liberia, Malawi, and Sierra Leone — before the R21 rollout began. Burundi and Niger were next on the list for RTS,S shipments.
Why the Central African Republic First
The Central African Republic has one of the highest rates of malaria incidence globally. In 2022, an estimated 1,733,000 malaria cases were reported in the country — averaging about 4,747 cases per day. The disease claimed approximately 5,180 lives over that year, or roughly 14 deaths each day.
Central African Republic was joined by Chad, Côte d'Ivoire, Democratic Republic of the Congo, Mozambique, Nigeria, South Sudan, and Uganda in preparing to receive R21 shipments through 2024.
Closing the Supply Gap
"With two products now available to countries, expanded supply of malaria vaccines is a game changer for child survival and health," said Leila Pakkala, Director of UNICEF Supply Division. "Previous concerns about supply meeting demand are firmly behind us. Now our priority is for the vaccines to reach every child at risk."
Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance, emphasised the strategic significance of having two vaccines in the pipeline: "Having two safe and effective vaccines means we have greater supply security and can be more confident about meeting countries' needs. That is what matters most — that countries where our vaccines can be most impactful are able to access them, saving thousands of lives each year and offering relief to families, communities and entire health systems."
Clinical Evidence Behind R21
Clinical trial data for R21/Matrix-M, published in The Lancet in early 2024, demonstrated high efficacy of approximately 75% when administered prior to peak transmission seasons in highly seasonal transmission areas. The vaccine is administered in a four-dose regimen, with the first three doses given monthly before the high-transmission season and a fourth dose delivered 12–18 months after the third dose to maintain protection.
| Characteristic | R21/Matrix-M | RTS,S/AS01 |
|---|---|---|
| Developer | University of Oxford / Serum Institute of India | GSK / PATH |
| WHO recommendation | October 2023 | October 2021 |
| WHO prequalification | December 2023 | July 2022 |
| Adjuvant | Matrix-M (Novavax) | AS01 (GSK) |
| Dose schedule | 4 doses | 4 doses |
| Reported efficacy | ~75% (seasonal administration) | ~30–40% (real-world) |
| Cost per dose | ~USD 2–4 | ~USD 5–9 |
Integration with Existing Malaria Control
Dr Kate O'Brien, Director of WHO's Department of Immunization, Vaccines and Biologicals, stressed that malaria vaccines are not a standalone solution but a powerful addition to comprehensive national malaria control plans. "Malaria vaccines, introduced as part of the tools available in comprehensive national malaria control plans, will substantially reduce early childhood deaths and can help revitalize the fight against malaria," she said.
The WHO guidance emphasises that vaccines must be combined with other interventions — including insecticide-treated bed nets, targeted indoor residual spraying, chemoprevention, diagnosis, and prompt treatment — to maximise public health impact. The high community demand for malaria vaccines also provides an opportunity for children to receive other childhood vaccines that may be due, resulting in even more lives saved.
Operational Challenges Ahead
Gavi, UNICEF, WHO, and partners are supporting governments as they prepare to receive and introduce the vaccines. This involves supporting countries to develop vaccine implementation plans and communication strategies, conducting health worker trainings and community engagement, and ensuring sufficient cold chain capacity.
Vaccine deliveries to countries funded through the Vaccine Alliance depend on government requests and readiness to include the vaccine in routine immunisation programmes — a process that requires months of preparation, infrastructure investment, and community trust-building.
The Broader Malaria Landscape
Malaria remains one of the world's most lethal diseases. According to the WHO World Malaria Report 2023, there were an estimated 249 million malaria cases and 608,000 malaria deaths in 85 countries in 2022. The African Region accounted for approximately 94% of all malaria cases and 95% of all malaria deaths. Children under five accounted for an estimated 76% of all malaria deaths in the region.
The introduction of two vaccines into routine immunisation programmes represents the most significant advance in malaria prevention tools in a generation. The RTS,S pilot programme demonstrated not only a 13% reduction in all-cause mortality but also high community acceptance and feasibility of delivery through routine immunisation systems.
Sources
- World Health Organization, "Shipment of newest malaria vaccine, R21, to Central African Republic marks latest milestone for child survival," 24 May 2024 —
- World Health Organization, "WHO recommends R21/Matrix-M vaccine for malaria prevention," 2 October 2023 —
- World Health Organization, "WHO prequalifies a second malaria vaccine," 21 December 2023 —
- Novavax, "R21/Matrix-M Malaria Vaccine Phase 3 Trial Results Published in The Lancet" —
- University of Oxford, "R21/Matrix-M malaria vaccine: discovery paving the way for a malaria-free future," 1 May 2024 —
- Gavi, the Vaccine Alliance, Routine Malaria Vaccinations Communication Toolkit —
FIRAT Editorial Board
Institutional Research Desk · Foresight Institute of Research and Translation
The collective editorial and research translation board of FIRAT, synthesising peer-reviewed evidence, policy briefs, and division milestones across our seven foundational research pillars.
