Page 68 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

risk of dying from malaria (WHO, 2023). But not even for this high-risk group are

the available vaccine doses sufficient. Elaborate rationing plans are currently being
implemented (TDR, 2023). However, many people are not able and will not be able to
get vaccinated with RTS,S/AS01 under these circumstances, including older children
who with the changing epidemiology of malaria are increasingly at risk of dying from

malaria, adults or people in very large malaria endemic regions outside of Africa.

If there is one positive lesson to be learned from the COVID-19 pandemic it may
very well be the fact that if there is a will, billions of doses of novel vaccines can be
rolled out within a year or two (Mathieu et al, 2021). Aware of the demand for malaria
vaccines, the R21 development team at the Jenner Institute in Oxford is working with

the Serum Institute of India Pvt. Ltd. on the scale up of R21/MM production. Serum
Institute of India (SII) is the world’s largest vaccine-producing company in the world’s
largest vaccine-producing nation, India (NPR, 2021). SII produces a range of childhood
vaccines including measles, tetanus, pertussis, diphtheria, and hepatitis. SII also exports

vaccines to 170 countries and estimates that two-thirds of the world’s children are
inoculated with its vaccines (NPR, 2021). During the COVID-19 pandemic investigators
from the Jenner Institute worked closely with the SII on COVISHIELD, the ChAdOx1
nCoV- 19 recombinant corona virus vaccine. In December 2021 SII estimated that its

monthly production capacity for COVISHIELD was approximately 250-275 million
doses (The_Times_of_India, 2021). Considering the 3.3 billion people at risk globally
for malaria, the need for a 4-dose vaccine regimen, and the need to include older age
groups not only young children in malaria vaccination programmes, 100s of millions

of vaccine doses will be needed annually. SII has the capacity and is willing to fill this
demand.

In 2023 R21/MM received regulatory approval first in Ghana, then Nigeria, and
most recently in Burkina Faso (Quartz, 2023, Guardian, 2023, University_of_Oxford,
2023). The WHO has recommended the use of R21/Matrix-M for malaria preventions

in October 2023 and is likely that R21/MM will be prequalified later in 2023.

Author’s Note

Funding: no funding was received for writing this article. Conflicts of interest: LvS is
collaborating with the Jenner Institute and SII on the evaluation of the co-administration
of R21/MM with antimalarial drugs.

60 The First Licensed Malaria Vaccines: From RTS,S to R21