While the first malaria vaccine's manufacture set high goals, in reality, efforts are falling well short of that, with a lack of funding and commercial potential thwarting GSK Plc's capacity to produce as many doses of its shot as needed, according to Reuters interviews with about a dozen WHO officials, GSK staff, scientists and non-profit groups.
A GSK spokesperson told Reuters that it could not make enough of its vaccine Mosquirix to meet the vast demand without more funds from international donors, without giving details on the numbers of doses it expected to produce annually in the first years of the roll-out.
The British drug maker committed to produce up to 15 million doses every year through 2028, following 2019 pilot programs - considerably less than the WHO says is needed. It is currently unlikely to make more than a few million annually before 2026, according to a source close to the vaccine rollout.
"Demand over the next five to 10 years will probably outstrip the current forecasts on supply," said Thomas Breuer, GSK's chief global health officer.
The vaccine's effectiveness at preventing severe cases of malaria in children is relatively low, at around 30% in a large-scale clinical trial. Some officials and donors are hoping that a second shot being tested by Oxford University may prove better, cheaper and easier to produce in bulk.
Yet the world's inability to fund more Mosquirix shots dismays many in Africa. Children on the continent account for the vast majority of the roughly 600,000 global malaria deaths every year.
"Mosquirix has the potential to save a lot of precious lives before another new vaccine arrives," said Kwame Amponsa-Achiano, a public health specialist leading a pilot vaccination program in Ghana. "The more we wait, the more children die needlessly."
The limited international appetite to produce and distribute more Mosquirix stands in stark contrast to the record speed and funds with which wealthy countries secured vaccines for COVID-19, a disease that poses relatively little risk to children.
Unlike many pharmaceutical products, there is no major market for a malaria vaccine in the developed world, where drug companies typically make the large profits that they say allows them to make their products available at far lower prices in poorer countries.
"This is a disease of the poor, so it's not been that appealing in terms of the market," said Corine Karema, chief executive of the nonprofit RBM Partnership to End Malaria, which is working with governments in Africa to eliminate the disease.
"But one kid dies of malaria every minute - that's unacceptable."
Two of the biggest funders behind the development and pilot programs for Mosquirix, the Bill and Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria, told Reuters they were committing almost no additional financing to deploy the vaccine.
"It's not a silver bullet, and it's relatively expensive compared to other interventions used for malaria," said Peter Sands, head of the Global Fund. "The fundamental issue with malaria isn't actually about tools. It's about the fact that we spend far too little money on it."
The Gates Foundation said it would continue to back research into how to best use the "historic" vaccine, but "concerns about the relatively low efficacy, short duration, and constrained supply challenges" meant it would not fund deployment.
Gavi is currently the only significant source of funding for a wider Mosquirix rollout. It has approved about $155 million for 2022 through 2025, alongside some funding from the countries themselves. Internal documents seen by Reuters suggest Gavi's investment in the first year is only expected to be $20 million.
"We should have had this vaccine a long time ago," said Alassane Dicko, professor of public health at the University of Science, Techniques and Technologies of Bamako in Mali, who has led some of the Mosquirix trials.
"We have to do more."