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The world’s first malaria vaccine should be tested in several pilot implementation projects to assess how best to use it, according to a World Health Organization (WHO) advisory group.

The recommendation from the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC) in Geneva this week recommended that pilot implementations should be the next step in considering current evidence about the vaccine, known as RTS,S.

There is concern about how to effectively implement the four doses of the vaccine to ensure protection in young children.

The vaccine also has limitations. RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. But, it offers no protection against P. vivax malaria, which predominates in many countries outside of Africa, including in Southeast Asia.

Funding for research into additional new malaria vaccines needs to continue despite this first breakthrough to address P. vivax malaria which kills hundreds of thousands of people, many young children, each year. Leading Burnet researchers, Professor James Beeson and Dr Freya Fowkes raised these concerns in a special international Forum published in BMC Medicine.

Four doses are required of RTS,S for a child to be fully protected, requiring additional contact with the health care system. The first three doses are given one month apart followed by an 18-month pause before the fourth dose. Without the fourth dose, children had no overall reduction in severe malaria.

“The question about how the malaria vaccine may best be delivered still needs to be answered,” Professor Jon S. Abramson, Chair of SAGE, said. “After detailed assessment of all the evidence we recommended that this question is best addressed by having 3-5 large pilot implementation projects.”

The WHO indicates the vaccine is being assessed as a complementary malaria control tool that could potentially be added to—but not replace—the core package of proven malaria preventive, diagnostic and treatment measures.

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