Equity Amid Scarcity: Rethinking Malaria Vaccine Rollout

Abstract We present a case on the rollout of two malaria vaccines, RTS,S and R21. We examine the implementation of the World Health Organization’s framework for the ethical allocation of these vaccines, questioning its founding principles of greatest need, maximizing health impact, equity and fair benefit. We highlight the inequitable distribution of the vaccines, and question the basis for prioritized countries with low vaccine dropout rates. In addition, we examine the disconnect between vaccine availability and uptake, as well as the financial challenges associated with implementing the rollout, arguing that without adequate funding and support for delivery, the potential benefits of these vaccines will be undermined, leaving the rollout to be another missed opportunity in the long fight against malaria.