Tag Archives: PATH

Why GiveWell funded the rollout of the malaria vaccine

Since our founding in 2007, GiveWell has directed over $600 million to programs that aim to prevent malaria, a mosquito-borne disease that causes severe illness and death. Malaria is preventable and curable, yet it killed over 600,000 people in 2021—mostly young children in Africa.[1]
Following the World Health Organization’s approval of the RTS,S/AS01 malaria vaccine (RTS,S) in late 2021,[2] GiveWell directed $5 million to PATH to accelerate the rollout of the vaccine in certain areas of Ghana, Kenya, and Malawi. This grant aimed to enable these communities to gain access to the vaccine about a year earlier than they otherwise would, protecting hundreds of thousands of children from malaria.[3]
Although we’re very excited about the potential of the RTS,S malaria vaccine to save lives, it isn’t a panacea. We still plan to support a range of malaria control interventions, including vaccines, nets, and antimalarial medicine.
In this post, we will:

Explain how we found the opportunity to fund the malaria vaccine
Discuss why we funded this grant
Share our plan for malaria funding moving forward

Identifying a gap in vaccine access
In October 2021, we shared our initial thoughts on the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). At that point, we weren’t sure whether the vaccine would be cost-effective and were not aware of any opportunities for private donors to support the expansion of vaccine access.
In the following months, our conversations with PATH, a large global health nonprofit that we’ve previously funded, revealed that there might be an opportunity to help deploy the vaccine more quickly in certain regions. PATH had been supporting the delivery of the vaccine in Ghana, Kenya, and Malawi as part of the WHO-led pilot—the Malaria Vaccine Implementation Program (MVIP)–-since the pilot began in 2019.[4] In order to generate evidence about the effectiveness of the vaccine, randomly selected areas in each country received the vaccine during the early years of the pilot, while “comparison areas” would receive the vaccine at a later date, if the vaccine was recommended by the WHO.[5]
Once the vaccine had received approval from the WHO, the WHO and PATH believed there was an opportunity to build on the momentum and groundwork of the pilot to roll out the vaccine to the comparison areas as soon as possible. However, the expectation at the time

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IPTi for malaria: a promising intervention with likely room to scale

Summary
Intermittent preventive treatment in infants (IPTi) for malaria provides preventive antimalarial medicine to children under 12 months old. It is among the most promising programs we’ve identified in our active pipeline of new interventions. Not only does IPTi appear to be highly effective at reducing clinical malaria, it’s also underutilized (more below), and the population it targets is especially vulnerable to malaria. That implies potential to open up large amounts of room for more funding if IPTi begins to be used more widely—our crude estimate is between $50 million and $200 million globally once it’s scaled—which is something we’re increasingly thinking about as we aim to direct $1 billion in cost-effective funding by 2025.
In September 2021, we recommended a small grant to Malaria Consortium and PATH to assess the feasibility and cost-effectiveness of implementing IPTi at national scale in two countries. This grant was the result of an atypical process for us: because we don’t know of any organizations currently implementing IPTi, we issued a request for information to several charities that we thought might be good candidates to do so (more below). We’re hopeful that this scoping exercise will answer some of our many open questions about IPTi, and that this intervention continues to look promising as we learn more.
What is IPTi?
Intermittent preventive treatment in infants (IPTi) for malaria is a program that distributes preventive antimalarial medicine (usually sulfadoxine-pyrimethamine, or SP) to infants, regardless of whether they have malaria, during routine immunization services. A Cochrane meta-analysis of 12 randomized controlled trials (RCTs) found that IPTi reduced cases of clinical malaria by 30%.[1]
IPTi appears effective enough that the World Health Organization (WHO) began recommending it 12 years ago, in 2010.[2] However, our research has identified only one country, Sierra Leone, that has integrated IPTi into its routine national health care practice.[3] We think this neglectedness is due in part to potentially surmountable logistical factors, such as the need to coordinate work between national malaria control programs and national immunization programs.[4] Other barriers to implementation have included the way WHO guidelines identified which settings are appropriate for IPTi[5] (though we understand from speaking with other organizations in the malaria space that these guidelines are currently under revision), and challenges with administering previously available formulations of SP.[6]
Why we’re excited about it

Effectiveness –

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