Ethical considerations for introducing RTS,S/AS01 in countries with moderate to high Plasmodium falciparum malaria transmission

On Oct 6, 2021, WHO recommended the widespread use of the RTS,S/ASO1 malaria vaccine (Mosquirix; GlaxoSmithKline, Brentford, UK) among children in areas with moderate to high Plasmodium falciparum malaria transmission.1 This recommendation was made despite RTS,S showing only a 30% reduction in preventing deadly severe malaria, falling short of the WHO effectiveness threshold of 75%, and in light of promising vaccines—such as the R21/Matrix-M—under clinical development.2–4