This is a long (>9000 word) essay written by myself (Saloni Dattani), Rachel Glennerster and Siddhartha Haria for Works in Progress.

Over half a million people die from malaria each year, but it took 141 years to develop a vaccine for it.

One fundamental reason for this was the scientific complexity of the pathogen – malaria is caused by a parasite, not a virus or bacteria. But another, repeated obstacle was a lack of financial incentive and urgency.

In this piece, which includes a lot of data and charts, we tell the story of how the malaria vaccine was developed, why the financial market for the vaccine was missing, and how it could have been sped up with smarter incentives and market mechanisms, like Advance Market Commitments.

About the authors:

  • Saloni Dattani - I'm a researcher on global health at Our World in Data and a founding editor of Works in Progress
  • Rachel Glennerster is associate professor of Economics at the University of Chicago. She was previously chief economist at the UK Foreign Commonwealth and Development Office and the Department for International Development and a key figure behind ‘Deworm the World’.
  • Siddhartha Haria is policy lead at the Development Innovation Lab.
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A second reason was that – according to speculative post-hoc analyses of the data – there appeared to be a higher rate of meningitis in older children who received the vaccine than in those who didn’t. There also seemed to be a higher rate of deaths among young girls, but not boys – even though the total number of deaths in either group was small.

The WHO explained that these cases were not actually believed to be related to the vaccine itself: they weren’t related to the timing of the doses, only occurred in patients in two of the trial sites, and included different types of meningitis. Nevertheless, they argued, the disease needed to be ruled out as a potential side effect with more pilot studies.


Do you think this was the wrong call? Should they have started treatment and used that as a sort of much larger study? On purely cost benefit terms?

Wow this is a spectacular article, I have read stuff on the history of malaria before, but you packaged this particularly well

I had no idea just how torturous the path was for the RTSS malaria vaccine. I've heard lots of positive snippets over the years, but when the whole story is put together like this there seems to be as much frustration as success.

Have subscribed to further articles nice one.

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