US leadership on malaria vaccinations: A prescription for improving our national security 

This October, the World Health Organization recommended a new malaria vaccine, R21-Matrix-M, as safe and effective. This is the second malaria vaccine ever approved and the first that can be produced in large quantities.  

The vaccine, a collaboration between Oxford University, the Serum Institute of India, and the American biotech company Novavax, can save an enormous number of lives, but unfortunately plans to distribute it are confusing and have been criticized publicly as moving too slowly.  

George Mason University economist Alex Tabarrok has called for malaria vaccine distribution to be treated as an emergency. The humanitarian case for this is strong: according to one estimate, it will save more than 6,000 lives per million children vaccinated. Since about 30 million children in sub-Saharan Africa are born each year, this vaccine could save almost 200,000 lives annually.  

Not since former President George W. Bush’s PEPFAR program, the President’s Emergency Plan for AIDS Relief, has a public health opportunity of this scale been possible. COVID was treated as such an emergency, and half a billion Africans received the vaccine within a couple of years. Supporting vaccination efforts would be an appropriate and impactful addition to the President’s Malaria Initiative, currently being managed by USAID. Since 2006, this program has focused on preventing malaria in children and pregnant women. It has distributed insecticide-impregnated bed nets, supported indoor insecticide spraying and improved malaria diagnosis and treatment in 30 partner countries. 

Beyond the humanitarian value, mitigating malaria’s health, social and economic impacts on Africa will have direct global health security benefits. Global health security promotes resilient public health systems to prevent, detect and respond to infectious disease outbreaks. The U.S. government assisted African nations distributing COVID vaccines; expanding the President’s Initiative to include malaria vaccination efforts can further develop and sustain the capacity for future rapid vaccine deployments that would be needed to mitigate emerging disease, pandemic or engineered biothreats.  

Enabling the country to vaccinate its own population during an outbreak would reduce the risk that an emerging disease or pandemic arises, spreads elsewhere and can then be introduced into the United States. Further, effectively mitigating outbreaks and pandemics can prevent longer-term political, economic and social destabilization that can result in mass migration, which could impact our national security and geopolitical interests.  

Improving mitigation of infectious disease threats is also important to America’s national — and our allies’ collective — security. We cannot assume that American adversaries would be above deploying biological weapons if it would provide them an advantage. The State Department notes several countries are known or suspected to have a bioweapons program. The more we can credibly reduce our vulnerability, as well as that of our allies and the world, the more likely we can achieve “deterrence by denial” — that is, convincing adversaries that investments in bioweapons will not work to achieve their political ends.  

But beyond the global health and national security value, helping to create vaccine delivery networks promotes goodwill and alliances with countries that China is attempting to pull into its own orbit.  

On the most obvious level, identifying America and the West more broadly with saving children from malaria will improve public attitudes toward the United States. Just as America improves a country’s security and political stability by training their military and countering terrorism, assisting countries with their otherwise-intractable health challenges improves their social and economic stability. Empowering African health leaders to achieve real gains for their people can, over the long term, connect health and Western-powered progress with political stability favoring Western-style liberal democracy. 

The bulk of the global population growth in this century will happen in Africa. That is why China is building infrastructure and businesses and acquiring assets in these countries. It is important that the United States provide a positive counterweight. President Bush’s PEPFAR program prevented millions of Africans from dying of AIDS, which can affect African public sentiment toward the U.S. We can successfully build on this model and prevent millions of children contracting and dying from malaria. 

The Serum Institute of India has committed to make more than 100 million doses of vaccine ready next year, but international institutions so far have not committed to distribute all the vaccines that can be produced. America needs to embrace the challenge of malaria vaccine distribution as part of the President’s Malaria Initiative, leveraging existing logistic networks from the COVID pandemic. The cost of the malaria vaccine is already paid for; USAID can provide logistical and technical assistance with distribution to achieve this outcome. 

Without American leadership and logistical prowess, it is not clear how many children will be protected from malaria in 2024. The benefits are not just for the children who won’t contract or die from malaria; this initiative would support our long-term national interests to provide equitable access to medical treatments, responding to biosecurity threats, improving global social, economic and political stability, and improving our moral standing in the world.  

This is clearly a worthwhile role for America to take on. 

Robert Kadlec, M.D., M.A., served as Health and Human Services assistant secretary of preparedness and response for former President Trump, and as a career officer and physician in the U.S. Air Force.  

Josh Morrison is the founder and president of 1Day Sooner, a nonprofit that advocates for people who want to participate in medical research.