By Zacharia Kafuko (Director of 1Day Africa) and Ollie Sayeed, PhD
The international vaccine provider Gavi and the UN children’s agency UNICEF announced on Sunday that the price of the R21 malaria vaccine will fall from $3.90 to $2.99 within the next year. R21 is manufactured by the Serum Institute of India, the world’s largest vaccine manufacturer with a pioneering role in high-volume, low-cost pharmaceuticals production. The 23% drop in price is fantastic news, and should soon significantly help to accelerate the fight against malaria.
According to 1Day Africa’s modelling, on top of the 57 million doses that have already been allocated since 2023 based on Gavi’s shipment reports, an extra 360 million doses are needed to vaccinate every child currently between five and 36 months old in malarial areas of Africa. This volume of doses will cover 90 million children at four doses per child. On top of this, at current birth rates, 38 million new children are born in malarial areas of Africa every year, requiring an ongoing commitment of 152 million new doses per year.
Assuming all future doses are covered by R21 rather than the more expensive RTS,S, the old price of $3.90 per dose meant a total cost of around $1.4 billion to vaccinate all children currently eligible, and an ongoing cost of $592 million per year to vaccinate children ageing into the eligibility window. This assumes conservatively that all children complete their vaccination courses and no doses are wasted: in reality, with incomplete vaccination courses and dose wastage, the total cost of fully vaccinating everyone is even higher.
The new price of $2.99 means large savings for Gavi and UNICEF in procuring doses of R21. Covering all currently eligible unvaccinated children now has a total cost of around $1.1 billion, a saving of $330 million. The ongoing cost has dropped to $454 million, saving $138 million per year. Again, this conservatively assumes no wasted doses: if more doses are needed, the amount of money saved by the price cut is even higher. Over five years, the cumulative savings reach just over $1 billion, mostly to Gavi’s benefit – a huge amount compared to Gavi’s current 2026-2030 fundraising goal of $11.9 billion, especially given that Western donor countries are becoming increasingly unreliable.
The savings for the governments of individual countries in Africa will potentially be more limited. Under Gavi’s current co-financing system – due to be updated for the 2026-2030 period under “Gavi 6.0” – most countries are paying a rate per dose that doesn’t depend on the price of the vaccine. Low-income countries in Gavi’s “initial self-financing” group, like Ethiopia, Sudan and the Democratic Republic of Congo, pay a fixed rate of $0.20 per dose. The next income group up, “preparatory transition” countries like Tanzania and Cameroon, pay an amount that starts at $0.20 and ramps up by a fixed percentage every year, also independent of the price of the vaccine.
The price change does mean significant savings under the current system for the governments of “accelerated transition” countries, like Nigeria, Kenya, Côte d’Ivoire, Ghana and the Republic of Congo. These countries pay a rate proportional to the price of the vaccine, so a 23% drop in the price of R21 means a 23% drop in their co-financing obligations. Nigeria is expected to show the majority of the absolute savings as the most populous country in Africa, shaving $61 million off the total cost of vaccinating all currently unvaccinated children in the age window. Kenya is expected to save $6 million, Côte d’Ivoire will save $3.6 million, Ghana $3 million, and the Republic of Congo $500,000.
Angola, the only country that simultaneously has a large malaria burden and a per capita income too high to qualify for a co-financing arrangement with Gavi, is scheduled to pay the full cost of the vaccines it orders. Under the price change, Angola is expected to save $12 million.
In total, African countries will save around $87 million, with Nigeria accounting for around three quarters of the total. The price cut will likely lead to higher potential savings for a wider range of countries under the upcoming Gavi 6.0 financing arrangements: if countries are given more freedom to allocate Gavi funding between programs, they become more sensitive to changes in price than under the current system.
The drop in price also shifts the landscape of malaria interventions more into line with the assumptions made in 1Day Africa’s previously released cost-effectiveness analysis. Our review of malaria vaccine studies involves a single study of R21, Schmit et al. (2024), which reports results for three potential prices per dose: $2, $3 and $4. The Serum Institute’s previous price of $3.90 was towards the higher end of the range, meaning the paper’s median cost-effectiveness estimate overstated the cost-effectiveness of R21 under the old price. Under the new price, the $3 scenario is a close match for reality.
This update sharpens the conclusions of our earlier analysis. The R21 vaccine is an extremely cost-effective tool in the fight against malaria, saving one disability-adjusted life year for every $43 spent. Notably, this makes R21 several times more cost-effective than the alternative RTS,S vaccine ($251), mostly driven by a difference in manufacturing costs. R21 also comes out ahead of insecticide-treated bednets ($53), beaten only by antimalarial drugs ($18).
The new R21 deal between Gavi, UNICEF and the Serum Institute is exciting news both for Africa and for the world. The more the R21 vaccine is rolled out and the more cost-effective it becomes, the stronger the case for further investment in anti-malaria tools, including future more effective vaccines. We hope that countries and other funders will make use of the new pricing to speed up the roll-out and bring us one step closer to eradicating malaria forever.