Malaria vaccine and its relevance in an Indian setup: Worlds first anti malaria vaccine RTS, S was launched on oct 2021 in african countries under brand name mosquirix. WHO has recommended use of this vaccine in children in areas of moderate to high risk malaria transmission. It is a protein subunit vaccine which works on pre erythrocytic stage of P.Falciparum malaria. 3 doses are given intramuscular at monthly interval followed by a booster at 20thmonth. Mechanism of action: The vaccine contains P. Falciparum cirumsporozoite antigen clubbed to a surface antigen from hepatitis b and a chemical adjuvant to boost the immune response. The vaccine produces antibodies to circumsporozoite antigen and neutralise the P.Falciparum parasite in the pre erythrocytic stage of cycle. This prevents the liver from getting infected and the malarial infection is aborted. Trial data: This vaccine has undergone phase 3 trials in african subcontinent among children from 5 months to 17 months of age. The trial shows upto 36% reduction of P. Falciparum malaria among the trial population with minimal adverse events. Relevance in India: India carries 3% of the global malaria cases and 47% of global P. Vivax case burden. The highest case load is seen in age group 15 to 70 yrs. Mortality is highes in P.Falciparum cases. There are many challenges before applying this vaccine to indian setup. This vaccine has been tried only in african children age group 5 months to 17 months. Vaccine is only for p falciparum malaria.We need trials among Ondian patients from all age groups to assess its efficacy. Also a multi strain vaccine which has protein capsids from both P.falci, P. Vivax would be more effictive in an Indian setup as P. vivax contributes to a big case load. Vaccines are just one step in prevention. Other measures of vector control, use of chemopropellants to control breeding larvae need to be practised along with vaccine use. Currently Bharat biotech is in process of manufacturing this RTS, S vaccine. It will take a couple of years for it to be launched in commercial indian market. Newer vaccines: A more potent malaria vaccine R21/ Matrix-M is under trails. It has a whopping 77% efficacy as compared to current RTS, S vaccine and higher antibody titres. Dr Hardik Thakker, MD MED.