In the spirit of quick answers, yes

R21 is good, the case for going faster is ethically strong and is pretty well articulated already, making this a relatively easy lift. Concerns around relative cost effectiveness vs other malaria control measures (e.g. bednets, SMC) are reasonable questions to raise but largely irrelevant for this given the proposal is to accelerate something that will happen anyway, the funding for delivering a malaria vaccine is largely secured already (via Gavi, Global Fund, national governments) and is unlikely to meaningfully funge more cost-effective alternatives. R21 is much cheaper than RTS,S, and almost certainly more effective.

Thanks for bringing this to our attention Nathan. I completely agree, and am a little sheepish that I did not pick up on this obvious moral problem myself sooner. The reality that malaria vaccines which work so well have been around for so long now, has almost numbed me to the fact that we don't have them yet.

To confirm this is probably possible, in many African countries like Uganda where I manage health centers, there are few practical problems rolling out vaccines like this. Government and private sector healthcare providers have the cold chain, community health workers and willing population ready to get started any time. This ability has been proven with many other successful mass vaccination campaigns which have been rolled out almost at the drop of a hat, like measles last year. 

I would say that mass vaccination campaigns like thisare probably one of the very few things that Uganda does well on a national level.

If 10 million doses arrived in Uganda tomorrow, with moderate confidence I think thousands more lives would be saved compared to if it dropped in 6 months. 

Another guess with lower confidence, is that the RTS-S vaccine is already in the process of being rolled out slowly, so there will be concerns and politics about accelerating another vaccine (that looks far better) over the top of it. As much as the WHO is talking about both of these vaccines being rolled out together over the next few years, I don't think it will be long before the R21 vaccine mostly takes over due to the far greater production capacity and potentially slightly better efficacy.

Another problem might be that its not just about the vaccine availability, but the  large additional costs of the rollout as well. These malaria vaccination campaigns will be almost completely donor funded - its not just about getting the doses to the countries, millions of dollars  also has to be mobilised to make it happen in every country. Countries don't pay for these rollouts themselves, which I think needs to change but that's a whole nother discussion.. Vaccinators are hired, vehicles are fueled, important people are paid to sit at meeting tables. Mobilising this money quickly might be a barrier - which is why GiveWell recently provided 5 million dollars to an NGO to solve this exact problem for an RTS-S rollout, and that was only for a few hundred thousand doses. Multiply that by 10 and you might find that the money isn't sitting around ready right now.

As ChrisSmith said I don't think cost-effectiveness compared with nets or SMC is an issue, because this is basically already paid for and happening anyway.

If anyone's interested, 1Day's hosting a brainstorming session this Friday at noon eastern to share information and identify possible tactics for accelerating the R21 rollout. Message me or reply here if you're interested in joining or want to be kept updated.