This is a linkpost for https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00442-X/fulltext
Suggestion here that the cost is $5 a dose https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244995 which seems very likely to push it into cost-effective territory surely? (assuming distribution costs etc aren't absolutely enormous)
Context: there has recently been a new phase 1/2b RCT in The Lancet, confirming a ~80% effectiveness rate for the R21/MM malaria vaccine (and confirming that booster shots work).
'Prof Hill said the vaccine - called R21 - could be made for "a few dollars" and "we really could be looking at a very substantial reduction in that horrendous burden of malaria".
He added: "We hope that this will be deployed and available and saving lives, certainly by the end of next year."'
If the vaccine makes it through phase III trials, this seems intuitively like a much more effective malaria intervention than bednets.
I think an 80% effectiveness rate is a fair bit higher than you get from using bednets - if I recall correctly they tend to reduce malaria deaths (or perhaps cases) by 30-50%.
The question is cost-effectiveness. If it's a few dollars for the whole set of vaccines ('three initial doses followed by a booster a year later'), and this includes distribution costs, then this seems pretty clearly more cost-effective than bednets.
It's also worth considering that vaccines can't rip, get lost, or be installed incorrectly. It also protects the user no matter where they go-- they don't have to stay in bed to be protected.
Even if slightly more expensive, vaccines seem like they might be more convenient for the people who need protection from malaria.
I wonder though if there are other major mosquito-borne diseases that bed nets protect from besides malaria. If there are, then a combination of nets+vaccine seems best.