Mass rollout of (LAGOS/SciDev.Net). Malaria Vaccines are beginning to change the landscape of disease control in Africa. But success will depend less on availability and more on how well they are delivered disease experts
After a decade-long search for an effective malaria vaccine, two World Health Organization-recommended malaria vaccines—RTS,S/AS01 and R21/Matrix-M—are now given as part of routine immunization programs in 25 countries.
This marks a milestone in the response to a disease in Africa, where 270 million cases and 595,000 deaths were recorded in 2024. three quarters Among these deaths were children under the age of five.
However, the vaccines provide only partial protection and require four doses, placing new demands on an already stretched health system, as international funding cuts bite.
Evidence from large pilot programs in Ghana, Kenya and Malawi suggests that when combined with existing malaria interventions, RTS,S and R21 can reduce child mortality. by 13 percent.
Researchers say the greatest impact is seen when vaccines are used alongside tools such as insecticide-treated nets and seasonal chemoprevention, emphasizing their role as complements rather than replacements in malaria control.
“We always knew these were not going to be magic bullets,” said Fotini Sinis, an expert at the Johns Hopkins Malaria Research Institute in the US.
“The thought is that the vaccine adds to what we already have.”
That shift—from seeking a single breakthrough solution to combining multiple interventions—is now shaping how countries approach rollout. Public health experts say it is important to embed vaccines within existing malaria control systems.
joint force
Ghana, one of the early adopters, began piloting RTS,S in 2019 under the Malaria Vaccine Implementation Program and has since expanded delivery, later introducing R21 as part of its scale-up.
Here, the rollout has been driven by synergy between routine immunization and malaria eradication programmes, says Naziru Tanko Mohammed (RD1.1), Deputy Manager of the Expanded Program on Immunization (EPI) at the Ghana Health Service.
“We’ve had both programs around the same table from the beginning,” he said.
On the ground, the same healthcare workers deliver both malaria interventions and routine vaccinations, making integration a real necessity. Joint planning has helped define roles, align messaging and ensure vaccination complements existing tools such as insecticide-treated nets and chemoprevention, Mohammad said.
He says this coordination has also proven important in responding to misinformation about the safety of the (RD2.1) vaccine being circulated on social media. “Before the rumours, we had already trained people ready to respond,” Mohammed said.
Early uptake has been strong, with first dose coverage greater than 80 percent (RD3.1). But maintaining coverage across the four doses remains a challenge, with a dropout rate of about five percent as children move through the schedule.
Scaling Challenges
In Nigeria, Africa’s most populous country, the scale of this challenge is greater.
The RTS,S vaccine introduced in 2024 is being phased in, starting in selected high-burden states. WHO Both vaccines are recommended for children living in moderate to high infection areas.
According to Nenna Ogbulafor, Director of the National Malaria Elimination Program in Nigeria, (RD4.1)(OE4.2) The structure of the country’s health system presents both challenges and opportunities.
“Nigeria’s health system is complex,” he said.
As in Ghana, integration with the malaria program has been concentrated within the existing immunization framework. But initial implementation revealed a hurdle.
“One of the key issues we’re seeing is dose completion,” Ogbulafor said.
The four-dose schedule, starting at five months and extending to 15 months, does not align well with regular immunization contacts, making it difficult for caregivers to complete the full course. In areas with low immunization coverage, these challenges are even more pronounced, Ogbulfor added.(RD5.1)(OE5.2)(OE5.3)
To address this, Nigeria has begun linking vaccination to existing malaria delivery platforms, including seasonal malaria chemoprevention campaigns, to improve uptake and identify children who previously missed doses.
Data-driven models
Health leaders say these experiences point to a broader lesson: Malaria vaccines cannot be delivered through a one-size-fits-all model.
“In Nigeria, every state is different,” said Vivian Ihekweju, managing director of Nigeria Health Watch, adding: “The burden, the environment, the context, they are all different (RD6.1).”
Ihekweju says countries need to use data to determine the most effective mix of interventions in each setting.
“People often assume that you can distribute the net everywhere and solve the problem, but that’s not the case,” he said.
Malaria control requires a combination of different tools – insecticide-treated nets, seasonal chemoprevention, indoor sprays and vaccines – depending on local transmission patterns. with funds The tighter the constraints, the more critical this approach becomes.
“With reduced funding, we need to ensure that we use limited resources efficiently. And the only way to do that is to use data to guide interventions that are deployed,” Ihekweju said.
However, the data itself remains a limitation. “We need to improve the way data is collected and used at the tribal level,” he added.
As countries work to maximize the impact of these tools, Research Continued in the next generation vaccine (RD7.1).
William Moss, deputy director of the Johns Hopkins Malaria Research Institute, said the new vaccine has the potential to save thousands of lives, “but there is room for improvement”.
“We must continue to invest in the research needed to develop more effective vaccines while ensuring children have access to current vaccines,” he said.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English Desk.
