Mass rollout of two new malaria vaccines, RTS,S/AS01 and R21/Matrix-M, is changing disease control across many countries, but experts warn they are not a single solution. In 2024 malaria caused 270 million cases and 595,000 deaths, and three quarters of those who died were children under five. The vaccines give only partial protection and require a four-dose schedule, which places new demands on already stretched health systems at a time of international funding cuts.
Evidence from large pilot programmes in Ghana, Kenya and Malawi shows that, when vaccines are combined with existing interventions, child mortality can fall by about 13 per cent. Ghana began piloting RTS,S in 2019 and added R21 during scale-up; coordination between general immunisation and malaria elimination programmes was central. On the ground, the same health workers deliver routine vaccines and malaria care, and staff were trained to respond to safety rumours on social media. Early first-dose coverage in Ghana exceeded 80 per cent, with overall dropout across the four-dose schedule around five per cent.
Nigeria introduced RTS,S in 2024 and is deploying it in phases in selected high-burden states. WHO recommends both vaccines for children living in areas of moderate to high transmission, but the four-dose schedule, from five months to 15 months, does not align well with routine contacts, so dose completion is difficult. Nigeria is linking vaccination with seasonal malaria chemoprevention campaigns to reach children who missed doses.
Experts say countries must combine tools and use local data to guide choices. Other important measures include:
- insecticide-treated mosquito nets
- seasonal chemoprevention
- indoor residual spraying
Researchers continue work on next-generation vaccines. As one expert noted, the new vaccines could save tens of thousands of lives, but there is still room to improve delivery and effectiveness.
Difficult words
- rollout — Large introduction of a product or programme
- pilot programme — A small initial project to test methodspilot programmes
- scale-up — Increase a programme to reach more people
- dropout — Failure to finish a required course or schedule
- chemoprevention — Use of medicine to prevent disease before infectionseasonal chemoprevention
- transmission — Process by which a disease spreads between people
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- How could combining vaccines with other malaria interventions change outcomes in your community or country? Give reasons.
- What problems do four-dose vaccine schedules create for families and health services, and how could they be addressed?
- How can local data help health officials choose which malaria measures to use in different areas?
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