* As Uganda launches the largest malaria vaccine introduction to date targeting 1.1 million children aged under two years in 105 high- and moderate-transmission districts
* Becoming the 19th country to receive the vaccine that resulted in a 13% reduction in all-cause mortality among children in Malawi, Kenya and Ghana
* This vaccine is a game-changer, and together, we must ensure that every child receives it—WHO representative to Uganda, Dr Kasonde Mwinga
By Duncan Mlanjira
In order to combat malaria, which is the leading cause of illness and death among young children in Africa, the World Health Organisation (WHO) coordinated the pilot evaluation of the first malaria vaccine, RTS,S/AS01, in Malawi, Kenya and Ghana in 2019 — which was co-funded by Vaccine Alliance (Gavi) and other partners.
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The pilot malaria vaccine implementation programme (MVIP) protected millions of children in Malawi, Kenya and Ghana and “generated evidence that the introduction of the vaccine resulted in a 13% reduction in all-cause mortality among children” — says Gavi, WHO and UNICEF in joint statement that announces the scaling up of routine provision of the vaccine.
The global health partners say the multi-year MVIP in the three countries that piloted it, “led to WHO’s recommendation and prequalification of the two safe and effective malaria vaccines available today”.
“WHO continues to support countries by providing guidance, sharing experiences and offering technical assistance to ensure successful implementation,” says the statement that announces thelaunch in Uganda of “the largest malaria vaccine introduction to date — targeting 1.1 million children aged under two years in 105 high- and moderate-transmission districts”.
The malaria vaccination campaign was rolled out in Apac District, northern Uganda, making it the 19th country in Africa to introduce the malaria vaccine into routine immunisation, which is also the largest malaria vaccine roll-out to date in terms of target districts and population.
The statement reports that malaria is the leading cause of illness and death among young children in Uganda, responsible for up to 33% of all outpatient visits; 22% of hospital admissions and 6% of deaths, quoting 2023 data from WHO.
In 2023, Uganda was among the top five African countries with the highest malaria burden, alongside Nigeria, Democratic Republic of the Congo, Ethiopia and Mozambique.
Of the 19 countries, 14 introduced the vaccine in 2024; including Cameroon, Burkina Faso, Sierra Leone, Benin, Liberia, Côte d’Ivoire, South Sudan, Mozambique, Central African Republic, Niger, Chad, Democratic Republic of the Congo, Sudan, Nigeria and Burundi.
Apac District, which has been provided with the R21/Matrix-M malaria vaccine — to administered in four doses at 6, 7, 8 and 18 months with plans to expand nationwide — is reported to have the highest number of mosquito bites per person globally of over 1,500 bites per person annually.
WHO representative to Uganda, Dr Kasonde Mwinga
WHO representative to Uganda, Dr Kasonde Mwinga is quoted as saying: “Today marks a historic turning point in Uganda’s fight against malaria. By integrating the malaria vaccine into routine immunization, Uganda is taking a bold step to protect its children, save lives and secure a healthier future.
“This vaccine is a game-changer, and together, we must ensure that every child receives it,” said Dr Mwinga, while Uganda Minister of Health, Dr Jane Ruth Aceng Ocero, said the introduction of the vaccine marks a significant milestone in that country’s fight against malaria.
“It is expected to prevent at least 800 cases of severe malaria among children every day and ease the financial burden on families, saving them approximately UGX 15,000 per case that would have been spent on treating severe malaria.
“I urge all parents and caregivers to ensure that children aged 6 to 18 months receive the malaria vaccine at the nearest health facility. For the best protection, it is essential that the children complete all four doses on schedule.”
Gavi, which coordinates the global malaria vaccination programme, providing essential financial support for the procurement, transport and roll-out of doses, reports that its model relies on co-financing, “meaning that countries contribute to the cost of their own vaccines, paying progressively more as their income rises to the point where they fully pay for their own programmes”.
“Future support for its global malaria programme is dependent on Gavi securing sufficient funds for its next five-year strategic period starting in 2026, however; and any shortfall in funding will result in programmes being cut back, leading to preventable deaths and a greater threat to global health security.”
On the historic roll-out, Gavi CEO, Dr Sania Nishtar is quoted as saying: “With one of the highest malaria incidence rates globally, Uganda faces a relentless battle against this deadly disease that has devastated families and communities for far too long. “The malaria vaccine, proven safe and effective, saves lives and prevents hospitalisations. However, without sustained financial support, these life-saving efforts could falter, leaving millions of children vulnerable and undermining the progress made so far.
“Continued funding is crucial to sustain and expand these efforts, ensuring that more children are protected, and more countries benefit from this vital tool.”
Gavi CEO, Dr Sania Nishtar
UNICEF, responsible for the procurement and air freighting of the vaccines and raising awareness within the community to enhance demand for vaccines, reaffirmed its commitment to child health and immunisation efforts in Uganda.
Why children, not adults?
“Children under the age of 5 are at the greatest risk of dying from malaria and account for more than 75% of the global deaths from the disease,” says the statement.
“The malaria vaccine in Uganda, as in the other 18 countries supported by Gavi, will be integrated into routine immunisation services to protect young children who are most vulnerable to the disease.
“Unlike adults, young children have not had the opportunity to develop partial immunity through years of exposure, making them particularly at risk. In 2023 alone, malaria caused 597,000 deaths globally, and 432,000 child deaths in Africa – highlighting the urgent need to protect our youngest and most vulnerable.”
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Malaria vaccine safety and effectiveness
Both the RTS,S/AS01 and R21/Matrix-M vaccines are prequalified and recommended by WHO to prevent malaria in children and are safe and effective. In phase 3 clinical trials, both vaccines reduced malaria cases by more than half during the first year after vaccination, a period when children are at high risk of illness and death.
A fourth dose given in the second year of life prolonged protection. Both vaccines reduce malaria cases by 75% when given seasonally in areas of highly seasonal transmission.
The vaccines target P. falciparum, the deadliest malaria parasite globally and the most prevalent in Africa; https://www.who.int/news-room/questions-and-answers/item/q-a-on-rts-s-malaria-vaccinee
In addition to Burundi (rolled out in March) and Uganda, four to six more countries, including Mali, Ethiopia and Guinea, plan to roll out the vaccine in 2025.
Gavi is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases — bringing together developing country and donor governments, such as the WHO, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners.
Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1.1 billion children – and prevented more than 18.8 million future deaths, helping to halve child mortality in 78 lower‑income countries.
Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines.
After two decades of progress, Gavi says it is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot.
Gavi indicates that it “employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency.
On its part, UNICEF maintains that it promotes the rights and wellbeing of every child, in everything they do: “Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.”
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