Saving The Next Generation: Can Malaria Vaccines Reduce Child Deaths in Africa?

UPDATE

A recent study led by Professor Victor Mwapasa and Doctor Kwoku Poku Assante, published in The Lancet, found that approximately 1 in 8 child deaths were prevented among those eligible for the RTS,S/AS01 malaria vaccine (also known as Mosquirix), when it was included in routine immunization programs [1] [2]. The RTS,S malaria vaccine was introduced in Ghana, Kenya, and Malawi in 2019 through the Malaria Vaccine Implementation Programme (MVIP), which aimed to evaluate its public health use over 4 years [3] [4]. These three countries were selected due to well-functioning malaria and immunisation programmes, and high malaria burdens [5]. This clinical investigation, funded by the World Health Organization (WHO), Gavi, the Vaccine Alliance, the Global Fund, and Unitaid [1], offers renewed hope for regions affected by malaria, especially in the WHO African Region, which accounted for 95% of global malaria cases (265 million) and 95% of global malaria deaths (579,000) in 2024 [3]

“Number of child deaths from malaria, 2023" Published online at OurWorldinData.org. Retrieved from: https://ourworldindata.org/grapher/child-deaths-from-malaria-number?time=2023 [Online Resource].

MALARIA VACCINES

RTS, S and R21/Matrix-M

According to the CDC, malaria vaccines have been in development since the 1960s. Significant advancements have been made in the last decade, notably the WHO’s 2021 recommendation of the RTS, S malaria vaccine for widespread use among children living in regions with moderate to high malaria transmission, which was supported by the WHO's MVIP [3] [4]. This vaccine was developed by GlaxoSmithKline (GSK) in partnership with the PATH Malaria Vaccine Initiative. It was engineered to target the P. falciparum parasite that causes malaria, making it the world’s first vaccine against a human parasitic disease[6].

Just two years after this groundbreaking development, the WHO would announce the R21/Matrix-M as the second safe and effective malaria vaccine approved for widespread use [3]. This vaccine was developed by the University of Oxford and manufactured by the Serum Institute of India, the world's largest vaccine manufacturer by number of doses produced and sold globally [7].

How do these vaccines work?

Both vaccines employ a similar mechanism of action. The malaria parasite has several stages in its life cycle, starting with its highly mobile and elongated form referred to as a “sporozoite”. These vaccines target the sporozoite stage and apprehend the parasite before it is able to further develop [6] [8]. The vaccines do this by targeting a protein found on the surface of sporozoites called the “Circumsporozoite Protein (CSP)”, which would usually help the sporozoites to invade liver cells, then mature and multiply [6] [8]. Vaccination stimulates the immune system to produce antibodies against the CSP [6]. Thus, if a vaccinated person is later bitten by a malaria-infected mosquito, the antibodies can neutralise the sporozoites in the bloodstream by targeting the CSP, preventing the parasite from establishing an infection [8].

Head-to-head record

According to the WHO, “the R21 and RTS,S malaria vaccines have not been tested in a head-to-head trial. There is no evidence to date indicating a more effective vaccine.

Dosage

The WHO recommends that both malaria vaccines be administered in a schedule of 4 doses, to children from 5 months of age, with a potential fifth dose given one year after the fourth dose, and potential for variation in schedules for areas with “highly seasonal malaria transmission” or “perennial malaria transmission with seasonal peaks”.

World Health Organization. RTS,S/AS01 Malaria Vaccine Current evidence, Including efficacy, safety, Feasibility and Impact and Update on R21/Matrix-M Malaria Vaccine [Internet]. 2023 Jan. Available from: https://tdr.who.int/docs/librariesprovider10/rtss-workshop/02_maryhamel_opt_smc-meeting_overview.pdf?sfvrsn=fc90c573_11

Why this matters

According to the WHO, both vaccines reduce malaria cases by more than 50% during the first year after vaccination. This period is when children are at the highest risk of developing malaria, and a fourth vaccine dose provides extended protection. Additionally, there can be major reductions in malaria-related deaths among young children with just moderate levels of vaccine coverage [1]. The WHO reports that 25 African countries are currently incorporating malaria vaccines into their childhood immunization programs [1] [5].

WHAT’S NEXT

To maximize the impact of these vaccines, a coordinated effort is essential, which requires collaboration, sufficient funding, and research to address implementation challenges, such as weak healthcare systems and regional conflicts. The development of the R21 vaccine can be easily deployed and manufactured on a large scale at a modest cost [7].

References

1. Mwapasa V, Asante KP, Milligan P, Akech S, Oduro A, Mathanga DP, et al. Impact of Introducing RTS,S/AS01E Malaria Vaccine on Mortality in Young Children in Ghana, Kenya, and Malawi: an Observational Evaluation of a cluster-randomised Implementation Programme. The Lancet [Internet]. 2026 May;407(10541):1796–808. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2826%2900248-5/fulltext
2. World Health Organization. New Evidence Confirms Malaria Vaccine Saves Child Lives and Will Have High Impact in Wider Rollout [Internet]. Who.int. World Health Organization: WHO; 2026. Available from: https://www.who.int/news/item/08-05-2026-new-evidence-confirms-malaria-vaccine-saves-child-lives-and-will-have-high-impact-in-wider-rollout
3. World Health Organization. Malaria [Internet]. World Health Organization. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria
4. Centers for Disease Control and Prevention. Malaria Vaccines [Internet]. Malaria. 2024. Available from: https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html
5. World Health Organization. Ghana, Kenya and Malawi to Take Part in WHO Malaria Vaccine Pilot Programme [Internet]. WHO | Regional Office for Africa. 2017 [cited 2026 Jun 13]. Available from: https://www.afro.who.int/news/ghana-kenya-and-malawi-take-part-who-malaria-vaccine-pilot-programme
6. GAVI, the Vaccine Alliance. Everything You Need to Know about the Malaria Vaccine | Gavi, the Vaccine Alliance [Internet]. www.gavi.org. 2024. Available from: https://www.gavi.org/vaccineswork/everything-you-need-know-about-malaria-vaccine
7. University of Oxford. Oxford R21/Matrix-MTM Malaria Vaccine Receives WHO Recommendation for Use Paving the Way for Global roll-out | University of Oxford [Internet]. www.ox.ac.uk. 2023. Available from: https://www.ox.ac.uk/news/2023-10-02-oxford-r21matrix-m-malaria-vaccine-receives-who-recommendation-use-paving-way-global
8. Geddes L. Two vaccines, One target: How the RTS,S and R21 Malaria Vaccines Work [Internet]. Gavi.org. 2024 [cited 2026 Jun 13]. Available from: https://www.gavi.org/vaccineswork/two-vaccines-one-target-how-rtss-and-r21-malaria-vaccines-work?gad_source=1&gad_campaignid=12319817265&gbraid=0AAAAADibICMTyRnUu-n-GA5HO3_tG74BR&gclid=Cj0KCQjw_7PRBhDcARIsAMjV7jn3hLzJ5GnB_6Z64suW9k-Lkzl0QKEA5QyPlcXS4BVz8KhXlMdVUuwaAjVfEALw_wcB