Africa: ‘We Are at a Critical Point in the Fight Against Malaria’ #WorldMalariaDay

Gavi, the Vaccine Alliance, has described the rollout of malaria vaccines across Africa as the fastest in its history, signalling a critical moment in the fight against one of the continent’s deadliest diseases. 25 countries in Africa have introduced malaria vaccines into their routine immunisation programmes with Gavi support. Early reports indicate that the initiative has had a significant impact on saving lives, reducing severe diseases, and reducing hospital admissions.

However, as countries increase rollout, questions persist about impact, delivery, and how to maintain progress.

In an interview, Thabani Maphosa, Chief Country Delivery Officer at Gavi, outlined how the rapid rollout of malaria vaccines is reshaping control efforts, the challenges countries face in delivery, and what is needed to sustain progress.

How would you assess the current state of malaria control and elimination?

Malaria remains one of the leading causes of illness and death in Africa, particularly for children under five, who account for more than 75% of malaria deaths globally. The continent still carries an overwhelming share of the global burden.

Today, we are at a critical point in our efforts to turn the tide against this disease. For the first time, malaria vaccines are being delivered routinely at scale, alongside established tools like bed nets, chemoprevention and treatment. As of today, 25 African countries provide malaria vaccines through routine immunisation, and early country reports are already showing reductions in severe disease and hospital admissions.

This does not mean elimination is imminent, but it does mean that countries are better equipped than ever before to protect children and relieve pressure on their health systems.

The rollout across 25 countries has been described as the fastest in Gavi’s history. What made this possible?

The speed of the rollout accurately reflects the high levels of demand we are seeing from countries to roll out vaccines. In anticipation of the vaccine’s availability, it is fair to say a lot of time was spent time planning for this, because we knew that when the vaccines were finally approved and available, countries would want us to help them move fast.

Strong partnerships were critical in this sense. With four doses recommended per child, it is a complex vaccination programme to introduce. I am pleased that the governments we work with, with the support of Gavi and our partners where necessary, have successfully integrated malaria into existing immunisation systems, even in fragile and high‑burden settings.

Early data show declines in severe cases and deaths. How much of this can be attributed to vaccines?

Malaria vaccines work best when layered on top of other interventions, and that is how countries are using them. Early reports from Kenya, Malawi, Ghana and Cameroon show reductions in severe disease and hospital admissions among vaccinated children, reinforcing results seen during earlier pilots.

Another striking example is Burkina Faso, where nationwide malaria vaccination, introduced alongside bed nets, seasonal chemoprevention and community mobilisation, contributed to a 32% decline in reported malaria cases between 2024 and 2025, with malaria‑related child deaths nearly halved.

This shows how vaccines, when delivered at scale as part of strong national programmes, can help shift malaria outcomes.

What lessons are emerging from countries scaling up malaria vaccination across Africa?

Delivering 4 doses of the malaria vaccine has been challenging because, while the first three doses are delivered in quick succession, the 4th dose is then administered sometime later. Making sure children receive all four doses, then, has required countries, who introduce malaria vaccination from different baselines in terms of routine immunisation coverage and health system capacity, to develop a strategy that works for them. Most countries have addressed this challenge by scaling up vaccination through a step-by-step phased approach, implementing and testing tailor-made strategies for their own unique contexts and challenges.

Gavi has also invested US$ 5 million in a learning agenda to test the impact and effectiveness of different methods of delivery across 7 African countries. This will help generate evidence on what strategies work best to effectively deliver the 4th dose and integrate malaria vaccination into existing malaria control programmes, immunisation programmes, and primary healthcare infrastructure.

What we are seeing clearly is that the countries gaining most ground against malaria are those that combine vaccines with other proven interventions and tailor delivery to their unique epidemiological context. Strong coordination between malaria and immunisation programmes, reliable surveillance and sustained community engagement all play a critical role.

How is climate change reshaping malaria transmission?

Climate change is increasingly influencing where and when malaria spreads.

Rising temperatures, flooding and changing rainfall patterns create new breeding conditions for mosquitoes and disrupt control efforts. Several countries are seeing sharp increases in cases linked to extreme weather events, underscoring how volatile malaria transmission is becoming.

This makes sustained prevention more urgent. Vaccines add an important layer of protection, particularly for young children, as malaria patterns become less predictable.

What should be the top priorities for malaria funding and R&D right now?

The top priority is to protect momentum. Countries have moved fast to introduce the vaccine, and now they need to ramp up to protect all vulnerable children. Over the next five years, Gavi hopes to support countries to ensure 50 million more children are fully protected with the malaria vaccine, to save 180,000 lives. However, realising the full potential of this vaccine will require our strategy to be fully funded, and countries themselves to invest further in this immunisation programme.

Equally critical is sustaining investment in integrated malaria programmes that combine vaccines, chemoprevention, vector control, diagnostics and treatment. Pulling back now risks losing gains that are beginning to materialise.

At the same time, continued research and development are also key. The two WHO-prequalified vaccines, RTS, S and R21, are often described as “first‑generation” malaria vaccines. They are the essential bridge between decades of research and a future where second‑generation vaccines could deliver even higher efficacy, longer duration of protection, simpler dosing, and more affordability.

Investing in these first vaccines does two things at once. It saves lives today by reducing the huge burden of illness and death among children at the highest risk. And it builds the evidence, delivery experience and market certainty that stimulate innovation for new, more effective vaccines in the future. Without sustained deployment of RTS, S and R21, the pipeline of next‑generation malaria vaccines becomes weaker, not stronger.

With funding shrinking and co‑financing rising, can countries sustain malaria vaccination gains?

The stark truth is that if we are not able to fully fund our malaria programme, more children will die, households will be poorer due to increased healthcare costs and health systems will continue to be strained. It really is essential that we build on the impressive progress that has been achieved to date, and I am optimistic that, through domestic political commitment and the support of our donors, we will be able to ensure the most vulnerable children are not left behind during this critical expansion phase.

What is Gavi’s role in achieving global malaria targets?

Gavi’s role includes shaping the malaria vaccine market to secure vaccine supply while catalysing future R&D, financing doses, supporting delivery through routine immunisation systems, and strengthening health infrastructure.

Malaria vaccines do not replace existing tools. They complement them. With sustained investment and coordination to build on the momentum generated by this powerful new tool, countries and partners can help change the trajectory of one of Africa’s deadliest childhood diseases.