"The global malaria vaccination program is at a critical juncture... proof of high demand, but without urgent funding, this progress could unravel."
Malaria remains one of Africa's deadliest childhood diseases, yet global health funding is under unprecedented pressure. Funding shortfalls, rising drug and insecticide resistance, climate change, humanitarian crises, and even invasive mosquito species are crippling malaria eradication efforts. According to the World Health Organization (WHO), the African Region continues to bear the brunt of the global burden of malaria cases and deaths, accounting for 94% of global cases and 95% of deaths.
"Children under five are disproportionately affected, representing over 75% of global malaria deaths due to their lack of partial immunity," according to Dr. Scott Gordon, the Head of Gavi's Malaria Programme. "This means millions of families and communities across Africa are grappling with the devastating impacts of malaria every day, from losing loved ones, particularly young children, to facing the long-term strain on household incomes and healthcare systems."
The rollout of WHO-approved malaria vaccines (RTS, S, and R21) shows promise. However, challenges include a funding gap, artemisinin drug resistance in countries like Uganda and Rwanda, insecticide resistance in 78 of 88 endemic countries, and climate-driven disruptions like the spread of Anopheles stephensi (a mosquito species that is capable of transmitting both Plasmodium falciparum and P. vivax, the parasites responsible for the most severe forms of the disease).
A child dies from malaria nearly every minute
The malaria vaccine rollout began with pilot programs in Ghana, Kenya, and Malawi, reaching over 2 million children from 2019 to 2023, with a 13% reduction in all-cause mortality among eligible children. In 2021, the WHO recommended the first malaria vaccine for children, RTS, S, following the success of the Malaria Vaccine Implementation Programme (MVIP) in Ghana, Kenya, and Malawi. Two years later, WHO recommended both RTS and S malaria vaccines to children living in malaria-endemic areas, with a focus on areas with moderate and high transmission rates.
In a landmark effort, 20 African nations have now rolled out the continent's largest-ever coordinated malaria vaccine campaign.
These countries are Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Kenya, Liberia, Malawi, Mali, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan, Sudan, and Uganda.
Mali became the 20th African nation to introduce the malaria vaccine, deploying a pioneering hybrid delivery strategy that combines age-based dosing with seasonal boosters before peak transmission. Mali's approach not only enhances protection for children under five but also sets a model for other Sahel nations, showcasing the adaptability of public health systems in addressing local challenges amid global funding constraints.
African countries have received over 24 million malaria vaccine doses since 2023 to scale up their immunization programs.
The unprecedented scale-up, supported by Gavi, the Vaccine Alliance, WHO, and UNICEF, aims to reduce the high burden of malaria among African children, who account for the vast majority of global malaria cases and deaths. However, global health funding constraints pose a threat to the scalability and sustainability of this initiative.
The question remains: Will global health funding keep pace with the urgency of this fight?
Global health budgets are increasingly under pressure, even as demand for malaria vaccines continues to rise. Gavi, the Vaccine Alliance, faces a funding shortfall estimated at $2 to $3 billion over the next five years, specifically for malaria vaccine support. This gap is largely driven by reductions in government aid, including significant cuts from the United States, which had been a major donor contributing about 13% of Gavi's overall budget. The withdrawal of U.S. funding and similar cutbacks from other donors threaten to undermine ongoing malaria vaccination efforts and broader immunization programmes, potentially leading to millions of children missing routine vaccinations and increased child mortality.
Gavi faces a $2-3 billion shortfall in malaria vaccine funding over the next five years
"The global malaria vaccination program is at a critical juncture," said Dr. Gordon. "We've delivered over 24 million doses since 2023, proof of high demand, but without urgent funding, this progress could unravel."
"The rapid rollout so far underscores high country demand for this new tool," he said. "However, while malaria remains a high priority for Gavi, it's important to note that, indeed, we do not yet have the funds required for this work beyond 2025." He said Gavi aims to vaccinate 50 million more children with four doses of malaria vaccines between 2026 and 2030.
He said that any cuts to aid would directly affect Gavi's capacity and that of countries and partners to implement essential health programs, including malaria vaccination. Delivering these vaccines requires extensive logistics, from trained human resources to robust supply chains and surveillance systems, integrated with other malaria control interventions.
Dr. Gordon said Gavi's ability to fund this program and support countries to save hundreds of thousands of lives and alleviate the burden on families, communities, and health systems is dependent on successful fundraising for Gavi's next strategic period (2026-2030). Gavi is currently seeking to raise financing from donors to support our most ambitious strategy ever: aiming to protect more people against more diseases faster than ever before.
Gavi is an extremely efficient and cost-effective organisation, with 97 cents of every dollar it raises going towards vaccine programmes.
However, he said that cuts to the organisation's budget would "directly impact our ability to protect children from preventable disease," making the world "less safe for everyone" by weakening the ability to prevent and contain dangerous disease outbreaks.
Despite the challenges faced by donors, Dr. Gordon said that they "remain cautiously optimistic that governments will continue to prioritise immunisation as one of the best investments in our collective health, security and prosperity, as they have done for the past quarter of a century".
Hope for Africa
Mali's introduction of malaria vaccines, supported by Gavi and partners, makes it the 20th African country to integrate the vaccines into its routine immunization program. Mali is also the first globally to implement a hybrid delivery approach, providing the first three doses based on age, followed by seasonal fourth and fifth doses before the high transmission season. This strategic approach maximizes impact by aligning protection with peak malaria risk.
In 2023 alone, Mali recorded over 8 million malaria cases and more than 14,000 deaths
"As we've witnessed in other countries on the continent, the introduction of the vaccines will help protect lives and reduce hospitalisations, driving down the burden of the disease and leading to healthier communities," said Dr. Gordon.
He said malaria treatment places a significant financial strain on families, with the disease costing the world approximately $12 billion annually in lost productivity, and can account for up to 40% of public health expenditures in affected countries. The vaccines lessen treatment costs for families and lost wages to care for sick family members. Lastly, by protecting children from malaria, the vaccine contributes to improved quality of life for families and communities.
"Innovation in research and development (R&D) is crucial for accelerating malaria elimination by providing new and improved tools," he said. "This includes developing next-generation vaccines with higher efficacy and broader protection, as well as advanced vector control tools like new insecticides and genetic technologies to combat mosquito resistance and outdoor biting."
R&D is not just about vaccines.
Dr. Gordon said that R&D also drives improvements in diagnostics for faster and more accurate parasite detection and creates novel antimalarial drugs to counter drug resistance. He said R&D in data and surveillance tools also helps monitor parasite populations and guide interventions.
Turning the tide
Despite malaria remaining one of Africa's deadliest childhood diseases, integrated approaches are proving crucial in significantly reducing its toll on children.
"It has been estimated that malaria vaccines can achieve the greatest impact when they are used alongside other interventions, including insecticide-treated bed nets, indoor residual spraying, seasonal malaria chemoprevention, and effective case management and treatment," he said.
The National Malaria Control and Immunisation Programs currently collaborate to assess the burden, identify priority areas, and coordinate activities, he said. Information campaigns for vaccines reference other anti-malaria interventions and vice versa, with opportunities for integrated service delivery, such as providing bed nets with vaccine doses or coordinating communication for the fourth dose and seasonal chemoprevention before high transmission seasons.
Data monitoring efforts can be synchronized, he said, such as verifying children's vaccination status during the administration of seasonal malaria chemoprevention.
According to Dr. Gordon, Gavi supports countries in building strong, equitable, and sustainable immunisation programs through its Health Systems and Immunisation Strengthening (HSIS) investments in human resources, service delivery, demand generation, supply chains, data use, and sustainable financing. These support malaria vaccine rollouts while offering broader health benefits. Gavi also uses its Equity Accelerator Fund to reach zero-dose children - children that have not received a single dose of a vaccine - and vulnerable populations with life-saving vaccines.
The burden of malaria falls heaviest on vulnerable and underserved populations
Reducing inequities in malaria outcomes across Africa "requires strengthening health systems by improving data use, enhancing technical expertise, and fostering multisectoral collaboration, rather than over-relying on commodities". Dr. Gordon said context-specific initiatives are vital to tailoring responses to diverse malaria epidemiology at national and sub-national levels. This must be supported by increased funding from both domestic and international sources, and robust research and development for new vaccines, drugs, and technologies.
Dr. Gordon said that ensuring universal and equitable access to interventions like bed nets and drugs is paramount, shifting towards mass distribution and leveraging community health workers.
"Community engagement and empowerment are essential, encouraging decentralized decision-making and ownership in health promotion. Integrated approaches that combine vaccines, mosquito nets, spraying, and chemoprevention maximize impact. Addressing socioeconomic determinants such as housing, education, and income also plays a significant role in reducing malaria risk," he said.
"Finally, strong political will and coordinated national responses are fundamental, as emphasized by declarations like the Yaoundé Declaration on Malaria."
However, vaccine hesitancy and misinformation remain major hurdles in vaccine rollout.
"Hesitancy is not unique or specific to malaria vaccines," said Dr. Gordon. "From our experience rolling out new and existing vaccines, we know that for people to trust vaccines, information must come from trusted sources, whether health professionals, friends, family, or community leaders."
"Gavi's approach is built on this principle: listening, engaging with local contexts, and adapting to ensure people have the information they need to make informed decisions. Together with our in-country partners, we engage with a wide range of stakeholders, including trusted local leaders, to deliver clear, tailored messages and health workers to share accurate, evidence-based information with parents."
The introduction in Mali on World Malaria Day comes a few weeks after Uganda rolled out the largest malaria vaccine roll-out to date in terms of target districts and population.
Dr. Gordon said that Uganda's extensive malaria vaccine rollout offers key strategies replicable globally to enhance malaria control in several ways.
"First, Uganda is introducing the vaccine across most high and moderate transmission districts with plans for nationwide expansion, integrating it directly into the routine childhood immunization schedule (at 6, 7, 8, and 18 months) to leverage existing health infrastructure. Extensive preparation activities were conducted, including detailed planning, resource mapping, baseline surveys on community perceptions, intensive training for healthcare and village health teams, and ensuring sufficient cold chain capacity.
Secondly, there was intensified community mobilization through engaging Members of Parliament, cultural and religious leaders, the media, and conducting door-to-door campaigns. This was supported by close multi-partner collaboration between the Ministry of Health's immunization and malaria programs, and organizations like Gavi, WHO, and UNICEF.
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Lastly, the vaccine has been implemented as part of a broader malaria control strategy, complementing interventions like bed nets, indoor residual spraying, and chemoprevention for maximum impact."
He said that strong political commitment from top government leaders has been critical to achieve this and will be important to maintain success and sustainability. "It's also worth noting that Gavi's co-financing model, where countries such as Uganda pay an increasing share of the cost of the vaccines as their income grows, contributes towards full country ownership and program sustainability."
Overcoming obstacles
Dr. Gordon said that limited cold chain infrastructure and unreliable electricity in health facilities, especially in remote areas, significantly challenge immunization delivery.
Lack of reliable electricity in health facilities poses a significant challenge to immunization and overall health outcomes, particularly in remote areas. To address this, he said that Gavi already has one of the largest global programs providing solar power to health facilities, deploying approximately 10,000 solar-powered fridges annually. Most recently, Gavi invested $35 million in installing solar units across 1,000 health facilities in four countries, including Ethiopia, prioritizing facilities distant from the main power grid.
Up to 300 healthcare facilities in Ethiopia, for instance, are targeted for solarization. The initiative aims to improve healthcare outcomes by expanding services, including immunization and access to clean water, strengthening climate-resilient health facilities, and reducing carbon emissions.
He also said that countries like Ghana and Nigeria are leveraging new innovative technology, such as drones, to deliver malaria vaccines to hard-to-reach health facilities. These innovations help overcome logistical challenges associated with flooding and difficult road conditions, to ensure the most remote rural health facilities have access to life-saving vaccines.
Africa's 2030 malaria vision
Dr. Gordon said the malaria vaccine rollout has progressed significantly since its launch over a year ago, expanding from pilot programs to now 20 African countries and reaching millions of children. He said that early data from Cameroon suggests positive impacts, including reduced hospital visits and under-five deaths in vaccinated areas. However, while promising, he said that the data is preliminary, and a comprehensive analysis will take time as the rollout is phased and prioritizes the youngest children.
"Currently, vaccine availability meets demand, with two WHO-approved vaccines, R21 and RTS, S, now available," he said. "Gavi anticipates significant expansion in 2025, with vaccine introductions in 4 to 6 new countries, including Ethiopia and Guinea, and scaling up in existing programs."
Gavi and partners hope to fully vaccinate 50 million children with the malaria vaccine between 2025-2030
"Achieving this goal will require critical funding," said Dr. Gordon. "To this end, in just four weeks, Gavi, the European Union, and the Bill & Melinda Gates Foundation will co-host a high-level in support of Gavi's replenishment for the next five years, where we will seek to protect more people against more diseases, such as malaria, faster than ever before.
