Malaria vaccine rollout in Africa makes fast progress but faces threats from funding cuts and climate change
Introduction
Two recent reports describe the current situation of malaria vaccine programs in Africa. One report details a field trial in Tanzania for the R21 vaccine, which has led to a large reduction in local cases. The other report outlines the continent-wide rollout coordinated by Gavi, the Vaccine Alliance, now active in 25 countries. Both reports highlight significant progress but also point out risks caused by cuts in foreign aid and changes in the disease pattern due to climate change.
Main Body
Malaria remains a leading cause of death in sub-Saharan Africa, with children under five making up more than three-quarters of global deaths. In Tanzania, the disease is widespread: in 2024, the country recorded 9.4 million cases and 26,000 deaths. The global burden has worsened, with worldwide deaths rising from 598,000 in 2023 to 610,000 in 2024, partly due to drug resistance and climate change. In the village of Mwavi, Bagamoyo District, participation in a trial for the R21 vaccine—developed by Oxford University’s Jenner Institute and approved by the WHO in 2023—has been linked to a reported 90% drop in malaria infections over five years. Dr Angela Gwakisa, the doctor in charge, confirmed that data show a reduction in cases, which has been strengthened by booster doses. The vaccine also indirectly protects adults by stopping the spread of the parasite from humans to mosquitoes. Residents expressed appreciation for the program, with one mother giving 21 pineapples to the doctor. At the continental level, Gavi reports that the malaria vaccine rollout is the fastest in its history. Twenty-five African countries have added the vaccine to their routine immunization programs. Early data from Kenya, Malawi, Ghana, and Cameroon show reductions in severe disease and hospital admissions among vaccinated children. In Burkina Faso, a combination of vaccination, bed nets, seasonal preventive medicine, and community efforts helped reduce reported malaria cases by 32% between 2024 and 2025, and child deaths nearly halved. Gavi’s Chief Country Delivery Officer, Thabani Maphosa, noted that the speed of the rollout reflects high demand from countries and careful planning. However, giving the recommended four doses per child creates logistical challenges, especially for the fourth dose given later. Countries have used step-by-step plans that fit local conditions, and Gavi has invested $5 million in a learning program across seven nations to find effective delivery methods. Despite these advances, the long-term success of malaria control programs is threatened by reductions in foreign aid. The closure of the US Agency for International Development (USAID) resulted in a loss of $216 million in aid to Tanzania alone, affecting about 5,000 healthcare workers involved in HIV and malaria prevention. Residents of Mwavi reported that USAID-branded vehicles no longer distribute mosquito nets, and some malaria medicines are sometimes unavailable. The R21 trial in Bagamoyo is nearing completion, and while approval for routine use seems likely given earlier adoptions in Nigeria and Ghana, the Tanzanian government’s ability to pay for including the vaccine in the national immunization schedule remains uncertain. Dr Maxmillian Mpina, who oversees a trial for the RTSS vaccine, stated that the health system will continue to feel the impact of aid cuts as the government reorganizes its budget to make up for the sudden loss of funding. Research institutions are also affected. The Ifakara Health Institute, which runs both vaccine trials, lost a $15 million annual USAID program that employed 800 people. Dr Brian Tarimo, working on genetically modified mosquitoes, noted that moving foundation money has delayed other research. Dr Sarah Moore, who evaluates products to control mosquitoes, described research funding as "severely reduced," with less ability to take on PhD students and attend WHO meetings. The WHO estimates that the $3.9 billion invested each year in malaria eradication is less than half the $9.3 billion needed, and current aid cuts are likely to lower that figure further. Dr Moore emphasized that even a major technological breakthrough would require large investment in production and implementation, using polio eradication as an example where a lifelong vaccine has not yet reached full coverage due to logistical problems. Medicines for Malaria Venture (MMV), which has developed 19 antimalarial drugs since 1999 through public-private partnerships, treats an estimated 1.5 billion people. CEO Martin Fitchet stressed that grant-based financing is essential for both drug development and health system delivery, warning that stopping funding for health systems leads to immediate deaths, while stopping research and development causes future deaths. Gavi’s Maphosa agreed, stating that fully funding the malaria program is critical to prevent more child deaths, families falling into poverty from healthcare costs, and strain on health systems. He called for continued investment in combined programs that include vaccines, preventive medicine, mosquito control, diagnosis, and treatment, and noted that ongoing research is needed for second-generation vaccines with higher effectiveness and simpler dosing. The current vaccines, RTS,S and R21, are described as first-generation tools that save lives today while building the evidence and market conditions for future innovations.
Conclusion
The rapid expansion of malaria vaccination across Africa is a major public health achievement, with early evidence showing reduced severe disease and deaths. However, this progress depends on continued financial commitment from both domestic governments and international donors. Funding cuts, especially from USAID, have already disrupted distribution networks and research programs in Tanzania. Without enough and consistent investment, the gains made through vaccination and other measures risk being lost, leaving vulnerable populations—especially young children—exposed to a disease that remains a leading cause of death on the continent.