🦟 Malaria vaccine has reduced child mortality by 13% in three African countries

• A study confirms that the RTS,S vaccine has reduced overall child mortality by 13 percent in Ghana, Kenya and Malawi.
• The effect was achieved even though only 71 percent of children received three doses and 40 percent received the fourth dose.
• Hospital admissions for severe malaria fell by 22 percent during the evaluation period.

The study covered 158 areas in three countries

The study followed 158 areas in Ghana, Kenya and Malawi. 79 areas introduced the vaccine in 2019, while 79 served as comparison areas and received the vaccine later. Surveillance was built on a network of more than 26,000 local reporters who informed researchers of child deaths, followed by home visits to confirm the details.

The areas were randomly assigned and the baseline was balanced. The use of other interventions, such as bed nets, routine vaccinations and care for fever, was similar in both groups throughout the four-year period. This means that the reduction in deaths, according to the researchers, can be attributed to the vaccine itself.

During the evaluation period, 1.29 million children received the first dose, 1.07 million received the third dose and 436,527 children received the fourth dose. The effect was equally large for girls and boys.

Effect even at moderate vaccination coverage

There had previously been concerns that the vaccine would need to be given in all four doses to work. The new results show that this is not the case. By the end of the evaluation, 71 percent of children had received three doses and 40 percent had received the fourth, and mortality nevertheless fell substantially.

Doctor Kate O'Brien at the World Health Organization WHO, co-author of the evaluation, says the results are solid evidence that malaria vaccines can change the trajectory of child mortality in Africa.

The results have direct relevance for the 25 African countries that have now added malaria vaccines to their childhood immunisation programmes. Many of these countries have a higher malaria burden than the pilot areas. According to WHO, the effect is likely to be as large or larger in these countries.

The vaccine does not crowd out other interventions

The study shows that the introduction of malaria vaccines did not displace other interventions for child health. The use of routine vaccinations and bed nets remained stable. A significant share of the children who did not sleep under insecticide-treated nets still received the malaria vaccine, which increased the proportion of children with access to at least one form of malaria protection.

The four-dose schedule also creates new contact points with the healthcare system. The authors note that these visits can be used to deliver other vaccines, vitamin A or bed nets at the same time.

In 2024, an estimated 438,000 children died of malaria in Africa. Most had not reached their fifth birthday. The pilot project was launched in 2019 in Ghana, Kenya and Malawi, which were the first countries in the world to offer RTS,S to their population. WHO recommended the vaccine for wider use in 2021.

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