New Malaria Vaccine Brings Hope to African Children, Yet Booster Completion Remains a Challenge

YAOUNDE, Cameroon — Heavy rain had turned the dirt road into thick mud, yet Mabel Djoumessi continued walking, carrying her 9‑month‑old son Kenfack on her back. The malaria vaccination appointment at a central Cameroon clinic was too crucial to miss.

For decades, millions of children across Africa have contracted malaria, one of the continent’s deadliest diseases for youngsters. Yet Kenfack has never fallen ill, a success his mother credits to the recent introduction of a malaria vaccine.

“My other children who have never received the vaccine frequently fall ill,” Djoumessi said later, seated among other women cradling babies at Soa District Hospital.

More than two years after Cameroon became the first nation to add the RTS,S (Mosquirix) malaria vaccine to its routine immunization schedule, health workers report that it is lowering severe cases.

However, they worry that too few children return for the fourth and final booster dose — a critical shot recommended by the World Health Organization (WHO) to extend immunity, administered months after the earlier doses.

This challenge mirrors a broader issue with multi‑dose vaccines across Africa. Malaria claims a child under five every minute worldwide, the vast majority in Africa, according to the WHO and the United Nations children’s agency.

In a malaria vaccine pilot program spanning 158 districts in Ghana, Kenya, and Malawi, coverage — the proportion of eligible children receiving each dose — was about 80 % for the initial dose at roughly six months of age. Yet it fell to 46 % for the fourth dose, given between 22 and 24 months, according to a study published last year in the peer‑reviewed Malaria Journal.

“When my son turns two, I will be sure to receive the fourth dose,” Djoumessi said. “I do not want him to suffer as the others have.”

Completing All Four Doses Enhances Protection

Malaria remains the primary cause of hospital consultations and admissions in Cameroon, one of 11 countries that account for roughly 70 % of the global malaria burden, according to the WHO. The nation recorded an estimated 7.6 million malaria cases and 11,700 deaths in 2024.

Data from Cameroon’s National Malaria Control Program indicates that health facilities recorded a decline in cases in 2025, with 33,000 fewer cases than in 2024.

Nevertheless, some experts caution against attributing the decline solely to the vaccine.

“Isolating the specific impact of malaria interventions requires modeling, and we do not yet have a model to quantify the vaccine’s sole contribution,” said Dr. Bomba Amougou, head of prevention at the National Malaria Control Program. “Therefore, it is accurate to state that the vaccine has contributed to the reduction in cases and deaths, rather than being the exclusive cause.”

The WHO recommended the RTS,S vaccine for broader use in 2021 after pilot studies in Ghana, Kenya, and Malawi showed it reduced deaths among eligible children by 13%. Separate clinical trials in several African countries also demonstrated that both RTS,S and the newer R21 vaccine reduced clinical malaria cases by more than 50% within the first year after three doses.

Over 52 million doses have since been delivered to 25 high‑risk African countries with support from Gavi, the Vaccine Alliance. However, the organization notes that the rollout faces a \”stark constraint\” following extensive foreign‑aid cuts by the Trump administration and others. Gavi says it is guaranteeing vaccine supply to cover up to 70 % of eligible children in low‑income countries.

At Soa District Hospital, nurses say they can see the vaccine’s impact.

“Our pediatric wards have become empty,” said Alice Tchuenmegne, senior nurse in charge of vaccinations.

After introducing the vaccine in 42 high‑burden districts, Cameroonian authorities report that coverage among infants eligible for the first three doses — administered at six, seven, and nine months — has improved. First‑dose coverage rose from 66 % to 68 % between 2024 and 2025, second‑dose coverage increased from 53 % to 58 %, and third‑dose coverage grew from 48 % to 59 %, according to Amougou.

However, many children still miss the fourth dose, given around their second birthday. Coverage for the fourth dose stood at 25 % as of 2025, according to Cameroonian figures.

“Parents and even health workers sometimes forget the fourth dose, especially because it comes long after the third and this vaccine is relatively new,” Amougou said.

“Receiving all four doses \”makes the protection more potent,\” he said, adding that vaccination must complement bed nets, prompt treatment, and proper sanitation.

The Challenge Extends Beyond Cameroon

Research on the early rollout in Ghana, Kenya, and Malawi found that parents overwhelmingly accepted the malaria vaccine. Yet children often missed later doses due to transport costs, insufficient reminders, inadequate follow‑up, and competing work or childcare responsibilities.

The lower vaccination rates represent \”initial teething problems that I don’t think should take the spotlight away from the value of this vaccine,\” Gavi Chief Executive Officer Sania Nishtar, MD, PhD, said in an interview.

She also noted that the malaria vaccine encounters the least parental hesitancy, which she attributes to families’ desperation to protect their children from malaria deaths. Consequently, there is \”huge demand\” from governments and communities.

Cameroon and other African countries have since launched \”Big Catch‑up\” campaigns encouraging parents and health staff to prioritize children’s vaccination.

Despite the challenges in completing malaria vaccine doses, Gavi announced Wednesday that lower‑income countries vaccinated 73 million children with Gavi‑supported vaccines in 2025 — the highest number ever recorded.

Researchers Pursue a Single‑Dose Malaria Vaccine

Nishtar said research efforts continue toward a single‑dose malaria vaccine. \”The fewer the doses of a vaccine that need to be administered, the higher the uptake and the easier its administration,\” she said.

For many families, preventing malaria also means avoiding crushing medical bills.

Georgette Caroline Mengbwa, a mother of three awaiting her youngest daughter’s third dose, said her two older children were born before the vaccine became available.

“They fall ill every two or three months, and I have to spend between $53 and $107 each time one or all of them become ill,” she said. \”It’s a lot of money.\”

Such costs are substantial in a country where the monthly minimum wage is roughly $76 and nearly 40 % of the population lives in poverty, according to official figures.

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