Mali leads with hybrid malaria vaccine strategy for young children

Kalaban-Coro, Mali — As World Malaria Day is observed, the Ministry of Health and Social Development of the Republic of Mali, supported by Gavi, the Vaccine Alliance, UNICEF, and the World Health Organization (WHO), has launched an innovative hybrid vaccination approach targeting children aged five to 36 months.

Mali now joins 19 other African countries in introducing the malaria vaccine into routine immunization programs with Gavi’s backing. The West African nation is the first globally to implement this hybrid vaccination model, which combines age-based initial doses with seasonally timed booster shots. The first three doses are administered monthly throughout the year based on age, while the fourth and fifth doses are given prior to the high-transmission season in May or June. This timing aligns peak vaccine efficacy with the period of greatest malaria risk, as evidenced by research conducted in Mali.

The R21/Matrix-M vaccine will initially be deployed in 19 priority districts across five regions: Kayes, Koulikoro, Mopti, Ségou, and Sikasso. Mali currently has 927,800 doses available for this rollout.

According to the WHO’s 2024 World Malaria Report, Mali accounted for 3.1% (8.15 million cases) of the world’s malaria cases and 2.4% (14,328 deaths) in 2023, placing it among the 11 countries with the highest malaria burden globally. Between 2019 and 2023, Mali saw a 1.4 million-case increase, one of eight countries with significant rises during this period. The African Region bears the brunt of global malaria impact, representing approximately 94% of cases and 95% of deaths.

During the launch event, Mali’s Minister of Health and Social Development, Colonel Assa Badiallo Touré, expressed gratitude to Gavi, the Global Fund, WHO, and UNICEF for their unwavering support in integrating the malaria vaccine into the country’s Expanded Programme on Immunization (EPI).

« This vaccination rollout represents a monumental achievement built on extensive collaboration. I commend our researchers whose clinical trials were instrumental in securing WHO recommendations for the RTS,S and R21 vaccines. While this marks a significant milestone, our collective challenge remains scaling up implementation to benefit all Malian children. We are fully committed to this mission to reduce the disease burden and protect our population. »

Gavi’s malaria vaccination program operates through partnerships with countries and collaborators, providing funding for vaccine procurement, transportation, and deployment. Through its unique co-financing model, countries gradually increase their financial contributions to vaccination programs, including malaria initiatives. The program faces a critical juncture as Gavi seeks funding for its next five-year strategic period (2026–2030).

Dr. Sania Nishtar, Gavi’s CEO, highlighted the significance of this initiative: « Mali’s commitment to combating malaria demonstrates a crucial step in saving lives and alleviating the devastating impact of this disease on families, communities, and healthcare systems. With 20 countries now administering malaria vaccines and over 24 million doses delivered, sustained funding is essential to ensure equitable access to this vital tool. As long as resources permit, Gavi remains dedicated to supporting Africa’s fight against one of its deadliest diseases. We are proud to be part of this historic advancement. »

UNICEF plays a pivotal role in vaccine distribution, ensuring reliable supply chains for children in endemic regions while collaborating with governments and local communities to build evidence-based demand for malaria prevention, including vaccination. Dr. Pierre Ngom, UNICEF Representative in Mali, emphasized the vaccine’s potential:

« The introduction of the malaria vaccine marks a transformative moment for Malian children and families. After 35 years of dedicated research and development, this vaccine provides a powerful new tool to protect our youngest citizens from this life-threatening illness. While it represents a major advancement, it is not a standalone solution. UNICEF supports the government’s community mobilization efforts, combining vaccination with existing malaria prevention measures. Young volunteers using U-Report are crucial in this effort, leveraging digital tools like chatbots to engage communities, promote vaccination, and combat misinformation. »

The WHO coordinated the pilot evaluation of the RTS,S/AS01 malaria vaccine in Ghana, Kenya, and Malawi through the Malaria Vaccine Implementation Programme (MVIP), co-funded by Gavi, the Global Fund, and UNITAID. Between 2019 and 2023, over two million children received the vaccine, resulting in a 13% reduction in mortality among vaccinated age groups. These findings supported WHO’s recommendation and prequalification of both malaria vaccines.

Dr. Patrick Kabore, WHO Representative in Mali, noted: « The malaria vaccine is one of the most significant public health breakthroughs in recent years—a vital addition to our malaria-fighting arsenal. It will protect children from this deadly disease while strengthening our efforts to reduce the overall burden of malaria. »

The vaccine complements Mali’s existing malaria prevention strategies, which include insecticide-treated bed nets, seasonal malaria chemoprevention, intermittent preventive treatment in pregnancy, and indoor residual spraying.

Malaria vaccination progress across Africa

Mali’s vaccine introduction coincides with Uganda’s recent large-scale deployment, marking one of the continent’s most extensive initiatives to date. Since 2023, over 24 million malaria vaccine doses have been distributed across Africa, with countries accelerating their programs. This momentum reflects the continent’s urgent need for new tools against one of its deadliest diseases. According to the 2024 World Malaria Report, the 20 African countries adopting the vaccine represent over 70% of the global malaria burden.

Early results from countries like Cameroon demonstrate promising outcomes, with positive impacts on families and communities. Additional countries are expected to introduce the vaccine this year, with an estimated 13 million additional African children protected by the end of 2025. Gavi’s next strategic period (2026–2030) aims to scale up programs further, protecting an additional 50 million children with four doses—pending sufficient funding.

Why Mali’s hybrid vaccination approach?

Malaria transmission in Mali is highly seasonal, with most cases occurring between July and December. The hybrid approach ensures children receive three initial doses throughout the year based on age, followed by seasonally timed booster doses in May or June—just before the peak transmission period. Evidence shows that seasonal vaccination maximizes impact by aligning peak vaccine efficacy with the highest risk periods.

Why target children?

Children under five are at the highest risk of malaria-related death, accounting for over 75% of global malaria fatalities. Unlike adults, young children lack partial immunity developed over years of exposure, making them particularly vulnerable to severe malaria.

Vaccine safety and efficacy

The RTS,S/AS01 and R21/Matrix-M vaccines are WHO-prequalified and recommended for preventing malaria in children. These vaccines are both safe and effective:

• Phase 3 clinical trials showed both vaccines reduced malaria cases by over 50% in the first year post-vaccination—a critical period of high risk for children. A fourth dose administered in the second year extended protection.

• When given seasonally in high-transmission areas, the vaccines reduce malaria cases by approximately 75%, where half of child malaria deaths occur.

• Both vaccines target P. falciparum, the deadliest and most widespread malaria parasite in Africa. For more details, visit: WHO malaria vaccine Q&A.

Adapted vaccination programs

Administering four or five doses requires systematic strategies to reach high-risk populations. Countries are implementing tailored approaches based on local contexts and challenges. Examples include:

• Nigeria, with the world’s highest malaria burden, launched a phased rollout in December 2024 in Kebbi and Bayelsa States, targeting high-prevalence areas with over 800,000 doses in the initial phase.

• Chad integrated the malaria vaccine into a groundbreaking triple-deployment initiative targeting malaria, pneumonia, and diarrhea—maximizing impact in resource-limited settings.

• In fragile contexts like Sudan and the Democratic Republic of the Congo, deployments were integrated into broader response plans.