Mali pioneers hybrid malaria vaccine strategy to save children

On World Malaria Day, Mali becomes the first nation globally to implement a groundbreaking hybrid vaccination approach against malaria, targeting children aged five to 36 months.

The Ministry of Health and Social Development of the Republic of Mali, in collaboration with Gavi, the United Nations Children’s Fund (UNICEF), and the World Health Organization (WHO), launched this innovative strategy to combat malaria—a disease that accounted for 8.15 million cases and 14,328 deaths in Mali in 2023.

Mali is now the 20th African country to introduce the malaria vaccine into its routine immunization program, and the first to adopt a hybrid vaccination approach. This method involves administering the first three doses monthly throughout the year based on age, followed by two additional seasonal doses in May or June—just before the peak malaria transmission season. This timing aligns the vaccine’s highest efficacy period with the period of greatest risk, maximizing its impact.

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

Why a hybrid vaccination strategy?

Malaria transmission in Mali is highly seasonal, with most cases occurring between July and December. Data from clinical trials in Mali and other African countries show that seasonal administration of the malaria vaccine significantly enhances its effectiveness. This approach ensures children receive optimal protection during the months when they are most vulnerable to the disease.

Key benefits of the hybrid strategy:

• Targeted protection: The first three doses are given year-round based on age, while the fourth and fifth doses are administered seasonally before the high-transmission period.
• Maximized impact: Seasonal dosing aligns vaccine efficacy with peak malaria risk, reducing severe cases and deaths among children.
• Data-driven implementation: Evidence from Mali and other African nations supports the effectiveness of this approach in high-burden areas.

Malaria burden in Mali and Africa

According to the WHO’s 2024 World Malaria Report, Mali contributed 3.1% of global malaria cases and 2.4% of malaria-related deaths in 2023. The country was among the 11 nations with the highest malaria burden worldwide. The African region bears the heaviest toll, accounting for 94% of global cases and 95% of deaths.

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

“The introduction of the malaria vaccine into our EPI marks the culmination of immense collaborative efforts. I commend our researchers for their pivotal role in clinical trials, which contributed to the WHO’s recommendation of vaccines like RTS,S and R21. This achievement is a shared responsibility, and we are fully committed to scaling up this initiative to benefit all Malian children and reduce the disease burden.”

Global efforts and future outlook

Gavi leads the global malaria vaccination program, providing funding and support to countries for vaccine procurement, transport, and deployment. Through its unique co-financing model, countries contribute to the cost of vaccination programs, including malaria. The next strategic period (2026–2030) aims to raise funds to protect an additional 50 million children with four doses of the malaria vaccine, pending sufficient resources.

Commenting on this milestone, Dr. Sania Nishtar, CEO of Gavi, stated:

“Gavi applauds Mali’s commitment to saving lives and reducing the devastating impact of malaria on families and communities. With the vaccine now introduced in 20 African countries and over 24 million doses delivered, sustained funding is critical to ensure equitable access. As long as resources are available, Gavi remains dedicated to supporting malaria control efforts in Africa.”

UNICEF plays a crucial role in vaccine distribution, ensuring a steady supply of high-quality vaccines for children in endemic regions. Dr. Pierre Ngom, UNICEF Representative in Mali, highlighted the importance of community mobilization:

“The introduction of the malaria vaccine is a monumental step for Malian children. After 35 years of dedicated research and development, this vaccine offers a powerful new tool to protect our children from this deadly disease. While a significant advance, the vaccine is not a standalone solution. UNICEF supports the government’s community mobilization efforts, including the use of digital tools like U-Report to combat misinformation and promote vaccination.”

WHO coordinated the pilot evaluation of the RTS,S/AS01 malaria vaccine in Ghana, Kenya, and Malawi through the Malaria Vaccine Implementation Program (MVIP). Between 2019 and 2023, over two million children received the vaccine, resulting in a 13% reduction in child mortality. These findings supported the WHO’s recommendation and prequalification of both malaria vaccines.

According to Dr. Patrick Kabore, WHO Representative in Mali:

“The malaria vaccine is one of the most significant public health breakthroughs in recent times—a vital addition to our malaria control toolkit. It protects children from this deadly disease and strengthens our efforts to reduce the overall malaria burden.”

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

Expanding malaria vaccine programs across Africa

Mali’s introduction of the malaria vaccine coincides with Uganda’s recent large-scale deployment, marking a significant milestone in Africa’s fight against malaria. Since 2023, over 24 million vaccine doses have been delivered to African countries, with 20 nations now introducing the vaccine into their routine immunization programs. These countries represent over 70% of the global malaria burden.

Early results from countries like Cameroon demonstrate the vaccine’s promising impact. By the end of 2025, an additional 13 million children across Africa are expected to be protected. During the 2026–2030 strategic period, Gavi aims to help countries scale up their programs, potentially protecting 50 million more children with four doses of the vaccine.

Safety and efficacy of malaria vaccines

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

• Phase 3 clinical trials showed that both vaccines reduced malaria cases by more than 50% in the first year after vaccination—a critical period when children are at high risk of illness and death.
• A fourth dose administered in the second year of life extended protection.
• In areas with high seasonal transmission, the vaccines reduced malaria cases by approximately 75% when given seasonally.
• Both vaccines target P. falciparum, the deadliest and most widespread malaria parasite in Africa.

To learn more about the malaria vaccine, visit the WHO’s Q&A page.

Adapting programs to local needs

Administering four or five doses of the vaccine requires systematic strategies to reach those most at risk. Countries are adopting tailored approaches based on their unique contexts and challenges. Examples include:

• Nigeria: In December 2024, Nigeria, the country with the highest malaria burden globally, began a phased deployment of the vaccine in Kebbi and Bayelsa states, where malaria prevalence is particularly high. Over 800,000 doses are expected to be distributed in this initial phase.
• Chad: Gavi supported the integration of the malaria vaccine into an ambitious triple-deployment initiative targeting malaria, pneumonia, and diarrhea—maximizing impact in low-resource settings.
• Sudan and Democratic Republic of the Congo: In fragile contexts, the vaccine deployment has been integrated into broader response plans.