Malaria is the leading cause of illness and death among young children in Uganda, responsible for up to 33 percent of all outpatient visits, 22 percent of hospital admissions and six percent of deaths, data from the World Health Organisation (WHO) shows.
In 2023, Uganda was among the top African countries with the highest malaria burden, alongside Nigeria, Democratic Republic of the Congo, Ethiopia and Mozambique. And this week, when the country rolled out the world’s second malaria vaccine, R21/Matrix-M, two years after its prequalification by the WHO, its officials and global health leaders agreed that it could not have come at a better time.
On Wednesday, Uganda’s Ministry of Health, with support from Gavi, the Vaccine Alliance, WHO, and other partners, introduced the three-dose malaria vaccine in Apac District, a high-burden region in northern Uganda.
This rollout makes Uganda the 19th African country to integrate a malaria vaccine into its routine immunisation programme and represents the largest malaria vaccine rollout to date in terms of target districts and population, according to Gavi.
The WHO recommended the R21/Matrix-M vaccine in October 2023 for malaria prevention in children, following the guidance of its Strategic Advisory Group of Experts (Sage) on Immunisation and the Malaria Policy Advisory Group. The recommendation was based on Phase III clinical trials involving 4,800 children aged five months to three years across Kenya, Mali, Burkina Faso and Tanzania.
The WHO’s prequalification process ensures vaccines meet international safety, efficacy, and manufacturing standards, enabling wider access. Prequalification is also a prerequisite for Unicef procurement and Gavi funding for deployment in eligible countries.
The R21/Matrix-M is administered in four doses at six, seven, eight and 18 months. In Uganda, the initial phase will target 1.1 million children under the age of two across 105 high- and moderate-malaria transmission districts, with plans for nationwide expansion.
Apac District, according to the Ugandan government and Gavi, has the highest number of mosquito bites per person globally (over 1,500 bites per person annually).
Dr Jane Ruth Aceng Ocero, Uganda’s Health Minister, said the vaccine marks a significant milestone in the fight against malaria.
“It is expected to prevent at least 800 cases of severe malaria among children every day and ease the financial burden on families, saving them approximately Ush15,000 ($532) per case that would have been spent on treating severe malaria.
I urge all parents and caregivers to ensure that children aged six to 18 months receive the malaria vaccine at the nearest health facility. For the best protection, it is essential that the children complete all four doses on schedule,” the minister said.
While lauding the initiative Sania Nishtar, CEO of Gavi, noted that, with one of the highest malaria incidence globally, Uganda faces a relentless battle against a deadly disease that has devastated families and communities for far too long.
“The malaria vaccine, proven safe and effective, saves lives and prevents hospitalisations. However, without sustained financial support, these life-saving efforts could falter, leaving millions of children vulnerable and undermining the progress made so far,” she said. Dr Kasonde Mwinga, WHO representative to Uganda, described the moment as historic.
“By integrating the malaria vaccine into routine immunisation, Uganda is taking a bold step to protect its children, save lives and secure a healthier future. This vaccine is a game-changer, and together, we must ensure that every child receives it,” she said.
The R21 vaccine follows the RTS, S/AS01 which obtained prequalification status in July 2022. Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children. When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact.
Kenya Medical Research Institute (Kemri) describes the vaccine as a valuable addition to the malaria toolbox.
“The availability of a second malaria vaccine for children in the region should increase access to this valuable addition to the malaria toolbox. Malaria vaccines, used alongside other proven interventions, can help bring this deadly disease under control and take us another step closer to a world free from malaria,” Kemri said.
“The vaccine was also evaluated for safety with the researchers looking out for both adverse events of special interest and serious adverse events.”
The vaccine will cost between $2.32 and $4.64 per dose.
