Mali pioneers novel hybrid vaccine delivery approach to combat malaria

On World Malaria Day, Mali’s Ministry of Health, with support from Gavi, the Vaccine Alliance (Gavi), UNICEF and the World Health Organization (WHO), launched a first-of-its-kind malaria vaccine delivery approach, aiming to reach children aged 5 to 36 months.

The country becomes the 20th in Africa to introduce the malaria vaccine into its routine immunization programme with support from Gavi. It is the first globally to implement a hybrid approach to vaccine delivery: providing the first three doses monthly throughout the year based on age, followed by the fourth and fifth doses given seasonally in May or June of the following years, before the high malaria transmission season starts. Providing malaria vaccine doses seasonally is a strategic approach, as it aligns the period of highest vaccine protection with the period of highest malaria risk, and evidence, including research from Mali, shows it maximizes impact.

The R21/Matrix-M vaccine will initially be rolled out in 19 priority districts across five regions: Kayes, Koulikoro, Mopti, Ségou and Sikasso. The country currently has 927,800 R21/Matrix-M vaccines for introduction.

The 2024 WHO World Malaria Report shows Mali had 3.1% (8.15 million) of global malaria cases and 2.4% (14,328) of global malaria deaths in 2023, and it was 1 of 11 countries with the highest burden of malaria globally.

Mali was among eight countries with substantial increases in malaria caseloads between 2019 and 2023, with an increase of 1.4 million cases, according to data from WHO. The African region shoulders the heaviest malaria burden globally, accounting for about 94% of all cases and 95% of deaths.

In her opening speech, Mali's Minister of Health and Social Development, Colonel Assa Badiallo Touré, welcomed and thanked all stakeholders, particularly Gavi, the Global Fund, WHO and UNICEF for their continued and unwavering support throughout the process of introducing the malaria vaccine into his country's Expanded Programme on Immunization. 

“You will agree with me that the process of introducing the malaria vaccine into the EPI was marked by the deployment of immense efforts by all stakeholders. I pay tribute to our researchers, particularly those at the MRTC, for their very important role during clinical trials and whose prowess contributed to the recommendation of the RTS, S and R21 vaccines by the World Health Organization. The successful introduction of the Malaria Vaccine into the EPI is a challenge that each stakeholder must shoulder until we have taken it to scale. We are fully prepared to implement the vaccine, for the great happiness of the people of Mali, in order to reinforce our efforts in reducing the burden of this disease.

Gavi leads the global malaria vaccination programme, working with countries and partners, and provides funding to countries and partners such as UNICEF and WHO for the procurement, transport and roll-out of doses. Through Gavi’s unique co-financing model, countries are also contributing to the cost of vaccination programmes – including malaria – gradually increasing their financial contributions as national income levels grow. The future of the global malaria vaccination programme is at a critical juncture as Gavi seeks to raise funding for its next five-year strategic period from 2026 to 2030.

Commenting on the historic roll-out, Dr Sania Nishtar, CEO of Gavi, said: “Gavi welcomes the Government of Mali’s commitment to saving lives and significantly reducing the devastating impact of malaria on families, communities and hospitals. With the malaria vaccine now being deployed in 20 countries and over 24 million doses delivered, consistent funding and investment are crucial to ensure this new, vital tool reaches all those who need it equally. As long as resources are available, Gavi pledges its continued commitment and support to the fight against one of Africa’s deadliest diseases. We are proud to be a part of this vital step forward.”

UNICEF plays a vital role in distributing and delivering vaccines, ensuring a steady supply of good quality vaccines for children in need across malaria-endemic regions, and supports governments and local communities in evidence-based demand generation for malaria control, including vaccination.

“The introduction of the malaria vaccine marks a critical milestone for the children and people of Mali,” said Dr Pierre Ngom, UNICEF Representative in Mali. “We have long awaited this moment. After 35 years of dedicated research and development, the malaria vaccine finally offers a powerful new tool to protect our children from this life-threatening disease. UNICEF is supporting the government's community engagement efforts in Mali to ensure the immunisation complements existing malaria prevention measures. Young volunteers using U-Report are key to this effort, utilising digital tools like chatbots to connect with communities, promote vaccination, and counter misinformation.”

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 to Fight AIDS, Tuberculosis and Malaria, and UNITAID. Between 2019 and 2023, over 2 million children received the vaccine, leading to a 13% reduction in mortality in children age-eligible for vaccination. This evidence supported WHO’s recommendation and prequalification of today’s two malaria vaccines.

“The malaria vaccine is one of the most consequential breakthroughs in public health in recent times – a crucial addition to malaria control tools to protect children from this deadly disease and bolster our efforts to lower the burden of malaria,” said Dr Patrick Kabore, WHO Representative in Mali. The vaccine complements existing malaria prevention measures already implemented by the Government of Mali, including the use of insecticide-treated nets, seasonal malaria chemoprevention, intermittent preventive treatment during pregnancy, and indoor insecticide spraying.

Malaria vaccination in Africa

The introduction in Mali on World Malaria Day comes a few weeks after Uganda rolled out the largest malaria vaccine introduction to date in terms of target districts and population.

Since 2023, more than 24 million malaria vaccine doses have been delivered to the African continent as countries steadily scale up their programmes. The pace of the roll-out across the continent underscores the high demand from countries for a new tool in the fight against one of Africa’s deadliest diseases. The total burden of malaria in the 20 countries in Africa that are currently vaccinating children accounts for over 70% of the global malaria burden, according to data in the 2024 World Malaria Report.

In addition to the data from the Malaria Vaccine Implementation Programme (MVIP) in Ghana, Kenya and Malawi, early results from countries such as Cameroon show the promise of the introduction of the malaria vaccine and the impact on families and communities. Additional countries are expected to introduce this year, and by the end of 2025, an additional 13 million children across Africa are expected to be protected with the malaria vaccine. In its next strategic period from 2026 to 2030, Gavi aims to help countries scale up these programmes, fully protecting a further 50 million children with four doses of the malaria vaccine – pending availability of sufficient funding.

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