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Background In October 2021, the World Health Organization (WHO) recommended the RTS,S/AS01 E (RTS,S) malaria vaccine for the prevention of Plasmodium falciparum malaria in children living in endemic areas informed by evidence from the subnational pilot introduction and evaluation in Ghana, Kenya, and Malawi as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). With the global vaccine supply boosted by the pre-qualification of a second malaria vaccine, R21/Matrix-M (R21), in October 2023, many endemic countries (20 as of April 2025) have introduced malaria vaccines into their national childhood immunization and malaria control programmes. More endemic countries are expected to introduce or scale up malaria vaccines in 2025 and beyond. This paper summarizes key operational lessons from the pilot countries to facilitate the introduction and scale-up of malaria vaccination in other countries. Methods Pilot areas were identified, in part, based on local malaria epidemiology. RTS,S was initially introduced in randomly selected areas, while other areas served as comparators until the four-dose schedule vaccine was scaled up following the WHO recommendation in 2021. In Ghana and Kenya, the vaccine was administered at ages 6, 7, 9, and 24 months (Ghana switched to administer the fourth dose at age 18 months in 2023), and Malawi chose a schedule of 5, 6, 7, and 22 months. Results Vaccination coverage improved over time, reaching about 80% for the first dose and around 75% for the third dose by 2023 in the initial pilot areas. Implementation challenges included an inadequate understanding of age eligibility among healthcare workers during the early phase of introduction, low fourth dose coverage (with a median coverage of 46% in 2023 across the three countries), and disruptions to service delivery caused by disease outbreaks and other natural disasters. Health stakeholders and caregivers attested to the positive impact of introducing the malaria vaccine, including a reduction in malaria hospitalizations and the strengthening of the National Immunization Programme (NIP) through routine immunization refresher training and supportive supervision. Conclusions The pilot highlighted lessons for malaria vaccine introduction: (1) clearly outlined roles and responsibilities of key stakeholders including NIP and National Malaria Programme (NMP); (2) appropriate approach to vaccine introduction launch, communication, and demand generation to enhance vaccine uptake; (3) flexibility with dose scheduling to optimize coverage; and (4) updated data collection tools for accurate documentation, and data quality.

Background The World Health Organization (WHO) recommends the use of malaria vaccines for the prevention of Plasmodium falciparum malaria in moderate to high transmission areas, administered in a 4-dose schedule in children from 5 months of age. The vaccine is a ground-breaking new tool to add to the existing package of recommended malaria interventions to reduce malaria morbidity and mortality. Ghana, Kenya, and Malawi were the first countries to introduce the RTS,S/AS01 E (RTS,S) malaria vaccine into their childhood immunization programmes in 2019 as part of a pilot programme called the Malaria Vaccine Implementation Programme (MVIP). Methods The WHO’s post-introduction evaluation (PIE) methodology was adapted to evaluate malaria vaccine implementation in each of the three pilot countries at least a year after the vaccine’s introduction. Semi-structured questionnaires were used to interview immunization staff at national, sub-national, and health facility levels, supplemented with systematic observations of vaccination sessions and vaccine storage sites. At the health facility, a sample of caregivers of eligible children was also interviewed. Sites were purposively selected to include a range of past immunization coverage and varied demographics among the populations served. Results All three countries successfully introduced the malaria vaccine during the MVIP. Reported malaria vaccine median coverage at least 2 years after the start of the pilot ranged from 69–91% for dose 1, 62–82% for dose 2, to 58–81% for dose 3 by 24–30 months from the start of the pilot. Coverage for dose 4 was lower as fewer children were eligible during the PIE reporting timeframe. Best practices identified during the PIEs included: early involvement of subnational stakeholders; advance updating and distribution of recording and reporting tools to include malaria vaccine; pre-assessment of cold chain capacity and scale-up; investment of time and resources in health worker trainings and refreshers; involvement of community health workers; robust defaulter tracing mechanisms; ensuring community “dialogue” with continuity of advocacy, communication, and social mobilization activities after initial introduction; regular onsite supervisory visits before, during and after introduction; and use of social media for messaging. Conclusions Malaria vaccine is an important intervention as part of a comprehensive malaria control strategy. Conducting a PIE is useful to identify best practices and lessons learned. New vaccination contacts take time to establish and achieve high coverage as communities become aware of and understand when, why, and how to access the malaria vaccine. The malaria vaccine was successfully introduced as part of the routine childhood immunization programme with strong intersectoral collaboration and planning, involving both immunization and malaria stakeholders, comprehensive training, and social mobilization efforts pre- and post-introduction.

The World Health Organization (WHO) recommends the use of malaria vaccines for the prevention of Plasmodium falciparum malaria in moderate to high transmission areas, administered in a 4-dose schedule in children from 5 months of age. The vaccine is a ground-breaking new tool to add to the existing package of recommended malaria interventions to reduce malaria morbidity and mortality. Ghana, Kenya, and Malawi were the first countries to introduce the RTS,S/AS01.sub.E (RTS,S) malaria vaccine into their childhood immunization programmes in 2019 as part of a pilot programme called the Malaria Vaccine Implementation Programme (MVIP). The WHO's post-introduction evaluation (PIE) methodology was adapted to evaluate malaria vaccine implementation in each of the three pilot countries at least a year after the vaccine's introduction. Semi-structured questionnaires were used to interview immunization staff at national, sub-national, and health facility levels, supplemented with systematic observations of vaccination sessions and vaccine storage sites. At the health facility, a sample of caregivers of eligible children was also interviewed. Sites were purposively selected to include a range of past immunization coverage and varied demographics among the populations served. All three countries successfully introduced the malaria vaccine during the MVIP. Reported malaria vaccine median coverage at least 2 years after the start of the pilot ranged from 69-91% for dose 1, 62-82% for dose 2, to 58-81% for dose 3 by 24-30 months from the start of the pilot. Coverage for dose 4 was lower as fewer children were eligible during the PIE reporting timeframe. Best practices identified during the PIEs included: early involvement of subnational stakeholders; advance updating and distribution of recording and reporting tools to include malaria vaccine; pre-assessment of cold chain capacity and scale-up; investment of time and resources in health worker trainings and refreshers; involvement of community health workers; robust defaulter tracing mechanisms; ensuring community \"dialogue\" with continuity of advocacy, communication, and social mobilization activities after initial introduction; regular onsite supervisory visits before, during and after introduction; and use of social media for messaging. Malaria vaccine is an important intervention as part of a comprehensive malaria control strategy. Conducting a PIE is useful to identify best practices and lessons learned. New vaccination contacts take time to establish and achieve high coverage as communities become aware of and understand when, why, and how to access the malaria vaccine. The malaria vaccine was successfully introduced as part of the routine childhood immunization programme with strong intersectoral collaboration and planning, involving both immunization and malaria stakeholders, comprehensive training, and social mobilization efforts pre- and post-introduction.

In October 2021, the World Health Organization (WHO) recommended the RTS,S/AS01 (RTS,S) malaria vaccine for the prevention of Plasmodium falciparum malaria in children living in endemic areas informed by evidence from the subnational pilot introduction and evaluation in Ghana, Kenya, and Malawi as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). With the global vaccine supply boosted by the pre-qualification of a second malaria vaccine, R21/Matrix-M (R21), in October 2023, many endemic countries (20 as of April 2025) have introduced malaria vaccines into their national childhood immunization and malaria control programmes. More endemic countries are expected to introduce or scale up malaria vaccines in 2025 and beyond. This paper summarizes key operational lessons from the pilot countries to facilitate the introduction and scale-up of malaria vaccination in other countries. Pilot areas were identified, in part, based on local malaria epidemiology. RTS,S was initially introduced in randomly selected areas, while other areas served as comparators until the four-dose schedule vaccine was scaled up following the WHO recommendation in 2021. In Ghana and Kenya, the vaccine was administered at ages 6, 7, 9, and 24 months (Ghana switched to administer the fourth dose at age 18 months in 2023), and Malawi chose a schedule of 5, 6, 7, and 22 months. Vaccination coverage improved over time, reaching about 80% for the first dose and around 75% for the third dose by 2023 in the initial pilot areas. Implementation challenges included an inadequate understanding of age eligibility among healthcare workers during the early phase of introduction, low fourth dose coverage (with a median coverage of 46% in 2023 across the three countries), and disruptions to service delivery caused by disease outbreaks and other natural disasters. Health stakeholders and caregivers attested to the positive impact of introducing the malaria vaccine, including a reduction in malaria hospitalizations and the strengthening of the National Immunization Programme (NIP) through routine immunization refresher training and supportive supervision. The pilot highlighted lessons for malaria vaccine introduction: (1) clearly outlined roles and responsibilities of key stakeholders including NIP and National Malaria Programme (NMP); (2) appropriate approach to vaccine introduction launch, communication, and demand generation to enhance vaccine uptake; (3) flexibility with dose scheduling to optimize coverage; and (4) updated data collection tools for accurate documentation, and data quality.