Major study confirms impact of the malaria vaccine, saving lives and reducing hospitalisations
A rigorous evaluation of the RTS,S malaria vaccine in Ghana, Kenya and Malawi has now confirmed what earlier data indicated: the jab is preventing child deaths at a scale that could reshape Africa’s fight against the disease.
- 12 May 2026
- 4 min read
- by Priya Joi
At a glance
- A new study in The Lancet confirms that the RTS,S malaria vaccine reduced all-cause child mortality by 13% across pilot programmes in Ghana, Kenya and Malawi, averting roughly one in eight deaths.
- The impact was achieved despite only 71% of children receiving three doses and 40% receiving the fourth dose, easing earlier concerns that high coverage was essential.
- Earlier data from the same programme showed a 32% drop in severe malaria hospitalisations and informed WHO's 2021 recommendation. The new analysis is the first to measure mortality impact over the full four-year evaluation.
In 2024, malaria killed an estimated 438,000 children in Africa. Most hadn’t even reached their fifth birthday.
The majority of these deaths are in places where the disease has been a leading killer for generations and where families have long balanced bed-nets, repellents and antimalarials against a parasite that adapts faster than the tools used to fight it.
The arrival of the RTS,S malaria vaccine was a landmark moment; Ghana, Kenya and Malawi were the first countries in the world to offer it to their populations as part of a pilot project launched in 2019, and the World Health Organization (WHO) recommended it for wider use in 2021.
Early studies indicated that the vaccine had a 13% drop in all-cause mortality, and a comprehensive new study of the last four years of vaccine roll-out published in The Lancet has confirmed this figure. That translates to roughly one in eight deaths prevented.
“This is very solid evidence of the potential for malaria vaccines to change the trajectory of child mortality in Africa,” Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, and co-author of the evaluation, said in a WHO press release.
Measuring impact
The study tracked 158 clusters across the three countries, with 79 areas introducing the vaccine in 2019 and 79 serving as comparison areas that received it later. Surveillance was built on a network of more than 26,000 local reporters who notified researchers of child deaths in their communities, followed by home visits to confirm details.
The findings carry particular weight because of how the study was designed. Clusters were randomly assigned, baseline characteristics were balanced, and coverage of other interventions, including bed-nets, routine vaccines and care-seeking for fever, remained similar across implementation and comparison areas throughout the four years.
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This means, say the researchers, that the drop in deaths can be “confidently attributed” to the vaccine itself rather than to other shifts in malaria care.
Across the pilot countries, 1.29 million children received the first dose during the evaluation period, 1.07 million received the third dose and 436,527 received the fourth. The mortality benefit held in both girls and boys, with no significant difference between the sexes.
Hospital admissions for severe malaria also fell by 22%, with no evidence of the safety signals (excess meningitis, cerebral malaria or deaths in girls) that had been flagged in the original trial.
Success despite uneven coverage
By the end of the evaluation, 71% of eligible children had received three doses of the vaccine and 40% had received the fourth. There had been concern in earlier years that the public health impact of RTS,S might depend on children getting all four doses.
The new data suggests otherwise.
Even at moderate coverage, with significant numbers of children missing the fourth dose, the vaccine cut deaths substantially.
The authors describe this as reassuring, and it has direct implications for the 25 African countries that have now added malaria vaccines to their childhood immunisation schedules. Many of these countries have higher malaria burdens than the pilot areas.
According to WHO: “Positive impact is likely to be as high or higher in other African countries now offering malaria vaccines to young children in areas of high malaria burden.”
The study also noted something the WHO has been keen to emphasise: introducing the malaria vaccine does not crowd out other child health interventions.
Uptake of routine vaccines and bed-net use stayed steady. In fact, a meaningful share of children who were not sleeping under insecticide-treated nets still received the malaria vaccine, broadening the proportion of children with access to at least one form of malaria prevention.
The four-dose schedule also creates new touchpoints with the health system, which the authors note could be used to deliver other vaccines, vitamin A or bed-nets at the same visits.
The authors note that, “In many areas where malaria vaccines are most urgently needed, vaccine delivery is often constrained by weak health systems, mistrust, and conflict.”
Nevertheless, they say: “Our findings show that substantial reductions in deaths among young children are possible even when only moderate levels of malaria vaccine coverage can be achieved.”
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