Apac, Uganda · 2 April 2025
Uganda's Ministry of Health, with support from Gavi, UNICEF, WHO, PATH, and the Clinton Health Access Initiative (CHAI), launched a malaria vaccination campaign in Apac District, northern Uganda, making the country the 19th in Africa to introduce the malaria vaccine into routine immunisation. The rollout is the largest to date in terms of both target districts and population.
The R21/Matrix-M malaria vaccine will initially target 1.1 million children under two years of age across 105 high and moderate transmission districts, with plans to expand nationwide. The vaccine is administered in four doses at 6, 7, 8, and 18 months of age.
A District at the Epicentre
The choice of Apac District for the launch was symbolic and strategic. Apac is reported to have the highest number of mosquito bites per person globally — over 1,500 bites per person annually. In a district where malaria transmission is this intense, the vaccine represents not just an incremental tool but a fundamental shift in the epidemiological landscape.
Uganda was among the top five African countries with the highest malaria burden in 2023, alongside Nigeria, the Democratic Republic of Congo, Ethiopia, and Mozambique. Malaria is the leading cause of illness and death among young children in the country.
The R21/Matrix-M Vaccine
The R21/Matrix-M vaccine, developed by the University of Oxford's Jenner Institute and manufactured by the Serum Institute of India, was recommended by WHO in October 2023 and prequalified shortly after. It joins the RTS,S/AS01 vaccine — the first malaria vaccine, recommended by WHO in 2021 — as the second WHO-prequalified malaria vaccine.
Both vaccines target Plasmodium falciparum, the deadliest malaria parasite globally and the most prevalent in Africa. In Phase 3 clinical trials, both vaccines reduced malaria cases by more than half during the first year after vaccination. A fourth dose given in the second year of life prolonged protection. In areas of highly seasonal transmission, both vaccines reduce malaria cases by 75% when administered seasonally.
Leadership and Partnerships
Uganda's Minister of Health, Dr Jane Ruth Aceng Ocero, framed the launch as a financial as well as a public health milestone:
"The introduction of the vaccine marks a significant milestone in our 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 UGX 15,000 per case that would have been spent on treating severe Malaria. I urge all parents and caregivers to ensure that children aged 6 to 18 months receive the Malaria vaccine at the nearest health facility."
Dr Sania Nishtar, CEO of Gavi, highlighted the funding challenge on the horizon:
"With one of the highest malaria incidence rates globally, Uganda faces a relentless battle against this 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. Continued funding is crucial to sustain and expand these efforts."
Dr Robin Nandy, UNICEF Representative to Uganda, emphasised the importance of combining the vaccine with existing preventive measures: "This vaccine must be combined with existing preventive measures and this combination of preventive measures will create a powerful shield against malaria."
Preparation and Logistics
The rollout was preceded by months of preparation. On 7 March 2025, Minister Aceng flagged off over 2.2 million doses of the R21/Matrix-M vaccine from the National Medical Stores in Kajjansi for distribution to the 105 target districts. Preparatory activities included:
- Developing vaccine implementation plans at district level
- Conducting health worker training across target districts
- Ensuring sufficient cold chain capacity
- Intensified community mobilisation engaging Members of Parliament, cultural leaders, and religious leaders
- Door-to-door awareness campaigns
UNICEF was responsible for the procurement and air freighting of the vaccines, as well as raising community awareness to enhance demand. Gavi coordinated the global programme, providing financial support for procurement, transport, and rollout. WHO provided technical guidance and shared experiences from the pilot implementation programme.
The Evidence Base
WHO coordinated the pilot evaluation of the first malaria vaccine, RTS,S/AS01, through a multi-year programme in Kenya, Ghana, and Malawi that protected millions of children. The pilot generated evidence that vaccine introduction resulted in a 13% reduction in all-cause mortality among age-eligible children — a finding that led to WHO's recommendation and prequalification of both malaria vaccines.
By April 2025, 14 countries had introduced the malaria vaccine in 2024 alone (Cameroon, Burkina Faso, Sierra Leone, Benin, Liberia, Côte d'Ivoire, South Sudan, Mozambique, Central African Republic, Niger, Chad, DRC, Sudan, and Nigeria), with Burundi introducing in March 2025. Six to eight additional countries, including Mali, Ethiopia, and Guinea, planned rollouts later in 2025.
The Funding Question
Gavi's model relies on co-financing, where countries contribute to the cost of their own vaccines, paying progressively more as their incomes rise. Future support for the global malaria programme depends on Gavi securing sufficient funds for its next five-year strategic period starting in 2026. Any shortfall would result in programmes being cut back — a prospect that public health officials view with alarm given the momentum built over the past two years.
A Turning Point
Dr Kasonde Mwinga, WHO Representative to Uganda, captured the moment's significance: "Today marks a historic turning point in Uganda's fight against malaria. By integrating the malaria vaccine into routine immunization, Uganda is taking a bold step to protect its children, save lives, and secure a healthier future."
The launch in Apac District represents the intersection of decades of scientific development, years of pilot evaluation, and months of logistical preparation. For the 1.1 million Ugandan children now eligible for the vaccine, it offers something that was unavailable to any previous generation: a proven, WHO-prequalified tool to prevent one of humanity's oldest and deadliest infectious diseases.
Sources:
- WHO African Region, "Uganda launches largest malaria vaccine introduction to date," 2 April 2025.
- Gavi, "Uganda Minister of Health receives and flags malaria vaccines for 105 districts."
- UNICEF Uganda, "Uganda launches world's biggest malaria vaccine rollout."
- WHO, Q&A on RTS,S malaria vaccine.
- Uganda Ministry of Health, malaria vaccine reception.
FIRAT Editorial Board
Institutional Research Desk · Foresight Institute of Research and Translation
The collective editorial and research translation board of FIRAT, synthesising peer-reviewed evidence, policy briefs, and division milestones across our seven foundational research pillars.
