Cameroon’s historic malaria vaccine introduction shows signs of success, one year on

Gavi, the Vaccine Alliance | A year ago, Cameroon kicked off a wave of ground-breaking malaria vaccination campaigns. With nearly 140,000 kids now vaccinated across the country, authorities are already seeing the impact.

Eighteen-month-old twins Daniel and Daniella were the first children in Cameroon to receive the world’s first malaria vaccine when the country officially introduced the jab into its vaccination schedule a year ago, on 22 January 2024.

The Cameroonian launch marked the first in a history-making series of vaccine campaigns: by year’s end, a total of 17 African nations had kicked off their own malaria immunisation programmes.

Helen Akono, mother to the twins, recalls feeling fortunate – her kids had just turned six months old, the eligible age for the first dose of the four-part vaccine series, when the jab became available. Daniel and Daniella have since taken two additional doses of the vaccine, and are poised to take the fourth and last dose when they turn two in June this year.

“Since taking the vaccine, my children haven’t suffered from malaria and I believe it could be thanks to it,” Akono tells VaccinesWork over the phone, raising her voice to be heard over her children’s chatter in the background .

“My twins are so lucky. Many members of my family, including myself, have suffered from malaria in the past. And treating it usually costs us a fortune,” recalls the mother of five.

Taking stock

Malaria remains the leading cause of hospitalisations in Cameroon, one of 17 countries shouldering 70% of the global malaria burden.

The World Health Organization (WHO) estimates that Cameroon saw more than 7.3 million malaria cases in 2023 alone, with 11,600 of those cases ending in death. Meanwhile, approximately 30% of outpatient visits in the country are malaria-related. As in other endemic countries, the disease’s impact is particularly felt among children aged under five, and among pregnant women.

The historic roll-out of the world’s first malaria vaccine in Cameroon has been hailed as a major step forward in the battle against one of the world’s deadliest diseases. One year on – early days, epidemiologically speaking – medics and beneficiaries have kept an eye out for signs of its impact at health facilities and in households. So have health officials, and the first statistical indicators are promising.

Data released this month by Cameroon’s Expanded Programme on Immunisation (EPI) found that the country saw a 13% drop in all-cause consultations for children aged under five. In districts that were included in the first wave of the malaria vaccine roll-out, that drop was higher: 17%.

Moreover, nationwide, 13% fewer children aged under five died, from any cause, in 2024 than in 2023.

Experts caution that it’s too early to attribute those positive trends to the vaccine with confidence, calling for more in-depth, longer-term research. But, as VaccinesWork found, health workers and parents are independently reporting heartening observations from the ground.

Reach

Part of the reason the full impact of the malaria vaccine programme won’t be seen for a while is that not all of Cameroon has access to the jab yet.

The country aimed to reach half a million children with the malaria vaccine in 2024 and 2025 (approximately 250,000 each year). Only the hardest-hit places – 42 of the country’s 206 health districts – were prioritised for involvement in the campaign’s first phase.

By December 2024, the first dose had achieved a 63% coverage rate Cameroon-wide. Coverage with the second dose stood at 50%, and coverage with the third dose was at 46%.

Dr Tchokfe Shalom Ndoula, Permanent Secretary of the Expanded Programme on Immunization (EPI) in Cameroon cautions, however, that these figures do not take into account ongoing catch-up sessions.

“For now, the roll-out concerned 42 malaria-prone districts,” Dr Ndoula tells VaccinesWork, explaining that the country has plans to reach the rest of the country in due course.

Cameroon has so far received 553,100 doses of the RTS,S, malaria vaccine – the bulk of which (539,100) were donated by Gavi.

“Our objective has not yet been attained. But the outcome is not negligible because we didn’t imagine attaining that coverage [right away], come to think of the conspiracy theories that accompanied the introduction of the vaccine,” Dr Ndoula says. “All districts in Cameroon are at risk of malaria and, as a result, need this vaccine. The malaria vaccine has already been integrated into Cameroon’s routine immunisation programme, meaning it shall henceforth be administered alongside other vaccines.”

Malaria vaccine testimonies

At the Soa District Hospital, located on the outskirts of Cameroon’s capital city, Yaoundé, where the malaria vaccination roll-out was officially launched, medics say they have seen fewer paediatric hospitalisation and consultations for malaria in the last year. Before the advent of the vaccine, three in every five patients received in the hospital presented with malaria.

Daniele Ekoto, a senior state registered nurse who runs the vaccination service at the hospital, says the introduction of the malaria vaccine has been “a huge success”, with the hospital beating its initial monthly target of vaccinating 28 babies every month.

More than 600 children have received the first dose of the vaccine at this health facility as of November 2024, hitting a 77% coverage rate for the entire period – higher than the EPI’s target for 2024, which was set at 69%. Nearly 500 children have received the second dose, giving a 70% coverage rate, while slightly over 500 have received the third dose, giving a 73% coverage rate.

“Parents – including those whose children are not eligible – are increasingly showing up to have their children vaccinated,” Ekoto tells VaccinesWork.

“We have had numerous testimonies from parents,” Ekoto continues. “A mother testified that her children who took the vaccines have not contracted malaria, whereas those who didn’t [because they were not eligible] have had bouts of malaria. Malaria-related hospitalisations among children have greatly reduced in this hospital since the introduction of the vaccine.”

The malaria vaccine is administered in four doses, the first at six months, followed by two more, each at a one-month interval from the last, with the fourth dose administered over a year later.

Each dose is delivered as an injection to the thigh, a method aligned with other long-established jabs that are part of Cameroon’s immunisation programme, which has been a stalwart presence in the country’s health system for almost 50 years. The RTS,S vaccine  joins the 14 antigens already well-established in Cameroon’s vaccination programme.

“The vaccine has come at an opportune moment”

Elsewhere in Cameroon, too, parents are turning out in rising numbers for the malaria jab. Such is the case in the greater north of the country, which encompasses the Adamawa, the Far North and the North regions, where malaria transmission follows pronounced seasonal patterns.

Eighteen-year-old Zenab Tchansia, a housewife living in the Gazawa district in Cameroon’s Far North region, is anxiously looking forward to completing her child’s malaria vaccine schedule this February. Ousman Bilal, aged 13 months, has already received three doses of the vaccine.

“My child didn’t suffer from any side-effects after taking the vaccine,” Zenab tells VaccinesWork in a telephone chat. “Having suffered from malaria twice in the past, I know what that means, which is why I don’t want my child to experience it,” the mother of one said.
Zouera Abdou, 26, living in the same district, says her seven-month-old son, Balkissou Ousmailla, has so far received two doses of the malaria vaccine.

“The child had a mild fever after taking the first dose of the vaccine in November but felt okay after taking the second dose in December,” recalls Zouera. “My child has been receiving all other vaccines, so why not the malaria vaccine? The vaccine has come at an opportune moment. My child is lucky. Malaria has cost my family a fortune in the past,” she tells VaccinesWork.

Nine out of 33 health districts in the Far North region were selected for the first phase of the roll-out. Statistics from the malaria control programme in the region reveal that 70,368 children have so far been vaccinated. This gives a 60% coverage rate for the first dose, 44% for the second dose, and 33% for the third dose.

“Conscious of the damage that malaria often causes in households, parents have totally embraced the anti-malaria vaccine,” Dr Kidwang Jean Pierre, who works for the National Malaria Control Programme as the regional malaria coordinator for the Far North region, tells VaccinesWork.

All aboard! Hopes rise as broad church of supporters assembles

Kidwang explains that several traditional and religious leaders have voluntarily opted to get personally involved in the roll-out.

“A number of strategies have been put in place in this region to fight malaria, namely the use of mosquito nets, seasonal malaria chemoprevention (SMC), malaria chemoprevention among pregnant women, and now the new malaria vaccine. All of these interventions have had a real impact on malaria morbidity and mortality in the region,” Kidwang says.

“We have observed that most of the children who received the vaccine and the SMC did not contract malaria this year. This saved households and families from constant hospital visits.”

Studies conducted on the RTS,S antimalarial vaccine pilot programme, which began in Ghana, Kenya and Malawi in 2019, found a 13% reduction in all-cause mortality among eligible vaccinated children.

Moreover, the vaccine was found to lead to a 22% reduction in hospitalisations for severe forms of malaria in these children, resulting not only in a significant reduction in suffering for families but also substantial savings for the healthcare system.

Dr Ndoula of the EPI had, during the vaccine’s introduction, hoped that achieving optimal coverage could potentially slash annual deaths by more than a third, and result in a major decrease – more than 60% – in hospitalisations for severe malaria cases in covered areas. One year into the roll-out, it’s too soon to comprehensively assess the vaccine’s impact, but the health expert rejoices at the “largely positive” feedback from beneficiaries.

“These households have confessed to witnessing fewer cases of malaria among children who have received the vaccine,” he says, nonetheless sounding a note of caution.

“But we still need time to be able to scientifically determine the impact of the vaccine on (malaria) mortality. It will take many years to do that alongside other malaria preventive measures.”

Dr Wirngo Mohamadu Suiru, malaria programme management specialist working with the President’s Malaria Initiative (PMI) at USAID Cameroon, says the introduction of the malaria vaccine constitutes an “important step” in boosting the fight against malaria in the country.

“This is especially important as it reduces the burden of the disease in the most vulnerable/affected age-group (children below five years),” Suiru tells VaccinesWork.

“Since its introduction, there has been optimal uptake of the vaccine by the population despite rumours at introduction that were properly handled through a communication strategy developed with support from PMI,” he says. “Cameroon is one of the countries in Africa with the highest burden of malaria and as such, drives the epidemic worldwide. In line with the HBHI (high burden high impact) approach by WHO, adopting new tools is imperative to accelerate progress towards eliminating malaria.”