A health worker administers a malaria vaccine to a baby at a hospital in Soa, Cameroon, Jan. 22, 2024, as the country launches the first malaria vaccination program to be offered nationwide and as a matter of routine, in a step the World Health Organization described as "historic." ETIENNE NSOM/AFP/GETTY

It seems hard to believe that Africa's biggest killer is a tiny insect, but almost every minute, an African child dies with malaria. The continent bears the brunt of the mosquito-borne disease, with 95% of the fatal cases recorded every year, and children under the age of 5 make up about 80% of those deaths.

The malaria parasite spreads to people bitten by infected mosquitos, and causes initial symptoms including high fever, headache and chills.

But finally, after four decades in the making, there's hope for the widespread prevention of malaria infections across Africa as a new vaccine is rolled out across the continent.

History was made Monday in Cameroon as the first routine vaccination program against the mosquito-borne illness got underway. Cameroon hoped to vaccinate roughly 250,000 children over the next two years.

"The arrival of the vaccines marks a historic step in our efforts to control malaria, which remains a major public health threat in the country," said Dr. Malachie Manaouda, Cameroon's Minister of Public Health.

"We have been waiting for a day like this," Mohammed Abdulaziz, the head of disease control and prevention at the Africa CDC, told journalists at a news conference to mark the launch. "We are not just witnessing history, but actively participating in a transformative chapter in Africa public health history. It brings more than just hope — a reduction in the mortality and morbidity associated with malaria."

The RTS,S/AS01 vaccine, also known as Mosquirix, was developed by British pharmaceuticals giant GlaxoSmithKline in conjunction with the Path Malaria Vaccine Initiative. It was recommended for use in such widespread fashion by the World Heath Organization in 2021, and is being rolled out in 19 countries in addition to Cameroon after having undergone successful trials in Ghana and Kenya.

The plan is for some 30 million doses of the vaccine to be administered in the coming months across all participating nations.

According to the WHO, malaria cases were up by almost 5 million in 2022 compared to the previous year. The increase in infections has been attributed largely to rising resistance to insecticides in the mosquitoes that carry the parasite, along with disruptions in health care and supply chains caused by the COVID-19 pandemic.

The WHO recommends a four-dose plan for children around five months of age, with a fifth dose in high-risk areas. The trials showed that vaccinating kids before the rainy season, while also administering anti-malarial drugs, cut deaths by nearly two-thirds.

Two million children in Ghana, Kenya and Malawi have already been vaccinated in a pilot program, and the WHO said studies of those children showed a 30% reduction in severe malaria symptoms.

A second vaccine, R21, developed by Oxford University and produced by the Serum Institute of India, completed a final regulatory step in December and is expected to be distributed in seven countries beginning in May or June. That vaccine's approval reassured health officials on the continent amid concerns that the eagerness of nations to participate in the program could lead to shortages.

Both vaccines, in trials, prevented half of malaria cases in the year after vaccination. Neither vaccine stops transmission of the disease.

The rollout will face challenges in many of the countries about to get the vaccine, as they struggle with transport and other infrastructure hurdles, leading those in charge of the program to suggest that local health workers schedule malaria vaccine shots in conjunction with other vaccinations, such as measles.

Health officials have warned the Ministries of Health in the initial 20 countries that the success of the vaccines will also depend on local health officials' level of preparation, including the continued provision and use of bed nets and spraying of insecticides.

Ten other countries have expressed an interest in the vaccine already, and officials involved expect that number to increase.

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