Accelerating Malaria Vaccine Uptake

The first vaccines for malaria were pre-approved for use by WHO in 2023 due to their potential to significantly reduce hospitalizations and deaths from the disease, particularly in sub-Saharan Africa where up to 95% of malaria deaths occur. Given supply constraints, the vaccine rollout was targeted at children living in malaria-endemic areas. As of April 25, 2025, 20 countries in Africa have introduced malaria vaccines into their routine immunization programs with Gavi, the Vaccine Alliance (Gavi) support. Gavi aims to help countries protect 50 million children with four doses between 2026 and 2030.

Building on research and learnings from the Malaria Vaccine Implementation Program (MVIP), Gavi established the Malaria Vaccine Learning Agenda (MVLA) to answer key implementation research questions.

Sabin Vaccine Institute is implementing two of the seven Gavi-funded MVLA projects.

Project Overview

The introduction of the malaria vaccine presents an opportunity to identify and assess approaches and interventions that may increase its uptake and that of other health interventions during routine touchpoints between children and the health system.

Sabin is leading a consortium of partners to conduct implementation research on the integration of malaria vaccination with existing child health services. The goal is to increase uptake of the four doses of the malaria vaccine needed for full immunization.

Location

Projects will take place over nine months in Kenya and Liberia, both malaria-endemic countries where malaria remains a leading cause of death for children under 5. While Kenya introduced the malaria vaccine in 2019 (one of three MVIP countries, alongside Ghana and Malawi) and Liberia in 2024, both are experiencing lower coverage rates for the third and fourth doses of the vaccine.

Aims and Objectives

This study design offers an inter-country learning opportunity, where successful interventions can be shared and refined between geographies. The study focuses on two aims through two separate projects:

1. Leveraging malaria vaccine visits to identify and provide other child health services, such as missed or overdue routine vaccinations or nutrition programs, and
2. Integrating malaria vaccine delivery into standard childhood immunization and primary healthcare visits, as well as community health touchpoints (e.g., malaria prevention and surveillance visits).

The study will measure:

• Coverage of fourth and final dose of the malaria vaccine
• Uptake of other child health services

Consortium partners

• Kenya Medical Research Institute
• Liverpool School of Tropical Medicine
• US Centers for Disease Control and Prevention
• University of Liberia School of Public Health

Activities will be implemented in close collaboration with the following key stakeholders and programs in both Liberia and Kenya:

• Ministries of Health and national Expanded Programme on Immunization (EPI)
• National Malaria Control Programme and its vaccine distribution strategies
• Global health partners, including Gavi, WHO, and UNICEF
• Local community health workers, health care workers, community leaders, and caregivers.

Our Approach

As Consortium leader, we will leverage our expertise in building and leading research consortia, implementation research and impact evaluation design and conduct, social and behavioral change and human-centered design approaches, strengthening immunization service delivery through building vaccination acceptance and demand generation, and supporting countries in expanding access to new vaccines.

Study activities will be conducted in partnership with our Consortium members who bring their own research expertise, deep knowledge of local communities and health systems, and relationships with on-the-ground health care workers. This approach ensures bi-directional learning with communities and the generation of practical, actionable evidence to enhance the uptake and impact of malaria vaccination.

Our implementation-forward monitoring, evaluation, and learning approach will enable us to assess the impact of the alternative schedule delivery in increasing coverage and conduct intervention cost assessments on an abbreviated timeframe, while also generating evidence to inform country and global malaria vaccine program policy decisions.

Sabin’s project design includes several unique approaches to fully understand and address barriers and test new approaches for full malaria vaccination:

Phase 1: Diagnose and Design

Sabin and the Consortium partners will lead human-centered design workshops that leverage the UNICEF Journey to Health mapping approach and WHO Behavioral and Social Drivers framework, and incorporate diverse perspectives throughout the design process. Healthcare workers, community members, and caregivers will work together to identify local barriers and opportunities and co-create tailored solutions.

Phase 2: Implement and Evaluate

The solutions generated in the Phase 1 workshops will be tested in real-world settings, sharpening strategies to improve outreach to eligible children and improve health service delivery. We will use the RE-AIM implementation science framework to measure the reach, effectiveness, feasibility, and sustainability of the innovations.