African countries are rolling out malaria vaccines at an unprecedented pace, with 24 nations now incorporating the shots into childhood immunisation programmes, even as deep cuts to United States foreign aid funding have raised serious fears about whether those gains can be sustained and what their reversal could cost in human lives.
The World Health Organization (WHO) confirmed in late 2025 that more than 47 million doses of malaria vaccines had been delivered across the continent, with more than 10 million children now targeted annually. The vaccines in use are RTS,S, which received WHO recommendation in 2021, and the R21/Matrix-M vaccine, both of which have demonstrated meaningful reductions in child deaths from malaria and from all causes in early deployment data.
Ghana holds a pioneering place in this effort. Ghana was one of three countries, alongside Kenya and Malawi, to run the Malaria Vaccine Implementation Programme pilot from 2019 to 2023, which reached over 2 million children and demonstrated that the malaria vaccine led to a significant reduction in malaria illness. The lessons from that pilot are now directly shaping the rollout across two dozen countries.
Uganda took the programme to a new scale in April 2025. Uganda launched Africa’s largest malaria vaccine rollout to date, targeting 1.1 million children aged under two in 105 high and moderate transmission districts using the R21/Matrix-M vaccine administered in four doses. Uganda’s Apac District is reported to have the highest number of mosquito bites per person globally, at over 1,500 bites per person annually, and malaria is responsible for up to 33% of all outpatient visits in the country.
Early data from Cameroon, the first country to integrate the vaccine into routine immunisation in January 2024, provides encouraging but still preliminary results. Districts included in the first wave of vaccination saw a higher drop of 17% in all-cause hospital consultations for children under five than those areas without the vaccine, and about 60% of the malaria-vaccinating districts recorded a drop in all-cause under-five deaths.
Despite this momentum, the financing architecture underpinning the rollout is under severe strain. The United States has historically been the largest single contributor to global malaria control, channelling funds through the President’s Malaria Initiative (PMI), which operated in 30 countries accounting for 90% of global malaria cases and deaths, and through contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Trump administration’s fiscal year 2026 budget request includes $424 million for malaria, a reduction of $381 million from previous levels. More than half of the 64 malaria-endemic countries surveyed by WHO reported moderate or severe disruptions to malaria services, including for medicines and health products, due to the US foreign aid freeze.
An internal United States Agency for International Development (USAID) memo estimated that an additional 12.5 to 17.9 million malaria cases and between 71,000 and 166,000 deaths could occur annually if PMI was halted permanently.
On-the-ground evidence of the consequences is already emerging, including spiking malaria deaths in northern Cameroon linked to breakdown in the global supply of antimalarial medicines. A Lancet study published in February 2026 projected that if current funding trends continue globally, aid cuts could contribute to at least 9.4 million additional deaths by 2030 across multiple disease areas.
Daniel Ngamije, director of WHO’s Global Malaria Programme, warned that history offers a cautionary example: “In 1969, the global eradication effort was abandoned, triggering a resurgence in cases and deaths.”
Gavi, the Vaccine Alliance (Gavi), which is the principal funder supporting country efforts to roll out malaria vaccines, has set an ambition to protect 50 million additional children with four doses of the malaria vaccine between 2026 and 2030. Achieving this goal is dependent on Gavi securing sufficient funds for its next strategic period, and any shortfall will result in programmes being cut back, leading to preventable deaths.
Against this backdrop, the Johns Hopkins Bloomberg School of Public Health will host a media briefing on April 8, 2026, at which researchers from the Johns Hopkins Malaria Research Institute will discuss vaccine rollouts, the current global state of malaria, early indications of how the funding reductions are affecting programmes, and what these developments mean for malaria control in 2026 and beyond. The briefing also marks the institute’s 25th anniversary. World Malaria Day falls on April 25.
