Paving the way for Uganda's malaria vaccine rollout

Malaria vaccine sensitisation workshop 

On 31st October 2024, the Ugandan Ministry of Health, in collaboration with Malaria Consortium, convened a sensitisation workshop in Moroto district to prepare the Karamoja region for the introduction of the malaria vaccine in April 2025. The event gathered over 100 community health workers, medical professionals, and political and technical leaders from the region’s nine districts, marking a pivotal step in stakeholder engagement and community readiness for the upcoming vaccination campaign. 

The big challenge 

The malaria vaccine is a vital addition to Uganda’s arsenal against a disease that remains a significant public health threat. Karamoja, which has historically carried a high malaria burden, recorded a prevalence rate of 34 percent in 2019, far exceeding the national rate of nine percent. Children under five bear the greatest impact, with the region’s nomadic pastoralist lifestyle presenting unique challenges that hinder the effectiveness of conventional malaria control methods, such as long-lasting insecticidal nets and indoor residual spraying. 

“A lot of progress has been made in the fight against diseases, and the Uganda Demographic Health Survey results demonstrate that, but more needs to be done, especially in child survival. Over the years, immunisation has played a significant role in improving child health, and Karamoja is unique — it needs the active involvement of community, political and civic leaders,” remarked Dr. Jimmy Opigo, Assistant Commissioner of the National Malaria Elimination Division at the Ministry of Health. 

The World Health Organization (WHO)’s recommendations for regions with highly seasonal malaria transmission, like Karamoja, underscore the need to align the malaria vaccine schedule with the malaria season. WHO suggests an optional five-dose seasonal delivery strategy to maximise vaccine efficacy, especially when coordinated with seasonal malaria chemoprevention (SMC), a highly effective intervention to prevent malaria that involves administering monthly doses of antimalarial drugs to children aged 3−59 months during the peak malaria transmission season.  

A new approach 

By combining the protective benefits of both SMC and the malaria vaccine, Uganda is adopting a pioneering integrated approach to malaria prevention. This approach leverages SMC’s seasonal protection during high-transmission periods with the malaria vaccine’s year-round immunity, enhancing the overall impact of malaria prevention efforts in high-risk areas. Together, these interventions work synergistically to provide more comprehensive and sustained protection for children under five, who are most susceptible to malaria.  

Clinical data show that an integrated approach can significantly reduce malaria incidence and severity, contributing to improved child survival rates and resilience within communities. Uganda’s holistic strategy not only addresses immediate health needs, but also strengthens Uganda’s long-term efforts against malaria, particularly in hard-to-reach regions like Karamoja. 

“The introduction of the malaria vaccine, in synergy with existing interventions like seasonal malaria chemoprevention, represents a monumental step forward in our fight against malaria”, said Dr Michael Baganizi, Assistant Commissioner of the Uganda National Expanded Programme on Immunization at the Ministry of Health. “This integrated approach provides a new layer of protection for our children, especially in high-burden areas like Karamoja. We are hopeful that this strategy will not only reduce malaria cases and save lives, but will also pave the way for a future where malaria is no longer a threat to Uganda’s health and economic growth.” 

The success of Uganda’s SMC programme — which integrates mosquito control, sanitation, nutrition and general healthcare to improve child survival rates —highlights the value of a holistic approach to community health. Introducing the zero-dose programme, which aims to integrate the identification and immunisation of zero-dose and under-vaccinated children with SMC campaigns, further complements this strategy, enhancing efforts to improve health outcomes for children in Karamoja. 

The SMC intervention in Karamoja has demonstrated high acceptability and effectiveness among various stakeholders, achieving remarkable coverage rates. Pre- and post-intervention measurements revealed substantial increases in SMC coverage, reaching 97.2 percent in the first cycle and achieving 100 percent coverage in subsequent cycles. Between 2020 and 2023, Malaria Consortium’s implementation of the SMC programme contributed to a considerable reduction in the malaria burden among children under five in Karamoja, with a 15 percent decrease in malaria admissions and 70 percent reduction in malaria-related deaths. 

Preparing for success 

Key strategies discussed during the workshop to ensure the success of the malaria vaccine rollout included training healthcare workers in effective communication with caregivers, community mobilisation and demand creation for the vaccine. Effective communication from trusted health workers about the vaccine and its benefits will be critical to prevent the spread of disinformation and overcome vaccine hesitancy, which could otherwise hamper uptake. A comprehensive plan was outlined to disseminate key messages on malaria vaccination to over one million people in Karamoja, aiming to reach 80 percent of the region’s population. The goal is to vaccinate 85 percent of eligible children in Karamoja (approximately 36,000 out of 42,000) within the first year.  

The workshop concluded with district leaders and health practitioners signing a declaration of commitment to support the malaria vaccine campaign, symbolising a unified effort to reduce malaria cases and safeguard Uganda’s future. This collective dedication provides renewed hope for bringing Uganda closer to a malaria-free future. 

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