In late April 2024, the Government of Sierra Leone, with support from WHO and other partners, launched its first-ever malaria vaccination campaign. The introduction of 550,000 doses of the RTS,S malaria vaccine marks a pivotal moment in the fight against malaria in the country.
Sierra Leone has one of the highest malaria burdens in the world, with more than 2 million hospital admissions a year, half of which are among children aged under 5 years ‒ accounting for 20% of deaths in this age group.
In addition to the existing tools in the fight against malaria, which include insecticide-treated nets, indoor spraying and effective diagnosis and treatment, two safe and effective vaccines ‒ RTS,S/AS01 (RTS,S) and R21 ‒ have been recommended by the World Health Organization (WHO) to prevent malaria in children.
In late April 2024, the Government of Sierra Leone, with support from WHO and other partners, launched its first-ever malaria vaccination campaign. The introduction of 550,000 doses of the RTS,S malaria vaccine marks a pivotal moment in the fight against malaria in the country. The vaccine campaign was recently rolled out across 15 of the country’s 16 districts, targeting 6-month-old babies, who are at high risk of malaria-related mortality.
It is early morning at Waterloo Community Health Centre, in the Western Rural Area district, Sierra Leone. Mothers arrive for the routine check-up for their babies. Height and weight measurements are taken and vitamin A is administered to 6-month-olds.
Since 12 April 2024, a new element has been added to the routine: administering the malaria vaccine to 6-month-old babies. It was in this same district that Mariama Jalloh became the first child in Sierra Leone to be vaccinated against malaria.
Isatu Kargbo is mother to 6-month-old Musu. She is visiting the health centre for Musu’s check-up and to have the vaccine administered. She says malaria is a “disturbance” in her community.
“Malaria has been disturbing my child, she is always sick with a high fever and I’m always worried,” she says. “As my child falls sick, her temperature becomes high and she becomes pale. Malaria is tormenting us in this community and in this country. It’s a threat to our children.”
Hawa Bayoh, the nurse in charge of immunization at the health centre, recalls the arrival of the malaria vaccine in the country. “It was surprising because we never thought about it happening now or in years to come. We are very excited about the malaria vaccines and it will help us a lot, especially our children,” she says.
The vaccine is another tool in the fight against this disease, in combination with insecticide-treated nets, effective diagnosis and treatment and indoor spraying, says Minister of Health, Dr Austin Demby. “With the new, safe and efficacious malaria vaccine, no child should die from malaria infection,” he says.
Prior to the introduction of the vaccine, more than 1500 teams of health workers across the country were trained in vaccine administration and handling, data management, risk communication and community engagement and safety management.
Cynthia Ernestine Reffel, focal person for the Expanded Programme on Immunization (EPI) at Waterloo Community Health Centre, was trained to counsel parents on the safety and efficacy of the vaccines. “We were taught about the age categories, how to administer the vaccine, when and how to give the vaccine to the children and what to tell their mothers as well,” she says.
Finda Kargbo, 36, lives in Grafton, also in the Western Rural Area district, with her four children. She took her youngest child, Mary Bangura, to the Grafton Community Health Centre to receive the first dose of the malaria vaccine.
Kargbo heard about the vaccine through outreach programmes, where health workers visit communities and conduct house-to-house sensitization to encourage parents to visit the health centre and have their children vaccinated.
“When I heard about the malaria vaccine, I was happy. I know after taking the malaria vaccine, all my stress will now go away and I thank God for that,” says Kargbo.
“On the launch day, we vaccinated 50 children,” recalls Isata Amara, EPI focal person at the centre. Since then, more than 11,500 children have received the first dose of malaria vaccine in Sierra Leone and 1060 children have been vaccinated in the district.
Amara continues to promote prevention methods and encourages parents to use mosquito nets.
“Anytime we come to the health centre, they ask us if we use bed nets and continuously remind us to use them. I was given two-bed nets. I use one for myself and my baby and the other one for my other children,” says Kargbo.
WHO supported Sierra Leone in the application process for malaria vaccines to Gavi, the Vaccine Alliance. As a result, Gavi approved 1.7 million doses for Sierra Leone between 2024 and 2025, with a first tranche of 550,000 doses. During the first year, 95% of 286,253 targeted children in 15 districts will receive three vaccine doses. Going forward, the vaccine will be administered in four doses, at 6, 7, 8 and 18 months of age.
“WHO is proud to support this important milestone in Sierra Leone’s efforts to reduce the burden of malaria,” says Dr Innocent Nuwagira, WHO Representative in Sierra Leone. “This will help to reduce child mortality and better health outcomes for under 5 children.”
As part of the Accelerating Malaria Vaccine Introduction and Rollout in Africa programme, WHO deployed an expert to support the EPI in developing a dashboard to assess readiness and track vaccine supply and vaccination rollout at the national and district levels. This tool plays a critical role in generating and sharing key data to better understand vaccine uptake and delivery.
“As a health worker, I’m so happy for the vaccine and it’s free. I want to thank the government and partners for what they have done for the people of Sierra Leone,” says Reffel.
