Leocadia Bongben (Lead Writer)
Before Cameroon received doses of the RTS,S malaria vaccine in November 2023, , 30 year old Josiane Busare, a mother of two from Soa, Yaoundé, shared how she often visited the hospital monthly for malaria treatment for her children, “I constantly visited the hospital for consultation every month,” she said. “And was often hospitalised from malaria with my five-year-old son, Bradon.”
Malaria remains the leading cause of death in Cameroonian children under five, and accounts for 30% of health facility visits. According to the 2023 World Health Organisation (WHO) World Malaria Report, Cameroon is among the 11 countries with the highest malaria burden globally, responsible for 2.6% of all cases in recorded worldwide in 2022.
These hospital visits are financially draining for low-income families like Josiane’s. “As a housewife, my husband is working menial jobs, it was hard to spend FCFA 20,000 every other month when we summed the cost of malaria consultations, laboratory examinations, and drugs for my son,” she explained.
The inaugural rollout of the RTS, S vaccine means the elimination of this preventable disease, with vaccines distributed in 42 health districts across Cameroon’s ten regions, representing approximately 20% of the country’s total health districts. It also means a reduction in malaria cases in children under five, which went from 333,805 cases in 2023 to 266,917 cases in 2024.
What lesser malaria consultation means
According to Dr Andreas Njoh Ateke, the Expanded Programme of Immunisation (EPI) Deputy Permanent Secretary, Cameroon’s initial assessment of the malaria vaccine rollout shows a positive trend in coverage, with the first dose reaching 70% by the end of the year and the third dose achieving 50% coverage.
“Consultations have [also] decreased by 17%, especially in health districts that are vaccinating against malaria. Similarly, a decrease of at least 13% in malaria-related mortality was observed in 2024 as opposed to 2023,” he noted.
Image credit: Nigeria Health Watch
Dr Benjamin Signe, Head of Soa Health District, noted that reduced malaria consultations have eased pressure on the Cameroonian health system, freeing up clinics to focus on other health conditions, reducing demand on resources, and potentially improving overall health outcomes.
Malaria vaccine roll out in Cameroon
Malaria is endemic in specific areas of the country, particularly the Central, South, and East regions. These areas face significant environmental risk factors, such as stagnant water and overgrown vegetation near homes, which creates an ideal breeding ground for female Anopheles mosquito, especially those carrying Plasmodium parasites, which causes the most severe and potentially fatal form of malaria.
The malaria vaccine was first tested in Ghana, Kenya, and Malawi, with about 2 million children vaccinated before the WHO recommendation in October 2021. Cameroon is among the first country to roll out the vaccine which was introduced into the EPI through a four-dose protocol in 42 malaria-endemic health districts out of 189 health districts.
In Cameroon, the malaria vaccine is administered in four doses: the first at six months, the second at seven months, the third at nine months, and the final dose at 24 months. The Soa Health District made history on January 22, 2024, when children received the first dose of the life-saving vaccine.
Josiane’s two-year old daughter, Brenda, is waiting for the fourth dose in July and was among the first set of children to be administered the malaria vaccine at the facility. “She is in good health, her temperature may rise [due to] stomach upsets, but not malaria,” Josiane explained.
“Unlike my daughter, my son was constantly ill, hospitalised because of malaria, almost monthly. With my [vaccinated] daughter, there is a difference. Since her vaccination, we have not been to the hospital for malaria,” she adds.
Kweka Meret, EPI focal person at the Soa health district, noted that, “parents accepted the vaccine, and there were no post-vaccination allergies. At this health district, the vaccine has been administered to 4,773 children for the first dose, the second dose 4,054 [children], and the third dose 2,484.” Data from WHO indicates that so far 35,614 children have received three doses as at January 2025.
The model parent approach
A few months after the vaccine’s introduction, a mini-evaluation in Cameroon revealed low uptake of follow-up doses. In response, the country’s health authorities intensified efforts to mobilise parents.
According to Kweka, many children in Soa district have taken the first dose, however, 400 children did not return for the second dose. “The gap between the second dose and the third seems wider [with] about 1,600 children lost,” she said.
A similar trend was observed in the three other health districts of the Southwest region, Tiko, Limbe, and Mamfe — where there is a significant drop between the first and last dose uptake. According to the SABIN Vaccine Institute, as of September 2024, 6,902 children received the first dose, 3,017 received the second, and only 993 received the third.
Parents whose children finished their doses and adhered to the immunisation schedule are compensated by the model parent approach as part of the EPI. Dr Andreas explained that “they receive a certificate and an award upon completion, and they are pleased with it.”
Josiane, who works at the Kolfoulou Integrated Health Centre, stated that, “as a model mother, I urge other mothers to follow my example, vaccinate their children for good immunity, health and safety from diseases.” Three times a week, Josiane combs her neighbourhood, vaccination centres, and meeting groups, pushing mothers to accept the malaria vaccine and adhere to doses timeline.
Scaling up beyond model parent approach
To address the gaps in dose uptake, quarterly catch-up campaigns have been put in place. “During these days of catch-ups, it is strategic. We leave the health centres and go to the community in search of children who missed their vaccines,” Kweka explained.
Dr. Andreas also emphasises the Ministry of Public Health’s objective of achieving full vaccination coverage, aiming for 100%, “at 70%, then we have 30% to go. That is a huge challenge to meet and difficult to hit the 100% target. Every infant should receive the vaccine from six months. Unfortunately, it’s not yet the case.”
“The malaria vaccine is still new, and many parents may forget the schedule since they aren’t accustomed to vaccination visits at six and seven months,” Dr Andreas explains. Additionally, long distances and limited resources make it difficult for some to reach health facilities, especially as the vaccine isn’t yet available in all health districts.
Even then, Dr Andreas noted that other measures are in place in these districts in addition to malaria vaccinations to prevent and control malaria for vulnerable populations. The public is still being educated on ways to reduce mosquito breeding; the distribution of mosquito nets is still ongoing; and intermittent preventive therapy has been used for unborn children. “Malaria vaccines were introduced as an adjunct to our current [prevention and control efforts],” Dr Adreas said.
In 2024, Cameroon hosted delegates from African countries resulting in the Yaoundé Declaration on Health, a pledge reaffirming their collective resolve that no one should die from malaria, especially with the tools and systems now in place.
The contribution of WHO through the Accelerated Malaria Vaccine Introduction and Rollout in Africa (AMVIRA) initiative is also supporting countries during critical roll-out phases, mobilising resources, strengthening health system capacities, and facilitating the provision of millions of vaccine doses in these countries.