Need for Real-World Evaluation of Malaria Vaccines and Reliable Vaccination Records in Africa

Evaluating the real-world effectiveness of the newly approved malaria vaccines, RTS,S/AS01 and R21/Matrix-M, is critical for informing vaccine policy, especially in areas not represented in the original clinical trials. Observational study designs such as cohort studies using the target trial emulation framework or the test-negative design offer promising approaches for estimating vaccine effectiveness in the real world. However, both designs require accurate, individual-level vaccination data, which remains a major challenge in many African countries. Strengthening electronic immunization registries, alongside continued efforts to improve the quality and completeness of paper-based immunization records, is essential in African countries, not only for the evaluation of current vaccines such as RTS,S/AS01 and R21/Matrix-M, but also in preparation for future malaria vaccines, to support robust vaccine monitoring and decision-making.