RTS,S /AS01 malaria vaccine administration program in children: perspectives from uganda; a review

Malaria remains a significant cause of morbidity and death in Uganda, particularly among children under five. Over 90% of Uganda’s population is at risk for malaria, with 13 million cases and 19,600 deaths in 2021 alone. To address this burden, on 2 April 2025 the World Health Organization approved the RTS,S/AS01 malaria vaccine. Thus, Uganda became the 19th African country to introduce the RTS,S/AS01 malaria vaccine into its Expanded Programme on Immunization. RTS,S/AS01 has been proven in clinical trials to provide 36% protection against clinical malaria and 32% protection against severe malaria over four years, with immunity reinforced by a booster dose. However, completing the entire four-dose schedule remains difficult. The trial programs in Ghana, Kenya, and Malawi have reported adherence rates below 50% and preliminary Ugandan data indicate a similar problem. This review explores the early stages of vaccine rollout in Uganda, highlighting the challenges encountered and opportunities for improvement, including but not limited to logistical difficulties in vaccine distribution, limited cold-chain infrastructure, staffing shortages, and low coverage of the four-dose schedule. It examines how misinformation and cultural biases influence public perception and acceptance. Ultimately, the study offers practical insights into improving implementation and advancing malaria control in Uganda and other countries facing similar challenges.