Rwanda Revisits Malaria Vaccination Strategies Amid Unexpected Resurgence

After years of significant progress in reducing malaria cases, Rwanda is experiencing an unexpected increase in infections, prompting health officials to reconsider the use of malaria vaccines. The country had successfully decreased malaria instances from nearly five million cases in 2016 to approximately 430,000 in 2023, representing a 90% decline, according to data from the Rwanda Biomedical Center (RBC). However, in 2024, malaria cases surged by over 45%, totaling around 620,000 cases, with a notable spike in January 2024, a period typically associated with declining malaria incidence.

This resurgence is surprising given Rwanda's previous success in eliminating the disease, including a sharp decrease in malaria-related deaths from 650 in 2016 to just 67 in 2023, and the progress of more than two dozen districts moving into the pre-elimination phase. By October 2024, the country had recorded nearly 200,000 more cases than the same period in 2023, with a concentration of cases in about 15 districts.

Despite substantial investments in conventional control measures—such as indoor residual spraying and distribution of mosquito nets—malaria cases continue to rise. Factors contributing to this include growing resistance of mosquitoes to antimalarial drugs, changing mosquito biting behaviors (shifting outdoor rather than indoor biting), and environmental changes that increase breeding sites. Preliminary data suggest that the effectiveness of artemisinin-based drugs is waning due to resistance.

Moreover, cross-border movement and epidemiological linkages with neighboring districts highlight the regional nature of the threat. In response, Rwanda has begun adopting alternative treatment strategies and is considering the broader deployment of malaria vaccines—something it initially declined during the first WHO and GAVI vaccination phase in 2023. Currently, 17 African countries have integrated malaria vaccines supported by WHO and Gavi, and Rwanda seeks similar support to address the resurgence.

Health officials remain committed to eliminating malaria by 2030. To this end, Rwanda is re-evaluating its malaria control strategies, including the possible adoption of vaccines, in efforts to curb the increasing burden of the disease amid challenges such as drug resistance and environmental shifts.