Next-generation malaria vaccines: R21, RTS,S and what's next

For the first time, there are two WHO-recommended malaria vaccines: RTS,S/AS01 (Mosquirix) and R21/Matrix-M. Both target the pre-erythrocytic stage of Plasmodium falciparum.

Where the evidence stands

• RTS,S showed roughly 30–40% efficacy against clinical malaria in young children over the first years, with waning protection requiring a booster.
• R21/Matrix-M reported higher efficacy in trials — up to ~75% over 12 months in seasonal administration settings — and, critically, can be manufactured at very large scale and low cost.
• WHO recommended R21 in late 2023, and national rollouts across sub-Saharan Africa have accelerated through 2025–2026.

Why this is a public-health milestone

These vaccines are aimed at reducing childhood malaria deaths in endemic countries, where the burden is overwhelmingly in children under five. Combined with bed nets, chemoprevention, and case management, they are expected to prevent tens of thousands of deaths annually as coverage grows.

What it means for travelers — an important caveat

• These vaccines are not currently indicated for travelers. They are designed for repeated, high-intensity exposure in endemic children, and the schedules (multiple doses over months, plus boosters) do not fit short-term travel.
• For travelers, the cornerstone remains chemoprophylaxis (atovaquone-proguanil, doxycycline, or mefloquine, per destination and resistance) plus bite prevention.
• A traveler-appropriate malaria vaccine may eventually emerge, but it is not here yet.

Bottom line: a genuine breakthrough for endemic populations — but if you're planning a trip, your protection is still prophylaxis and bite avoidance, not a vaccine.