The Malaria Vaccination Era: How Endemic Countries and Donors Can Make the Most of R21

Purpose: This paper provides a framework for evidence-informed decision- making in the rollout of new malaria vaccines, examining the interplay between research priorities, national health systems, and global health institutions. Originality: The recent approval of the R21 malaria vaccine in Ghana and Nigeria marks a potential turning point in malaria control, yet historical challenges in implementing health technologies suggest that scientific breakthroughs alone do not guarantee public health impact. Methodology: Analysis of existing malaria control measures and emerging vaccine data used to posit that R21's promising efficacy (up to 80% reduction in malaria cases) must be evaluated within broader health system contexts and resource constraints. Result: The article proposes an approach centered on integrated national priority setting systems, supported by scenario-based WHO guidance, locally adaptable health technology assessment models, and coordinated donor activities. Conclusions and Implication: The paper concludes that realizing R21's full potential requires moving beyond efficacy data to address pragmatic implementation challenges, including targeting strategies, resource allocation trade-offs, and health system integration. Recent developments in WHO guidance and regional health institutions suggest growing recognition of these needs, but successful implementation will require careful attention to local contexts, economic evidence, and systematic priority-setting processes.