Jab by jab, house by house, Nigeria slowly rolls out malaria vaccine

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The needle broke the skin, followed by wailing and the reassuring coo of "sorry, sorry" from the medical staff—and just like that, another baby was vaccinated against malaria, an intractable child killer in Nigeria.

Expectations were high when the world's first malaria vaccines arrived in Africa's most populous country in late 2024, promising to limit the devastation from the mosquito-borne disease that killed nearly 200,000 Nigerians and some 600,000 people worldwide that year.

Progress has been slow—but on the local level, some villages have seen child deaths drop off completely, with almost a quarter-million children fully vaccinated and 1.8 million jabs administered.

"It makes me feel happy," said hairdresser Ezibanyenami Paul, her own smile contradicting her daughter's tears after she received her fourth and final jab in the town of Oruma, in southern Bayelsa state.

Combating malaria requires a complicated mix of state and private-sector capacity to procure medicines, organize public health campaigns and keep up infrastructure such as drains and sewage.

"The malaria vaccine is a breakthrough," said Hadiza Hussayn Jibril, of the NGO PATH, which is aiding Bayelsa state in its vaccine rollout. "But it doesn't provide 100% protection."

Still, Bayelsa has already seen an 18% drop in the rate of children under 5 who have malaria at any given time, according to PATH—all the more impressive considering bed net and preventive drug distributions have been lagging in the state for years.

'It was hectic'

In Oruma, in a cluster of squat houses and shaded verandas on a neat grid carved out from the surrounding tangles of forest, clinic workers doled out a four-part immunization regimen spread over the first 15 months of an infant's life.

Children under 5, with weaker immune systems, account for more than 75% of malaria deaths in Africa, according to the World Health Organization.

The vaccine's effectiveness fades over time, but the idea is to protect children while they're most vulnerable.

"It was hectic," Elizabeth Ogisi, director of primary health care for the wider Ogbia local government area, said of the time before the vaccine.

"A child died. What happened? He was convulsing," she said, recalling "rampant" cases of malaria progressing to the point of seizure.

Since the introduction of the vaccine, "we have not recorded anything like the death of a child," she told AFP.

Zuweira Nasiru, 39, said her 2-year-old son Abdulrauf—the first of her seven children to get the vaccine—has only ever had mild cases of malaria.

Paul's infant has not had it once—a big deal, the 24-year-old hairdresser told AFP, because of the cost of malaria drugs.

At 5,000 naira ($3.75), she said, medicine for the easily treatable disease is too expensive.

Slow rollout

Oruma represents a small slice of Nigeria's 240 million people and 68.5 million annual infections.

So far, jabs are only being deployed in four out of 36 states.

The slow start has helped health workers bring down "dropout rates" between doses and work out kinks in reaching remote villages.

There "are very difficult zones that we normally don't get to. No roads, you have to take a boat," said James Kurofou, director of immunization for Sagbama local government area, speaking to AFP on the banks of one of the Niger Delta's many wide, mud-colored rivers.

In some cases, health care workers decided to dole out jabs during home visits, in cases where parents—often those who couldn't afford to travel—missed appointments.

Bayelsa's verdant mangroves and winding creeks are repeatedly interrupted by armed men guarding oil pipelines—a reminder of the glaring economic inequality in the country.

"The oil wealth you see in a state like Bayelsa does not automatically translate into functioning primary health care," said Muhammed Afolabi, co-director at the London School of Hygiene and Tropical Medicine's Vaccine Centre, noting decades of government corruption and underinvestment in health infrastructure in Nigeria.

The Bayelsa health ministry did not respond to a request for comment.

At a ceremony in the state capital, Yenagoa, organized by PATH and local authorities to thank health care workers from Sagbama and Ogbia, the mood was raucous as people took turns singing and dancing in a meeting hall.

But the gifts the workers were given were a reminder of the task that remains: rubber boots, a raincoat and an umbrella to help them keep trekking through the tropical elements.

Key medical concepts

MalariaMalaria VaccinesChild Mortality

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Infectious diseasesChildren's healthPediatricsCommon illnesses & PreventionPreventive medicine Who's behind this story?

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