Malaria Vaccine Rollout in Nigeria: Current Status and Challenges

Abstract

Malaria remains a leading cause of morbidity and mortality in Nigeria, particularly among children under 5 years of age, despite ongoing control efforts. The introduction of RTS,S/AS01, and R21/Matrix-M vaccines provides a promising complementary prevention strategy. This systematic review assessed malaria vaccine rollout in Nigeria, focusing on implementation, awareness, acceptance, willingness to pay, and health system readiness. A comprehensive search of PubMed, ScienceDirect, Google Scholar, African Index Medicus, and gray literature (2015-2026) identified 12 eligible studies. Caregiver acceptance ranged from 76.6% in Lagos to 95.6% in Owerri, and exceeding 90% in Enugu, Ondo State, and Gombe. Among health care professionals, only 54.1% of pharmacists were willing to vaccinate their children. Caregiver awareness ranged from 9.7% in Lagos to 72.1% in Enugu. Physicians demonstrated higher adequate knowledge (68.9%) than nurses (35.9%), with 55.5% of nurses having only heard of the vaccine. Pharmacists expressed concerns about vaccine failure (53.6%), adverse effects (63.4%), and storage conditions (77.8%). Willingness to pay was moderate; median willingness in Enugu was USD $0.82 per dose; 71.2% of Lagos caregivers expressed willingness to pay; and 90% of respondents nationally preferred government-funded vaccination. Health system readiness was critically inadequate, with overall facility preparedness scores ranging from 33% to 51%. Advocacy and social mobilization were at 0% across all three facilities, and monitoring and supervision ranged from 0% to 33%, all far below the WHO-recommended 95% threshold. Strengthening health systems, targeted communication, and sustainable public financing are essential for a successful nationwide malaria vaccine rollout.