Malaria vaccine implementation in Nigeria: Addressing the coverage challenges within the national immunization program for high impact

The malaria vaccines, RTS,S/AS01 and R21/Matrix-M, bring fresh hope to curbing malaria mortality globally, especially among children below age five who are most susceptible. Nigeria carries the heaviest burden of malaria globally, accounting for 38.4 % of under-five malaria mortality and the highest number (7.2 million) of at-risk newborns in 2023. Rightly, the country has moved to introduce the R21 vaccine by 2025, with plans to integrate the vaccine rollout into the existing National Program on Immunization (NPI). However, there are serious concerns with achieving a high-impact malaria vaccine implementation in Nigeria, given the current average performance and challenges of the NPI in providing effective immunization coverage for children. Nigeria has a high prevalence of unimmunized and under-immunized children. Also, barriers to effective immunization coverage, on both the demand and supply sides, are rife in the country. This commentary broadly discusses the prospects of the malaria vaccine implementation in Nigeria amidst the immunization coverage challenges. It draws from review-level evidence to propose four priority areas for improvement within the NPI to achieve a high-impact implementation—i.e., Reach Maximization, Social Mobilization, Program Management, and Progress Monitoring—in line with global immunization strategy frameworks. Evidence-based strategies to influence these domains in the Nigerian context are emphasized.