# Need for Real-World Evaluation of Malaria Vaccines and Reliable Vaccination Records in Africa

## TL;DR

This paper highlights the need to evaluate malaria vaccines in real-world settings in Africa and improve vaccination record-keeping for better vaccine policy decisions.

## Contribution

The paper emphasizes the importance of reliable vaccination data for real-world vaccine effectiveness studies in African countries.

## Key findings

- Observational study designs can estimate real-world malaria vaccine effectiveness.
- Accurate vaccination data is a major challenge in many African countries.
- Improving electronic and paper-based immunization records is essential for vaccine monitoring.

## Abstract

Evaluating the real-world effectiveness of the newly approved malaria vaccines, RTS,S/AS01 and R21/Matrix-M, is critical for informing vaccine policy, especially in areas not represented in the original clinical trials. Observational study designs such as cohort studies using the target trial emulation framework or the test–negative design offer promising approaches for estimating vaccine effectiveness in the real world. However, both designs require accurate, individual–level vaccination data, which remains a major challenge in many African countries. Strengthening electronic immunization registries, alongside continued efforts to improve the quality and completeness of paper-based immunization records, is essential in African countries, not only for the evaluation of current vaccines such as RTS,S/AS01 and R21/Matrix-M, but also in preparation for future malaria vaccines, to support robust vaccine monitoring and decision-making.