Erin Fleming has recently posted a perspective on the new malaria vaccine intervention testing at “Social, Cultural & Behavioral Issues in PHC & Global Health.” See her observations below. Malaria is one of the world’s deadliest diseases. In Malawi, it is endemic across 95 percent of the country and is one of the leading causes of morbidity and mortality across all ages, and has a disproportionate impact on children under 5. In collaboration with many international partners such as the Centers for Disease Control and Prevention (CDC), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States Agency for International Development (USAID), and Gavi, the Vaccine Alliance, the Malawian Ministry of Health’s Malaria Control Program has been combating malaria for years by scaling up distribution of artemisinin-based combination therapies (ACTs), intermittent preventive treatment for pregnant women (IPTp) using sulfoxide-pyrimethamine (SP), and insecticide-treated net (ITNs) based on the World Health Organization’s (WHO) malaria guidelines and national level policies. But now, they may potentially have another tool to add to their existing package of services, a malaria vaccine! On April 23, 2019, Malawi, 1 of 3 countries selected for the Malaria Vaccine Implementation Programme (MVIP) pilot rolled out RTS,S/AS01 (RTS,S) – also known as Mosquirix , as part of their routine immunization for children under 5. It has been met with great excitement, as early speculation is that the vaccine could be a gamechanger in the fight against malaria. But there is still a way to go, four years to be exact after the completion of the pilot and research, before we know for sure. IF the pilot findings present positive results, i.e. higher levels of efficacy and effectiveness, does not have any severe adverse health effects, and can be incorporated into national immunization programs, then yes, we may have on our hands a new control to help reduce severe malaria morbidity and mortality in children under 5 in a significant way. Now, despite my excitement regarding the potential impact RTS,S could have on malaria on childhood morbidity and mortality, it is too soon to tell. I am supportive of the vaccine pilot and the potential inclusion into policies and see the life changing benefits for patients, but with reservations. And, perhaps I am taking a more conservative stance based on my experience working and living in sub-Saharan Africa, seeing firsthand some of the systemic issues (i.e. lack of human resources, funding, poor infrastructure – in particular supply chain management, and government commitment) that continue to plague the efforts being made to improve health service delivery – all of which directly impacts routine immunization programs. That said, I’m eager to see what the pilot results yield, in particular as it relates to the economic and operational feasibility of implementation in low-income countries who are the hardest hit by malaria. But while we wait, we must not lose track of continuing to implement existing prevention approaches and enforcing adherence to treatment guidelines, especially as we know malaria is on the rise again in Malawi, and around the world. There still needs to be significant increases of support and investment from cooperating governments and international stakeholders in improved surveillance systems and research on some of the challenges we’re encountering with existing methodologies, i.e. increased insecticide and anti-malarial drug resistance, and the biggest “unknown” of them all, how climate change will impact the mosquito burden and potentially increase the reach of this deadly disease globally.