Peer-reviewed article

The Cost and Budget Impact of Malaria Vaccine Introduction in Uganda.

Perez N Ochanda, Elizabeth Ekirapa-Kiracho, Chrispus Mayora, Richard Ssempala, Brenda Nakimuli et al. · 15 Mar 2026

Abstract

OBJECTIVES: The World Health Organization recommends deploying the RTS,S/AS01 malaria vaccine in high-burden regions. Although effective in reducing malaria cases, affordability challenges hinder widespread adoption in low-resource settings. This study examines the cost and budget impact of introducing the vaccine into Uganda's expanded immunization program. METHODS: A budget impact analysis based on prospective studies conducted in Uganda and sub-Saharan Africa, with unit costs per dose obtained from existing literature. The primary outcome was the number of malaria cases averted among eligible children. The budget impact was calculated by comparing total vaccination costs to savings from reduced malaria treatment costs, incorporating sensitivity analyses for varying vaccine coverage and malaria incidence levels. RESULTS: The treatment costs for complicated malaria in children under 5 were estimated at $1.1 million before vaccination, decreasing to $297 465 afterward. The estimated annual vaccination rollout cost was $29 million, representing 24% of Uganda's immunization budget and about 3.5% of total health budget. Over 5 years, the total budget impact was $145.5 million, with a net cost of $141 million. The impact varied with coverage levels, ranging from $106.3 million at lower coverage to $175.6 million at higher coverage. CONCLUSIONS: Implementing the malaria vaccine would lead to significant increase in Uganda's immunization budget and the overall health sector budgets. To ensure sustainability, the government should prioritize funding and adopt cost-effective strategies, such as targeting high-transmission areas and expanding prevention efforts, to maintain affordability and achieve long-term success.