Fig. 1

Geospatial distribution of vaccine allocation, health financing, and malaria mortality in Africa. a Distribution of government health financing and malaria mortality share. The color of each dot is proportional to health financing in percentage. Health financing denotes the average health financing in 2019–2021 measured as geometric mean of central government health spending as a share of general government expenditure. The color of the surface of each country represents whether such country was part or not of the four African countries that in 2021–2022 accounted for just over half of global malaria deaths. Most malaria-endemic countries with high disease burden do not comply with the Abuja Declaration of 2001 to allocate ≥ 15% of their annual budget to improve the health sector. b Malaria vaccine allocation status. Vaccine allocation categories shown with color for each country are as follows: Allocated, countries allocated vaccine for phase 1 areas; Awaiting, countries approved for Gavi support for malaria vaccine allocation but currently without supply; Not approved, countries not approved for Gavi support for malaria vaccine allocation; Partial, countries allocated partial supply awaiting further supply; Pilot, countries allocated vaccines to continue in the WHO-coordinated vaccine piloting program (i.e., MVIP countries). These were determined based on proxy measures of malaria disease burden and of child risk of death. R21 status denotes country-level regulatory status of R21 vaccine. The presence of a black dot in each country indicates that R21 has been licensed in the country. Gavi-eligible countries Burkina Faso (allocated), Ghana (pilot), and Nigeria (not approved) have licensed R21. Nigeria and Tanzania, although being among the four countries that the World Malaria Reports 2022–2023 identified as having accounted for just over half of all malaria deaths in 2021–2022, were not approved for Gavi support for priority allocation for 2023–2025. Data sources: [1, 6, 8,9,10]