[Comment] A safe start for PfSPZ Vaccine, but efficacy in children remains elusive

Malaria is a major global health challenge, especially in sub-Saharan Africa. In 2023 alone, malaria caused about 597 000 deaths worldwide, mostly in children.1 A safe and effective vaccine for children is therefore a top global health priority. In this issue of The Lancet Infectious Diseases, Selidji T Agnandji and colleagues2 report a randomised, double-blind, placebo-controlled, phase 2 trial evaluating the safety, tolerability, and efficacy of a radiation-attenuated Plasmodium falciparum sporozoite (PfSPZ) vaccine in children aged 1–12 years in Gabon.