The Four-Dose Protocol and Implementation Challenges
In 2026, the standard WHO-recommended schedule remains a four-dose regimen.
The primary series of three doses begins at five months of age, with a critical fourth dose administered 12 to 18 months later to maintain long-term protection. Some regions with highly seasonal transmission are now experimenting with a fifth dose to sustain immunity through a third or fourth rainy season. While the medical efficacy is proven, the logistical challenge in 2026 remains the "dropout rate" between the third and fourth doses. Community health programs are now focusing on mobile health (mHealth) reminders and integrating malaria shots with other routine childhood immunizations to ensure that the most vulnerable children receive the full course of protection.