Malaria killed over 600,000 people in 2022, a death toll that has not improved since 2015. Additionally, parasites and mosquitoes resistant to existing interventions are spreading across Africa and other regions. Vaccines offer hope to reduce the mortality burden: the first licensed malaria vaccines, RTS,S and R21, will be widely deployed in 2024 and should substantially reduce childhood deaths. In this Review, we provide an overview of the malaria problem and the Plasmodium parasite, then describe the RTS,S and R21 vaccines (the first vaccines for any human parasitic disease), summarizing their benefits and limitations. We explore next-generation vaccines designed using new knowledge of malaria pathogenesis and protective immunity, which incorporate antigens and platforms to elicit effective immune responses against different parasite stages in human or mosquito hosts. We describe a decision-making process that prioritizes malaria vaccine candidates for development in a resource-constrained environment. Future vaccines might improve upon the protective efficacy of RTS,S or R21 for children, or address the wider malaria scourge by preventing pregnancy malaria, reducing the burden of Plasmodium vivax or accelerating malaria elimination.

疟疾在 2022 年导致超过 600,000 人死亡，自 2015 年以来，死亡人数一直没有改善。此外，对现有干预措施有抵抗力的寄生虫和蚊子正在非洲和其他地区蔓延。疫苗为减轻死亡负担带来了希望：第一批获得许可的疟疾疫苗 RTS、S 和 R21 将于 2024 年广泛部署，应会大幅减少儿童死亡。在这篇综述中，我们概述了疟疾问题和疟原虫寄生虫，然后描述了 RTS、S 和 R21 疫苗（针对任何人类寄生虫病的第一批疫苗），总结了它们的好处和局限性。我们探索利用疟疾发病机制和保护性免疫的新知识设计的下一代疫苗，这些疫苗结合了抗原和平台，以引发针对人类或蚊子宿主不同寄生虫阶段的有效免疫反应。我们描述了一个决策过程，该过程优先考虑在资源受限的环境中开发疟疾候选疫苗。未来的疫苗可能会提高 RTS、S 或 R21 对儿童的保护效果，或通过预防妊娠疟疾、减轻间日疟原虫的负担或加速消除疟疾来解决更广泛的疟疾祸害。