The R21/Matrix-M malaria vaccine demonstrated 74–77% efficacy against clinical malaria in African children aged 5–36 months in a Phase IIb trial across four Sub-Saharan African countries. This study presents 18-month follow-up data from 4,800 participants. Efficacy was sustained at 71.9% (95% CI: 66.8–76.3%) with a favorable safety profile. These findings support WHO recommendation for widespread deployment and suggest this vaccine may significantly reduce the 627,000 annual malaria deaths.