The world’s first malaria vaccine is seeing its first large-scale rollout in Malawi, according to BBC News. The program is aiming to vaccinate 120,000 children under the age of two, and the vaccine will soon see pilot programs in Ghana and Kenya as well.

All three countries face high rates of malaria despite running large programs in place to combat the disease.

Trials of the vaccine have shown that it protects about 40 percent of children between the ages of 5 and 17 months. Globally, malaria kills 435,000 people annually, and disproportionately affects children. It’s decades-long decline has also stalled, with increases in some countries.

“We’re no longer seeing a decrease in malaria as we were over the past few years,” according to the World Health Organization’s (WHO) Global Malaria Programme senior advisor Alistair Robb.

Speaking to BBC News, the WHO Director of Immunization and Vaccines, Dr. Kate O’Brien called the program “a landmark moment for immunizations, malaria control, and public health,” and noted that malaria is “a really difficult disease to develop a vaccine against.”

The vaccine was created in 1987, by GlaxoSmithKline, and has since faced three decades of tests costing about $1 billion. While the 40 percent prevention rate compares poorly with other vaccines, it will be used in conjunction with other prevention measures like bed nets and insecticides, since the malaria parasite is spread through mosquito bites.

“It may not sound like much but we’re talking about 40% reduction in severe malaria which unfortunately still has high mortality even when you have good access to good treatment,” according to Dr. David Schellenberg, who has worked with the WHO to develop the vaccine.

Manufacturing a vaccine for parasites like malaria presents a different challenge than with viruses and bacteria, according to NPR. Many have developed more advanced ways of getting around our immune defenses.

Called RTS,S, the vaccine is administered once a month for three months, and then one more time 18 months later. Multiple trips to a clinic may prove difficult for some families in rural areas. Protection lasts for at least seven years, according to Schellenberg.

This phase of trial is set to be completed by 2023, aiming to vaccinate a total of 360,000 children. According to the WHO’s malaria report released last year, 92 percent of cases occur in Africa. In countries that have seen a decline in recent years, such as India, Pakistan, and Ethiopia, efforts to reach marginalized populations with drugs and bed nets have proven successful.

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