In contrast to the highly efficient immune response to a single smallpox vaccination, which generates long-lived (>50 years) MBCs in nearly all vaccinees [34], a remarkably high proportion of adults in the present study did not have detectable AMA1- or MSP1-specific MBCs despite annual exposure to 50–60 infective mosquito bites per person per month at the height of the malaria season [17], similar to what Dorfman et al. observed in a cross-sectional study in Kenya [35]. Here, ATAD1 is linked to smallpox.