Lassa fever has been estimated to cause 5,000 deaths annually in West Africa. Recently, war in the zone where Lassa fever is hyperendemic has severely impeded control and treatment. Vaccination is the most viable control measure. There is no correlation between antibody levels and outcome in human patients, and inactivated vaccines produce high titers of antibodies to all viral proteins but do not prevent virus replication and death in nonhuman primates. Accordingly, we vaccinated 44 macaques with vaccinia virus-expressed Lassa virus structural proteins separately and in combination, with the object of inducing a predominantly TH1-type immune response. Following Lassa virus challenge, all unvaccinated animals died (0% survival). Nine of 10 animals vaccinated with all proteins survived (90% survival). Although no animals that received full-length glycoprotein alone had a high titer of antibody, 17 of 19 survived challenge (88%). In contrast, all animals vaccinated with nucleoprotein developed high titers of antibody but 12 of 15 died (20% survival). All animals vaccinated with single glycoproteins, G1 or G2, died, but all those that received both single glycoproteins (G1 plus G2) at separate sites survived, showing that both glycoproteins are independently important in protection. Neither group had demonstrable antibody levels prior to challenge. We demonstrate that in primates, immune responses to epitopes on both glycoproteins are required to protect against lethal challenge with Lassa virus without having untoward side effects and that this protection is likely to be primarily cell mediated. We show that an effective, safe vaccine against Lassa virus can and should be made and that its evaluation for human populations is a matter of humanitarian priority.Lassa virus is endemic in rural West Africa. The prevalence of antibody to Lassa virus ranges from 5% in Guinea and 15 to 20% in Sierra Leone and Liberia to over 20% in Nigeria (7,30). Lassa fever has been estimated to cause from 100,000 to 300,000 infections a year and several thousand deaths (30). The fatality rate for hospitalized patients is about 17%, but in certain groups of patients, such as pregnant women in their third trimester, more than 30% may die, and fetal or neonatal loss is about 88% (34). Deafness is a common complication of Lassa fever, affecting as many as 15% of patients and rendering an estimated 1 to 2% of the population hearing impaired in areas with high rates of infection (11). Treatment with intravenous ribavirin has been shown to be effective; however, it is not widely available in the areas where the disease is endemic and must be administered in the first week of illness for optimal efficacy (28). Recently, social and economic conditions have deteriorated in areas of high endemicity of eastern Sierra Leone and Liberia, and incidence and mortality have increased (R. Allan, R. Ladbury, K. Skinner, and S. Mardel, Abstr. Int. Conf. Emerg. Infect. Dis., abstr. 16, p. 21, 1998).Lassa virus, an arenavirus, exhibits persistent, asymptomat...