There is a growing realization of the limitations of recombinant protein-based malaria vaccines. This, coupled with a better understanding of the protective immunity to malaria, both in animal models and in naturally exposed human populations and experimentally infected volunteers, as well as the increased capacity to manipulate parasites provides new impetus to evaluate whole blood stage parasite approaches to malaria vaccine development. In this review previous studies in rodents and primates of whole killed and attenuated blood stage vaccines, and recent work on the effect of genetically attenuated parasites on immunity in rodent models of blood stage immunity are discussed. The relationship between these findings and what is now known about protective immunity in human populations, specifically against the blood stages of the parasite lifecycle is discussed and recent findings from human experimental infection are be reviewed. Finally, the prospect for and impediments to the development whole blood stage parasites are reviewed.