Bridget Farham

Background: At the end of each year, stakeholders of the Essential Immunization Programme (EPI) in the DR Congo meet to review progress made and lessons learned from the implementation of the Annual Operational Plan (AOP) and to set priorities for the following year. This paper presents a conference report that summarizes the main outcomes of the 2025 annual review meeting, which took place from 15 to 20 December 2025, and attracted 76 participants. Conference takeaways: While the 2024 WUENIC data show that the DR Congo is off-track for the 2030 Immunization agenda targets for all antigens, the administrative coverages were reported as optimal in 2025. EPI activities are planned based on administrative coverages, likely overestimated. In 2025, 47% of health zones in North-Kivu, South-Kivu and Ituri (49 out of 104) were fully or partially controlled by armed groups, leading to partial disruptions of immunization service delivery. In 2025, the DR Congo successfully launched the measles–rubella vaccine introduction preceded by a catch-up vaccination campaign in children aged from 6 months to 14 years old and continued to roll out malaria vaccines using a phased approach. Conclusions: Learning from the implementation of the 2025 AOP, the EPI stakeholders adopted a set of priority actions for the immunization programme in 2026.

Background: Since 1974, Essential Programme on Immunisation managers from ten Central African countries meet yearly with partners to review progress made and share experiences and lessons learned from the implementation of immunization programmes. The 2024 meeting occurred in Kinshasa, Democratic Republic of Congo, in September 2024. This conference report summarizes the key takeaways from discussions on using immunization data for decision-making, the implementation of the Big Catch-Up (BCU) initiative to reduce the burden of zero-dose children, and progress and challenges in introducing selected new vaccines. Conference Takeaways: Inaccurate administrative data on routine immunization observed in most countries, compared to WHO/UNICEF Estimates of National Immunization Coverage and national survey estimates, affect timely decisions to improve the Expanded Programme on Immunization (EPI) performance. Five countries in Central Africa are among the priority countries of the BCU initiative but, as of the end of August 2024, are yet to formally start its implementation. Cameroon and Central African Republic introduced the malaria vaccine in January 2024 and August 2024, respectively, while the Democratic Republic of Congo, Chad, and Burundi have planned to do so by 2025. Conclusions and Recommendations: Meeting participants put forward several recommendations for countries and immunization partners, including but not limited to (i) investing more in routine immunization data quality assurance to better use data to inform decisions, (ii) accelerating the implementation of the BCU initiative to close the immunity gap resulting from routine immunization disruptions due to the COVID-19 pandemic, (iii) updating malaria vaccine introduction plans to invest more in demand generation and community engagement, and (iv) learning from Cameroon’s experience in tackling hesitancy to human papilloma virus vaccine. It is critical to set up an appropriate mechanism for monitoring the implementation of these recommendations.

Background/Objectives: The Addis Declaration on Immunization (ADI) is a historic pledge aiming at increasing political will to achieve universal access to immunization services and includes ten commitments to shape the future of immunization in Africa. Methods: To analyze African countries’ performance in achieving the fourth ADI commitment, a cross-sectional retrospective study was conducted including the 54 African Member States of the World Health Organization (WHO) out of 55 African Union (AU) Member States. The fourth ADI commitment aims at increasing the effectiveness and efficiency of immunization delivery systems and has four performance indicators. Results: The median percentage of districts with less than 10% of dropout rate between the first dose of diphtheria–tetanus–pertussis-containing vaccine (DTP1) and the third dose (DTP3) was 86.5%, ranging from 22% to 100%. Thirty-four countries (63%) recorded 80% or above of districts with less than 10% dropout rate between DTP1 and DTP3. Eleven countries (20.3%) and ten countries (18.5%) sustained 90% or above coverage for DTP3 and first dose of measles-containing vaccine (MCV1), respectively, in the past three years (2021–2023). Four countries (7.4%) had 44.5 skilled health workers per 10,000 people. Out of the 54 WHO Member States, 7 achieved at least three of the four indicators of the fourth ADI commitment (13%). Conclusions: It is critical, as a follow up to this study, to document best practices from the seven countries that achieved the fourth ADI commitment. Additionally, a deeper analysis of factors associated with achieving the ADI commitments is required.

To analyze African countries’ performance in achieving the fourth ADI commitment of the Addis Declaration on Immunization (ADI), a cross-sectional retrospective study was conducted including the 54 African Member States of the World Health Organization (WHO) out of 55 African Union (AU) Member States. The fourth ADI commitment aims at increasing the effectiveness and efficiency of immunization delivery systems and has four performance indicators. The median percentage of districts with less than 10% of dropout rate between DTP1 and DTP3 was 86.5%, ranging from 22% to 100%. Thirty-four countries (63%) recorded 80% or above districts with less than 10% dropout rate between DTP1 and DTP3. Eleven countries (20.3%) and 10 countries (18.5%) sustained 90% or above coverage for DTP3 and MCV1, respectively, in the past three years (2021-2023). Four countries (7.4%) had 44.5 skilled health workers per 10,000 people. Out of the 54 WHO Member States, seven achieved at least three of the four indicators of the fourth ADI commitment. It is critical, as a follow-up to this study, to document best practices from these seven countries that achieved the fourth ADI commitment. Additionally, a deeper analysis of factors associated with achieving the ADI commitments is required.

Cameroon introduced the malaria vaccine in its routine immunization program on 22 January 2024 in the 42 districts out of 200 that are among the most at risk of malaria. A cross-sectional analysis of the data on key vaccine events in the introduction roadmap and the vaccine uptake during the first 30 days was conducted. In addition to available gray literature related to the introduction of the malaria vaccine, data on the malaria vaccine uptake by vaccination session, collected through a digital platform, were analyzed. A total of 1893 reports were received from 22 January 2024 to 21 February 2024 from 766 health facilities (84% of overall completeness). Two regions out of ten recorded less than 80% completeness. As of 21 February 2024, 13,811 children had received the first dose of the malaria vaccine, including 7124 girls (51.6%) and 6687 boys (48.4%). In total, 36% of the children were vaccinated through outreach sessions, while 61.5% were vaccinated through sessions in fixed posts. The overall monthly immunization coverage with the first dose was 37%. Early results have shown positive attitudes towards and acceptance of malaria vaccines. Suboptimal completeness of data reporting and a low coverage highlight persistent gaps and challenges in the vaccine rollout.

Cameroon introduced the malaria vaccine in its routine immunization programme on 22 January 2024, in the 42 districts out of 200, among the most at risk of malaria. A cross-sectional analysis of data on vaccine key events in the introduction roadmap and vaccine uptake during the first 30 days was conducted. In addition to available gray literature related to the introduction of the malaria vaccine, data on malaria vaccine uptake by vaccination session, collected through a digital platform, were analyzed. A total of 1,893 reports were received from 22 January 2024 to 21 February 2024 from 766 health facilities (85% of overall completeness). Two regions out of 10 recorded less than 80% of completeness. As of 21 February 2024, 13,811 children have received the first dose of the malaria vaccine, including 7,124 girls (51.6%) and 6,687 boys (48.4%). Thirty six percent of children were vaccinated through outreach sessions versus 61.5% through sessions in fixed posts. The overall monthly immunization coverage with the first dose was 37%. Early results have shown positive attitudes towards and acceptance of malaria vaccines. Suboptimal completeness of data reporting and low coverage highlight persistent gaps and challenges in vaccine rollout.

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria–tetanus–pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region, disrupted by the COVID-19 pandemic. In 2022, the coverage with the first and third dose of diphtheria-tetanus-pertussis containing vaccine (DTP1 and DTP3 respectively) and with the first dose of measles-containing vaccine (MCV1), in the region, was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose were recorded (19.0% of target population). Ten countries of the region accounted for 80.3% of all zero-dose children including the four most populous countries (Nigeria, Ethiopia, Democratic Republic of the Congo, United Republic of Tanzania). Reported administrative coverage greater than WUENIC was found in 19 countries, highlighting routine immunization data quality issues. The WHO African region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for Governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching-up on vaccination of zero-dose and un-der-vaccinated children and improving data quality.

This study summarizes progress made in rolling out COVID-19 vaccinations in the African region in 2022, and analyzes factors associated with vaccination coverage. Data on vaccine uptake reported to the World Health Organization (WHO) Regional Office for Africa by Member States between January 2021 and December 2022, as well as publicly available health and socio-economic data, were used. A negative binomial regression was performed to analyze factors associated with vaccination coverage in 2022. As of the end of 2022, 308.1 million people had completed the primary vaccination series, representing 26.4% of the region’s population, compared to 6.3% at the end of 2021. The percentage of health workers with complete primary series was 40.9%. Having carried out at least one high volume mass vaccination campaign in 2022 was associated with high vaccination coverage (β = 0.91, p < 0.0001), while higher WHO funding spent per person vaccinated in 2022 was correlated with lower vaccination coverage (β = −0.26, p < 0.03). All countries should expand efforts to integrate COVID-19 vaccinations into routine immunization and primary health care, and increase investment in vaccine demand generation during the transition period that follows the acute phase of the pandemic.