Advancing Immunization in Africa: Overcoming Challenges to Achieve the 2030 Global Immunization Targets

"To enhance vaccination coverage in Africa, it is essential to implement community-level strategies."

The Immunization Agenda 2030 (IA2030) was endorsed by all World Health Organization (WHO) member states in August 2020 to ensure universal access to vaccines and improve health and well-being. IA2030 emphasises: tailored implementation, country ownership, partnerships, and data-driven decision-making; integrating immunisation into primary healthcare services; addressing inequities and gender-related barriers; and promoting global commitment and accountability for better health outcomes. Despite progress, achieving the global immunisation target for 2030 in Africa remains a challenge, having been met by only a few countries. This review provides an overview of the current status of immunisation efforts in Africa, highlights key challenges, and offers recommendations to help the continent achieve IA2030. 

Africa continues to face substantial challenges, with approximately 67 million children either partially or completely missing routine vaccinations between 2019 and 2021. In West and Central Africa, this number is as high as 19.5 million children. The decline in immunisation rates underscores a deep issue of inequality, disproportionately affecting marginalised communities. Many of the unvaccinated children belong to mothers who have limited education and lack decision-making power within their families.

As outlined here, several factors contribute to the low immunisation rates in Africa, with religion being one of the most significant. Religion is deeply embedded in African societies, and some religious beliefs perceive immunisation as a threat to life. Illiteracy further compounds the issue, as some parents lack an understanding of the healthcare system and its benefits. They may prefer locally trained caregivers to health workers, believing that a mixture of traditional drinks is more efficient than vaccines.

Community-related factors that affect immunisation in Africa include disagreements over vaccine acceptance, distance to immunisation centres, exposure to mass media, limited knowledge regarding the benefits of immunisation, and concerns about vaccination causing discomfort or pain in children. Furthermore, environmental factors, such as the distance to the healthcare facilities, mode of transportation, ease of access to vaccination sites, satisfaction with vaccine services, the quality of the vaccine provider-client relationship, and availability of the vaccine, also play critical roles in determining immunisation rates.

Numerous studies have established a strong connection between healthcare worker density and immunisation coverage. However, addressing the shortage of healthcare workers remains a challenge for public health stakeholders and governments alike. These solutions require significant investments in training, retention, and the development of healthcare workers. Moreover, merely making health services available to communities does not guarantee health-seeking behaviour, as vaccine hesitancy is a global issue, with over 90% of countries reporting encountering vaccine hesitancy for a variety of reasons.

Addressing barriers such as limited parental education, religious beliefs, inadequate healthcare systems, and vaccine hesitancy requires community-driven approaches like door-to-door campaigns and mobile clinics. This call is in keeping with the IA2030 strategy, which emphasises the importance of innovative technologies and strategies to improve immunisation programmes by addressing local needs and enhancing service delivery. These efforts should be designed to prioritise equity, strengthen systems, overcome bottlenecks, involve new products, implement research, and address managerial, socio-behavioural, financial, and communication challenges.

Achieving the IA2030 goals in Africa requires collaborative efforts to ensure equitable access to vaccines, address sociocultural challenges, and strengthen health system infrastructure. "Governments, international organizations, and civil society groups must work together to identify and address barriers to full vaccination and ensure that all children have access to life-saving vaccines."

Full list of authors, with institutional affiliations: Olalekan John Okesanya, University of Thessaly; Gbolahan Olatunji, University of Ilorin; Noah Olabode Olaleke, Obafemi Awolowo University Teaching Hospital Complex; Mba Oluebube Mercy, David Umahi Federal University Teaching Hospital; Ayodele O Ilesanmi, Oyo State Hospital Management Board; Hassan Hakeem Kayode, Chrisland University; Emery Manirambona, University of Rwanda; Mohamed Mustaf Ahmed, SIMAD University; Bonaventure Michael Ukoaka, Asokoro District Hospital; Don Eliseo Lucero-Prisno III, London School of Hygiene and Tropical Medicine, Biliran Province State University, and Southern Leyte State University