Source: The Conversation – Africa (2)
Africa has reached an important moment in its immunisation journey. Coverage is not rising fast enough to keep pace with population growth, persistent inequities and a growing number of vaccines. At the same time, outbreaks and financing pressures are intensifying.
Vaccination has transformed child survival. A landmark analysis found that global immunisation efforts have saved at least 154 million lives over the past 50 years, 52 million in Africa. Vaccines have virtually eliminated meningitis A epidemics and eradicated wild poliovirus from Africa.
But progress has slowed. In 2025, about 7.1 million African children (15.6% of those under a year old) did not receive even a single routine vaccine dose. Measles and other vaccine-preventable disease outbreaks are increasing, driven by immunity gaps, conflict, displacement and vaccine hesitancy. Meanwhile, donor budgets are under pressure from competing global crises. And rising debt-service costs are squeezing government spending on health.
Against this backdrop, the Africa Centres for Disease Control and Prevention (Africa CDC) has launched the Continental Immunisation Strategy 2026-2030. It covers six areas:
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financing and political commitment
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data and digital systems
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life-course vaccination integrated with primary healthcare
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community engagement
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vaccine manufacturing and supply
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emergency preparedness and epidemic-ready immunisation systems.
We are immunisation practitioners, researchers and advisers who contributed to the strategy’s development and now support its implementation. We identify five priorities that apply to all these six areas. They are:
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sustainable domestic financing
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fit-for-purpose digital systems
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integration with primary healthcare
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genuine community partnership
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vaccine sovereignty linked to epidemic preparedness.
1. Put sustainable domestic financing at the centre
The greatest threat to immunisation in Africa is not whether effective vaccines exist, but whether countries can finance and deliver them reliably. International partners such as Gavi, the Vaccine Alliance, Unicef, and the World Health Organization have helped countries introduce vaccines, procure doses and strengthen delivery systems. That support remains invaluable, but it cannot substitute for predictable national budgets.
The fiscal squeeze is real. Governments must service debt while also responding to food insecurity, climate shocks and conflict, and financing education, infrastructure and other essential health services. Growing populations increase the number of children who need routine vaccines. Every interest payment reduces the funding available for vaccines, cold-chain equipment, transport and health workers.
We argue for using scarce resources better. Immunisation is a best buy that returns about US$54 for every dollar invested. Predictable domestic financing gives countries more control over priorities, makes programmes less vulnerable to donor cycles and strengthens accountability to citizens.
2. Use digital technology to reach every person who needs vaccines
Many programmes still rely on paper registers kept by health workers. These records are increasingly ill-suited to highly mobile populations, expanding vaccine schedules and the need to identify missed individuals quickly. Digital systems can help solve these practical problems.
Electronic immunisation registries linked, with privacy safeguards, to birth registration and national health-information platforms can show who received which vaccine (or missed a dose) and improve stock management. Rwanda, for example, integrated its vaccine registry with electronic birth systems in 2022.
Better data can improve efficiency and accountability.
3. Make immunisation part of resilient primary healthcare
The original Expanded Programme on Immunisation was designed primarily to protect infants against a few childhood diseases, often through fixed health facilities and periodic outreach. Today’s realities are different. Africa has a rapidly growing and urbanising population; vaccine schedules now include adolescents, pregnant women and adults.
Vaccination should therefore become a routine part of primary healthcare throughout life. The Immunisation Agenda 2030 supports expanding vaccination across the life course and linking it with other essential services.
Community health workers are especially important to connect families with services. Nigeria’s community health influencer programme, for example, identifies zero-dose children and links them to healthcare services.
4. Build trust through genuine community engagement
Immunisation programmes succeed when people trust the vaccines, the health workers who provide them and the institutions running the programme.
People are more likely to accept vaccines when they feel respected, listened to and involved. Religious leaders, traditional authorities, teachers, civil-society organisations, youth groups and community health workers can all help.
In Sierra Leone’s Kailahun District, rumours that HPV vaccination caused infertility led parents to refuse consent and girls to avoid school. Health teams listened to concerns and worked through trusted local voices to rebuild confidence. In northern Nigeria, traditional and religious leaders have similarly helped vaccination teams address rumours and identify missed children.
Trust is built through consistent service quality and partnership; it cannot be manufactured during an emergency.
5. Strengthen Africa’s vaccine sovereignty and epidemic preparedness
COVID exposed Africa’s dependence on imported products and the vulnerability of global supply chains. The continent still imports about 99% of the vaccines it uses. The Continental Immunisation Strategy therefore supports the African Union’s ambition to produce 60% of Africa’s vaccine needs locally by 2040.
Africa is not starting from zero. Existing or expanding capabilities include the Institut Pasteur de Dakar in Senegal, Biovac and Aspen Pharmacare in South Africa, and manufacturers in Egypt and Tunisia. But sustainable manufacturing requires predictable demand, pooled procurement, technology transfer, skilled workforces, strong regulators and access to regional markets.
Reliable continental supply is most valuable when countries can quickly identify a threat, decide how vaccines should be used and deliver them equitably across borders.
Looking ahead
The Continental Immunisation Strategy already recognises these priorities. The task now is to come up with costed national plans, clear responsibilities, measurable milestones and transparent annual reporting. Governments must lead, while development partners align their support behind country priorities.
Success will be measured by whether a child in a remote village, an adolescent in an informal settlement, a pregnant woman in a fragile setting and an older person at risk can receive the vaccines they need, when they need them.
The continent will have stronger health systems, greater resilience to outbreaks and healthier populations able to contribute fully to Africa’s development.
This article was co-authored by Dr Folake Olayinka and Dr Chris Ngwa Akonwi.
Charles Shey Wiysonge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.