{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:10:38Z","timestamp":1793214638519,"version":"4.5.0"},"reference-count":112,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vaccines are instrumental in promoting preventive health and improving health outcomes globally. However, stark inequities in vaccine production, distribution, and access disproportionately burden low and middle-income countries (LMICs), which suffer significantly from these disparities. The COVID-19 pandemic further reinforced these existing inequities, prompting renewed debates on scaling up Africa's research and development (R&amp;amp;D) capacity as a proactive approach to enhance very limited domestic vaccine production and counter persistent inequities. However, there has been no consolidated review of the policy, legal, and governance frameworks that shape this capacity and their implications for vaccine equity. This rapid review asked which policy, legal, governance, and investment frameworks influence vaccine R&amp;amp;D and manufacturing capacity in African countries, and how they affect the continent's ability to secure equitable access to vaccines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a PRISMA guided rapid review of peer-reviewed and grey literature. Searches were conducted in Academic Search Premier, Business Source Premier, CINAHL via EBSCOhost, EconLit, Embase, and Ovid Medline via OVID Platform, as well as Google Scholar databases. Eligible documents reported on African vaccine R&amp;amp;D, manufacturing, or related policy, legal, governance, or investment frameworks. Grey literature was identified from the WHO, the World Bank, the Africa CDC, government organizations, private institutions, and policy think tanks. Data was extracted using a structured template and synthesized narratively into thematic areas that aligned with the study objectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>From 18,038 records, 68 publications met the inclusion criteria. We identified twelve active vaccine manufacturers in Africa and eleven additional initiatives in development, with the majority focusing on fill-and-finish operations and relatively few investing in upstream R&amp;amp;D and drug substance manufacturing. Persistent under-investment in vaccine R&amp;amp;D, fragmented and weak regulatory systems, and dependence on external financing constrain sustainable local manufacturing. Global and regional instruments, including the TRIPS Agreement, the Doha Declaration, ACT-A\/COVAX, and the Pandemic Influenza Preparedness (PIP) Framework, create opportunities for technology transfer and impose intellectual property and supply-chain barriers that limit expansion of African vaccine R&amp;amp;D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Africa has the capacity to produce vaccines and related health products. However, this potential is undermined by structural under-investment in R&amp;amp;D, constrained access to technologies and inputs, and weak coordination of policy and regulatory frameworks. Strengthening domestic R&amp;amp;D financing, enhancing regional regulatory and policy harmonization, and proactively engaging in IP and trade negotiations, alongside strategic public-private and product development partnerships, are critical to achieving vaccine equity for African populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1678143","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:36:14Z","timestamp":1785821774000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Vaccine equity in Africa: a rapid review of policy, legal and governance frameworks to improve research and development"],"prefix":"10.3389","volume":"6","author":[{"given":"John Ele-Ojo","family":"Ataguba","sequence":"first","affiliation":[{"name":"African Health Economics and Policy Association (AfHEA)","place":["Accra, Ghana"]},{"name":"Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba","place":["Winnipeg, MB, Canada"]},{"name":"Partnership for Economic Policy (PEP)","place":["Nairobi, Kenya"]},{"name":"School of Health Systems and Public Health, University of Pretoria","place":["Pretoria, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace Njeri","family":"Muriithi","sequence":"additional","affiliation":[{"name":"African Health Economics and Policy Association (AfHEA)","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Malik","family":"Achala","sequence":"additional","affiliation":[{"name":"African Health Economics and Policy Association (AfHEA)","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Naa Adukwei","family":"Adote","sequence":"additional","affiliation":[{"name":"African Health Economics and Policy Association (AfHEA)","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chijioke Osinachi","family":"Nwosu","sequence":"additional","affiliation":[{"name":"Department of Economics and Finance, University of the Free State","place":["Bloemfontein, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senait Alemayehu","family":"Beshah","sequence":"additional","affiliation":[{"name":"Health System and Research Directorate, Ethiopian Public Health Institute","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias Asfaw","family":"Zegeye","sequence":"additional","affiliation":[{"name":"Division of Health Economics and Financing, Africa Centers for Disease Control and Prevention","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadima Inna Kamina","family":"Yaya Bocoum","sequence":"additional","affiliation":[{"name":"Institut de Recherche en Sciences de la Sant\u00e9","place":["Ouagadougou, Burkina Faso"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jemima","family":"Sumboh","sequence":"additional","affiliation":[{"name":"University of York, Hull York Medical School","place":["York, United Kingdom"]},{"name":"Department of Health Policy, Planning and Management, School of Public Health, University of Ghana","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Setshegetso","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Botswana","place":["Gaborone, Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Yakhelef","sequence":"additional","affiliation":[{"name":"Division of Health Economics and Financing, Africa Centers for Disease Control and Prevention","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Muhwava","sequence":"additional","affiliation":[{"name":"United Nations Economic Commission for Africa, Demographic and Social Statistics Section, African Centre for Statistics","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1080\/21645515.2018.1522921","article-title":"Special focus on challenges and opportunities for the development and use of vaccines in Africa","volume":"14","author":"Madhi","year":"2018","journal-title":"Hum Vaccin Immunother"},{"key":"B2","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.vaccine.2021.11.005","article-title":"Child vaccination in sub-saharan Africa: increasing coverage addresses inequalities","volume":"40","author":"Bobo","year":"2022","journal-title":"Vaccine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1016\/S0140-6736(24)00850-X","article-title":"Contribution of vaccination to improved survival and health: modelling 50 years of the expanded programme on immunization","volume":"403","author":"Shattock","year":"2024","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S452","DOI":"10.1093\/infdis\/jiab284","article-title":"The world of immunization: achievements, challenges, and strategic vision for the next decade","volume":"224","author":"Lindstrand","year":"2021","journal-title":"J Infect Dis"},{"key":"B5","year":""},{"key":"B6","doi-asserted-by":"publisher","first-page":"126829","DOI":"10.1016\/j.vaccine.2025.126829","article-title":"Advancing local manufacturing capacities for vaccines within Africa \u2013 opportunities, priorities and challenges","volume":"50","author":"Doua","year":"2025","journal-title":"Vaccine"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4050","DOI":"10.1016\/j.vaccine.2023.05.009","article-title":"Building global vaccine manufacturing capacity: spotlight on Africa","volume":"41","author":"Rubin Thompson","year":"2023","journal-title":"Vaccine"},{"key":"B8","year":""},{"key":"B9","doi-asserted-by":"publisher","first-page":"585354","DOI":"10.3389\/fimmu.2020.585354","article-title":"A review of the progress and challenges of developing a vaccine for COVID-19","volume":"11","author":"Sharma","year":"2020","journal-title":"Front Immunol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1016\/j.immuni.2021.06.017","article-title":"COVID-19 vaccine access in Africa: global distribution, vaccine platforms, and challenges ahead","volume":"54","author":"Massinga Loemb\u00e9","year":"2021","journal-title":"Immunity"},{"key":"B11","year":"2022"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e1003948","DOI":"10.1371\/journal.pmed.1003948","article-title":"Vaccine equity: a fundamental imperative in the fight against COVID-19","volume":"19","year":"2022","journal-title":"PLoS Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e076335","DOI":"10.1136\/bmj-2023-076335","article-title":"Updated recommendations for the cochrane rapid review methods guidance for rapid reviews of effectiveness","volume":"384","author":"Garritty","year":"2024","journal-title":"Br Med J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1000100","DOI":"10.1371\/journal.pmed.1000100","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"6","author":"Liberati","year":"2009","journal-title":"PLoS Med"},{"key":"B16","author":"Gennari","year":"2021"},{"key":"B17","volume-title":"Vaccine Manufacturing in Africa: What It Takes and why It Matters","author":"Abiodun","year":"2021"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e1983","DOI":"10.1016\/S2214-109X(25)00314-6","article-title":"A landscape analysis of the vaccine ecosystem in Africa: research and development funding, clinical trials, regulation, and manufacturing readiness","volume":"13","author":"Fleck-Vidal","year":"2025","journal-title":"Lancet Glob Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s44155-026-00364-z","article-title":"Building equitable and sustainable vaccine ecosystems in Africa to achieve health sovereignty and universal immunization by 2040","volume":"6","author":"Okesanya","year":"2026","journal-title":"Discov Soc Sci Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s44337-025-00313-w","article-title":"Building vaccine and biotherapeutics manufacturing capacity in Africa: a practical approach","volume":"2","author":"Haakuria","year":"2025","journal-title":"Discov Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2560209","DOI":"10.1080\/16549716.2025.2560209","article-title":"Operationalizing African self-reliance in vaccine manufacturing","volume":"18","author":"Mwila","year":"2025","journal-title":"Glob Health Action"},{"key":"B22","year":"1995"},{"key":"B23","first-page":"263","article-title":"Intellectual property barriers to access to COVID-19 health products in South Africa","volume":"2021","author":"Vawda","year":"2021","journal-title":"South African Health Review"},{"key":"B24","author":"Ranjan","year":"2021"},{"key":"B25","first-page":"47","article-title":"TRIPS, pharmaceuticals, developing countries, and the Doha \u201csolution.\u201d","volume":"3","author":"Sykes","year":"2002","journal-title":"Chic J Int Law"},{"key":"B26","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/jwip.12198","article-title":"TRIPS Waiver of COVID-19 vaccines: impact on pharmaceutical industry and what it means to developing countries","volume":"24","author":"Chaudhary","year":"2021","journal-title":"J World Intellect Prop"},{"key":"B27","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1017\/S0008197322000241","article-title":"Addressing vaccine inequity during the COVID-19 pandemic: the trips intellectual property waiver proposal and beyond","volume":"81","author":"Thambisetty","year":"2022","journal-title":"Camb Law J"},{"key":"B28","first-page":"159","article-title":"Improving access to COVID-19 vaccines: an analysis of TRIPS waiver discourse among WTO members, civil society organizations, and pharmaceutical industry stakeholders","volume":"24","author":"Kohler","year":"2022","journal-title":"Health Hum Rights"},{"key":"B29","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1001\/jama.2021.10823","article-title":"Sharing technology and vaccine doses to address global vaccine inequity and End the COVID-19 pandemic","volume":"326","author":"Kavanagh","year":"2021","journal-title":"JAMA"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0003173","DOI":"10.1371\/journal.pgph.0003173","article-title":"\u2018Our project, your problem?\u2019 A case study of the WHO\u2019s mRNA technology transfer programme in South Africa","volume":"4","author":"Herder","year":"2024","journal-title":"PLOS Global Public Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2504698","DOI":"10.1080\/17441692.2025.2504698","article-title":"Challenges implementing technology transfer as a viable pathway for equitable vaccine production and access: a case study of the mRNA vaccine hub in South Africa","volume":"20","author":"Kolawole","year":"2025","journal-title":"Glob Public Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.3390\/life13091886","article-title":"Africa (COVID-19) vaccine technology transfer: where are we?","volume":"13","author":"Oladipo","year":"2023","journal-title":"Life"},{"key":"B33","doi-asserted-by":"publisher","first-page":"lsaf020","DOI":"10.1093\/jlb\/lsaf020","article-title":"Ensuring vaccine access through local production: the need for a harmonized and sustainable approach","volume":"12","author":"Tsega","year":"2025","journal-title":"J Law Biosci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2256822","DOI":"10.1080\/17441692.2023.2256822","article-title":"Can we move beyond vaccine apartheid? Examining the determinants of the COVID-19 vaccine gap","volume":"18","author":"Forman","year":"2023","journal-title":"Glob Public Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1186\/s12913-025-13211-9","article-title":"Decolonizing global health: africa\u2019s pursuit of pharmaceutical sovereignty","volume":"25","author":"Mulumba","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"B36","year":"2022"},{"key":"B37","year":"2022"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.chom.2021.06.007","article-title":"Global COVID-19 vaccine inequity: the scope, the impact, and the challenges","volume":"29","author":"Asundi","year":"2021","journal-title":"Cell Host Microbe"},{"key":"B39","year":"2022"},{"key":"B40","year":"2020"},{"key":"B41","year":"2023"},{"key":"B42","author":"Chang","year":"2023"},{"key":"B43","doi-asserted-by":"publisher","first-page":"DC37","DOI":"10.1038\/nbt1204supp-DC37","article-title":"South Africa\u2014blazing a trail for African biotechnology","volume":"22","author":"Motari","year":"2004","journal-title":"Nat Biotechnol"},{"key":"B44","year":"2023"},{"key":"B45","doi-asserted-by":"publisher","first-page":"11","DOI":"10.11604\/pamj.supp.2025.51.1.46888","article-title":"Advancing vaccine manufacturing in Africa: a new era for immunisation programmes towards self-sufficiency","volume":"51","author":"Wirsiy","year":"2025","journal-title":"Pan Afr Med J"},{"key":"B46","doi-asserted-by":"publisher","first-page":"7525","DOI":"10.1038\/s41467-025-62839-y","article-title":"Strengthening vaccine capacity building on the African continent","volume":"16","author":"Ndembi","year":"2025","journal-title":"Nat Commun"},{"key":"B47","doi-asserted-by":"publisher","first-page":"6592","DOI":"10.24926\/iip.v16i3.6592","article-title":"Africa\u2019s vaccines manufacturing revolution: lessons from COVID-19, ongoing efforts, and challenges to overcome","volume":"16","author":"Sibomana","year":"2025","journal-title":"Inov Pharm"},{"key":"B48","doi-asserted-by":"publisher","first-page":"e96","DOI":"10.1002\/puh2.96","article-title":"African Medicines agency: how it will change the landscape of medicines in Africa","volume":"2","author":"Ogbodum","year":"2023","journal-title":"Public Health Chall"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.34172\/ijhpm.2024.8070","article-title":"Comparison of three regional medicines regulatory harmonisation initiatives in Africa: opportunities for improvement and alignment","volume":"13","author":"Sithole","year":"2024","journal-title":"Int J Health Policy Manag"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2841","DOI":"10.1098\/rstb.2011.0100","article-title":"Accelerating vaccine development and deployment: report of a royal society satellite meeting","volume":"366","author":"Bregu","year":"2011","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"B51","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3389\/fpubh.2019.00056","article-title":"Vaccine production in Africa: a feasible business model for capacity building and sustainable new vaccine Introduction","volume":"7","author":"Makenga","year":"2019","journal-title":"Front Public Health"},{"key":"B52","year":"2019"},{"key":"B53","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.pt.2015.11.009","article-title":"Malaria vaccine development: focusing field erythrocyte invasion studies on phenotypic diversity","volume":"32","author":"Ahouidi","year":"2016","journal-title":"Trends Parasitol"},{"key":"B54","first-page":"127","article-title":"Regulatory collaboration: the African vaccine regulatory forum (AVAREF): a platform for collaboration in a public health emergency","volume":"29","year":"2015","journal-title":"WHO Drug Information"},{"key":"B55","doi-asserted-by":"publisher","first-page":"e1000293","DOI":"10.1371\/journal.pmed.1000293","article-title":"Developing ANDI: a novel approach to health product R&D in Africa","volume":"7","author":"Nwaka","year":"2010","journal-title":"PLoS Med"},{"key":"B56","year":"2023"},{"key":"B57","year":"2023"},{"key":"B58","year":"2023"},{"key":"B59","author":"Savoy","year":"2021"},{"key":"B60","year":"2023"},{"key":"B61","author":"Cochrane","year":"2016"},{"key":"B62","doi-asserted-by":"publisher","first-page":"010321","DOI":"10.7189\/jogh.10.010321","article-title":"From Africa to the world: reimagining Africa\u2019s research capacity and culture in the global knowledge economy","volume":"10","author":"Olufadewa","year":"2020","journal-title":"J Glob Health"},{"key":"B63","doi-asserted-by":"publisher","first-page":"e001047","DOI":"10.1136\/bmjgh-2018-001047","article-title":"Investing in health R&D: where we are, what limits US, and how to make progress in Africa","volume":"4","author":"Simpkin","year":"2019","journal-title":"BMJ Glob Health"},{"key":"B64","doi-asserted-by":"publisher","first-page":"274","DOI":"10.7196\/SAMJ.2020.v110i4.14349","article-title":"National expenditure on health research in South Africa: how has the landscape changed in the past decade?","volume":"110","author":"Barnab\u00e9","year":"2020","journal-title":"S Afr Med J"},{"key":"B65","year":""},{"key":"B66","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/14760584.2021.1886085","article-title":"Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis","volume":"20","author":"Bianchi","year":"2021","journal-title":"Expert Rev Vaccines"},{"key":"B67","doi-asserted-by":"publisher","first-page":"e069316","DOI":"10.1136\/bmjopen-2022-069316","article-title":"Vaccine coverage for recommended vaccines among splenectomised patients in apulia, south Italy: a retrospective cohort study","volume":"13","author":"Bianchi","year":"2023","journal-title":"BMJ Open"},{"key":"B68","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1111\/bjh.18731","article-title":"Burden of COVID-19 disease and vaccine coverages in apulian splenectomized patients: a retrospective observational study","volume":"201","author":"Bianchi","year":"2023","journal-title":"Br J Haematol"},{"key":"B69","doi-asserted-by":"publisher","first-page":"4057","DOI":"10.1016\/j.vaccine.2023.04.047","article-title":"Prevalence of poliovirus neutralizing antibodies in Italian population: a systematic review and meta-analysis","volume":"41","author":"Tafuri","year":"2023","journal-title":"Vaccine"},{"key":"B70","doi-asserted-by":"publisher","first-page":"e0280439","DOI":"10.1371\/journal.pone.0280439","article-title":"Understanding the barriers and facilitators of vaccine hesitancy towards the COVID-19 vaccine in healthcare workers and healthcare students worldwide: an Umbrella review","volume":"18","author":"McCready","year":"2023","journal-title":"PLoS One"},{"key":"B71","doi-asserted-by":"publisher","first-page":"151976","DOI":"10.1016\/j.apnr.2025.151976","article-title":"Clustering vaccine hesitancy and social media use of nurses and nursing students: a cross-sectional study","volume":"84","author":"Comparcini","year":"2025","journal-title":"Appl Nurs Res"},{"key":"B72","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.3390\/vaccines10111934","article-title":"Persisting vaccine hesitancy in Africa: the whys, global public health consequences and ways-out\u2014cOVID-19 vaccination acceptance rates as case-in-point","volume":"10","author":"Njoga","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"B73","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s41256-022-00255-1","article-title":"COVID-19 vaccine hesitancy in Africa: a scoping review","volume":"7","author":"Ackah","year":"2022","journal-title":"Glob Health Res Policy"},{"key":"B74","doi-asserted-by":"publisher","first-page":"e320","DOI":"10.1016\/S2214-109X(21)00563-5","article-title":"COVID-19 vaccine hesitancy in Africa: a call to action","volume":"10","author":"Mutombo","year":"2022","journal-title":"Lancet Glob Health"},{"key":"B75","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/s41182-021-00357-5","article-title":"COVID-19 vaccine hesitancy among the adult population in Ghana: evidence from a pre-vaccination rollout survey","volume":"49","author":"Alhassan","year":"2021","journal-title":"Trop Med Health"},{"key":"B76","doi-asserted-by":"publisher","first-page":"e0316969","DOI":"10.1371\/journal.pone.0316969","article-title":"Fake news, misinformation, vaccine hesitancy and the role of community engagement in COVID-19 vaccine acceptance in southern Ghana","volume":"20","author":"Kuatewo","year":"2025","journal-title":"PLoS One"},{"key":"B77","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12889-022-14972-2","article-title":"The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-saharan Africa","volume":"23","author":"Osuagwu","year":"2023","journal-title":"BMC Public Health"},{"key":"B78","doi-asserted-by":"publisher","first-page":"2107851","DOI":"10.1080\/21645515.2022.2107851","article-title":"Addressing COVID-19 vaccine hesitancy in South Africa- moving beyond a reliance on information-based responses","volume":"18","author":"Cooper","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"B79","doi-asserted-by":"publisher","first-page":"126","DOI":"10.14321\/jwestafrihist.6.2.0126","article-title":"\u201cAfrica isn\u2019t a testing lab\u201d: considering COVID vaccine trials in a history of biomedical experimentation and abuse","volume":"6","author":"Flint","year":"2020","journal-title":"J West Afr Hist"},{"key":"B80","doi-asserted-by":"publisher","first-page":"165","DOI":"10.3390\/covid5100165","article-title":"COVID-19 Vaccine hesitancy: experiences from the republic of the Congo, the democratic republic of the Congo and the republic of Guinea-Bissau","volume":"5","author":"Boiro","year":"2025","journal-title":"COVID"},{"key":"B81","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/S0140-6736(21)00306-8","article-title":"Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment","volume":"397","author":"Wouters","year":"2021","journal-title":"Lancet"},{"key":"B82","year":"2023"},{"key":"B83","year":""},{"key":"B84","year":"2023"},{"key":"B85","year":"2024"},{"key":"B86","year":""},{"key":"B87","year":"2023"},{"key":"B88","doi-asserted-by":"publisher","first-page":"344","DOI":"10.2471\/BLT.24.291388","article-title":"An mRNA technology transfer programme and economic sustainability in health care","volume":"102","author":"Dutt","year":"2024","journal-title":"Bull World Health Organ"},{"key":"B89","year":""},{"key":"B90","year":""},{"key":"B91","year":""},{"key":"B92","year":"2022"},{"key":"B93","doi-asserted-by":"publisher","first-page":"ii50","DOI":"10.1093\/heapol\/czs039","article-title":"Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions","volume":"27","author":"Brooks","year":"2012","journal-title":"Health Policy Plan"},{"key":"B94","year":"2017"},{"key":"B95","year":"2023"},{"key":"B96","year":"2023"},{"key":"B97","year":"2021"},{"key":"B98","year":"2009"},{"key":"B99","year":"2017"},{"key":"B100","year":"2023"},{"key":"B101","doi-asserted-by":"publisher","first-page":"82","DOI":"10.7774\/cevr.2022.11.1.82","article-title":"COVID-19 vaccines development in Africa: a review of current situation and existing challenges of vaccine production","volume":"11","author":"Lamptey","year":"2022","journal-title":"Clin Exp Vaccine Res"},{"key":"B102","author":"Lardieri","year":"2021"},{"key":"B103","year":"2021"},{"key":"B104","author":"Muanya","year":"2018"},{"key":"B105","author":"Obilade","year":"2020"},{"key":"B106","author":"Roelf","year":"2019"},{"key":"B107","year":"2022"},{"key":"B108","author":"Spencer","year":"2020"},{"key":"B109","author":"Sweitzer","year":"2022"},{"key":"B110","year":"2022"},{"key":"B111","article-title":"\u201cUnprecedented achievement\u201d: Who received the first billion COVID vaccinations?","volume-title":"Nature","author":"Kreier","year":"2021"},{"key":"B112","first-page":"e1000097","article-title":"The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume-title":"PLoS Med","author":"Moher","year":"2009"}],"updated-by":[{"DOI":"10.3389\/frhs.2026.1974743","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000}}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1678143\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:32:09Z","timestamp":1788514329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1678143\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":112,"alternative-id":["10.3389\/frhs.2026.1678143"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1678143","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"article-number":"1678143"}}