{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:46:55Z","timestamp":1788562015104,"version":"build-2803163510"},"reference-count":84,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: The end of the COVID-19 public health emergency of international concern (PHEIC) in May 2023 marked a transition from disruption to recovery and rebuilding of health systems. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. We conducted a critical narrative synthesis of post-PHEIC recovery and the transformation of immunization systems in the region from 2023 to 2025. Methods: We thematically analyzed publicly available data from the WHO and other sources using a systems-oriented framework covering immunization coverage, equity, vaccine introductions, disease control, governance, financing, and data systems. Results: Regional coverage for most antigens was restored to 2019 pre-pandemic levels by 2024, e.g., three doses of diphtheria-tetanus-pertussis-containing vaccines at 76%. However, progress remains insufficient to meet the Immunization Agenda 2030 (IA2030) target of 90% coverage. In addition, there were 6.7 million zero-dose children in the 2024 birth cohort (6.3% higher than the 6.3 million in 2019), concentrated in a few countries. The IA2030 target is a 50% reduction in the number of zero-dose children by 2030, compared to 2019. Recovery initiatives have restored services, while accelerated introductions (e.g., malaria vaccines introduced in 20 new countries in 2024\u20132025) signal renewed system momentum. Yet, progress has plateaued at pre-pandemic levels, reflecting structural constraints rather than sustained transformation. Concurrently, recurrent outbreaks of measles, yellow fever, and other vaccine-preventable diseases highlight persistent immunity gaps and surveillance limitations. Structural constraints (including financing fragility, subnational inequities, and system fragmentation) continue to limit sustained progress. Conclusion: This study offers important insights that can inform immunization policymaking in the WHO African Region and beyond. Current post-PHEIC trends reflect recovery without transformation. Achieving IA2030 targets will require a shift from broad coverage expansion to precision delivery approaches that prioritize zero-dose and underserved populations. Immunization must be positioned as a central pillar of primary health care and health security systems.<\/jats:p>","DOI":"10.3390\/vaccines14050386","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:33:37Z","timestamp":1777376017000},"page":"386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Vaccine-Preventable Disease Control in the WHO African Region After the COVID-19 Public Health Emergency of International Concern: Implications for Recovery, Resilience, and System Transformation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1273-4779","authenticated-orcid":false,"given":"Charles S.","family":"Wiysonge","sequence":"first","affiliation":[{"name":"Cochrane South Africa, South African Medical Research Council, Parrow Valley, Cape Town 7500, South Africa"},{"name":"Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3317-1319","authenticated-orcid":false,"given":"Abdu A.","family":"Adamu","sequence":"additional","affiliation":[{"name":"Independent Researcher, Kano 700104, Kano State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ado M.","family":"Bwaka","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance N.","family":"Wiysonge","sequence":"additional","affiliation":[{"name":"Department of Mathematical Sciences, Faculty of Applied Sciences, Cape Peninsula University of Technology, Bellville, Cape Town 7535, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson M.","family":"Ticha","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reggis","family":"Katsande","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre A.","family":"Bita Fouda","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nosheen","family":"Safdar","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aschalew","family":"Teka Bekele","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-7497","authenticated-orcid":false,"given":"Chinwe","family":"Iwu-Jaja","sequence":"additional","affiliation":[{"name":"Graduate School of Business, Faculty of Commerce, University of Cape Town, Cape Town 7701, South Africa"},{"name":"Centre for Tropical Diseases and Health, Catholic University of Bukavu, Bukavu P.O. Box 285, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise","family":"Bathondoli","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0399-5182","authenticated-orcid":false,"given":"Sidy","family":"Ndiaye","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adidja","family":"Amani","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9275-0874","authenticated-orcid":false,"given":"Maurice","family":"Demanou","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samafilan","family":"Ainan","sequence":"additional","affiliation":[{"name":"Polio Eradication Program, World Health Organization, Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miluka P.","family":"Gunaratna","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awa","family":"Diop","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Han","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1287-5934","authenticated-orcid":false,"given":"Anfumbom","family":"Kfutwah","sequence":"additional","affiliation":[{"name":"Polio Eradication Program, World Health Organization, Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renias","family":"Mukaro","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4631-9696","authenticated-orcid":false,"given":"Reena H.","family":"Doshi","sequence":"additional","affiliation":[{"name":"Emergency Preparedness and Response Program, World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles O.","family":"Lukoya","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwasi","family":"Nyarko","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Mwenda","sequence":"additional","affiliation":[{"name":"Diarrheal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3028-887X","authenticated-orcid":false,"given":"Balcha G.","family":"Masresha","sequence":"additional","affiliation":[{"name":"Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Djoue, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"ref_1","unstructured":"GBD 2023 Vaccine Coverage Collaborators (2025). 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