{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:13:26Z","timestamp":1793578406033,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"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 2025 EPI Managers\u2019 Meeting for West African countries in Guinea was a critical platform for EPI managers to make an in-depth analysis of immunization programmes. We present a structured analysis of immunization status in West Africa using a WHO Health System model to move beyond descriptive reporting toward systemic analysis for actionable solutions. Methods: The meeting convened EPI managers from 14 of the 17 West African countries and partners supporting the immunization program. Country and regional presentations, immunization and surveillance data and meeting discussions were analysed through a framework identifying (1) core problems, (2) systemic barriers using WHO health systems building blocks and (3) actionable recommendations or call for action. Results: Analysis revealed stagnating immunization coverage. Recovery from COVID-19 pandemic disruptions remained limited, with persistent outbreaks of vaccine-preventable diseases (VPD). Among the five Immunization Agenda 2030 objectives assessed, only Maternal and Neonatal Tetanus (MNT) elimination was on track. Four critical challenges emerged: (1) Routine immunization stagnation with DTP3 median coverage of 76%. This was associated with challenges related to poor data quality, weak implementation of innovative vaccination strategies and donor dependency, as 88.2% of countries financed less than 50% of routine vaccine costs domestically. (2) Sub-optimal progress in Big Catch-Up (BCU) implementation in some countries, revealing poor health system resilience. (3) Inability to sustain high coverage for new vaccine introductions despite significant progress, highlighting demand and service delivery gaps. (4) Persistent VPD outbreaks with geographical expansion and the resurgence of diphtheria epidemics since 2023. Conclusions: Persistent immunization challenges in West Africa appear to reflect interconnected systemic challenges, suggesting the need for a fundamental shift toward subnational strategies, integration of immunization services within primary health care (PHC) and improved data quality. Sustainable financing of the national EPI and acceleration of local vaccine manufacturing is essential to achieve immunization sovereignty in West Africa. Country Call for Action provides strategic guidance to reverse the trend toward the Immunization Agenda 2030 targets.<\/jats:p>","DOI":"10.3390\/vaccines14060501","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:38:42Z","timestamp":1780411122000},"page":"501","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The 2025 Expanded Programme on Immunization (EPI) Managers Meeting in West Africa: A Health Systems Analysis of a Decade of Stagnating Routine Immunization Performance"],"prefix":"10.3390","volume":"14","author":[{"given":"Ado Mpia","family":"Bwaka","sequence":"first","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 242, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7727-3504","authenticated-orcid":false,"given":"Marcellin Mengouo","family":"Nimpa","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 242, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rija","family":"Andriamihantanirina","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund, Centre of Excellence for Child Survival and Development, Nairobi P.O. Box 40326, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain Komi","family":"Ahawo","sequence":"additional","affiliation":[{"name":"Gavi, The Vaccine Alliance, Chemin du Pommier 40, Le Grand-Saconnex, 1218 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daman","family":"Keita","sequence":"additional","affiliation":[{"name":"Essential Immunization Programme, Ministry of Health, Conakry P.O. Box 585, Guinea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evanilda","family":"Santos","sequence":"additional","affiliation":[{"name":"Essential Immunization Programme, Ministry of Health, Praia 7600-001, Cape Verde"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2543-349X","authenticated-orcid":false,"given":"Desmond Maada","family":"Kangbai","sequence":"additional","affiliation":[{"name":"Essential Immunization Programme, Ministry of Health and Sanitation, Freetown P.O. Box 529, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milse William Nzingou","family":"Mouhembe","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 242, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves Medessi","family":"Armand Mongbo","sequence":"additional","affiliation":[{"name":"West African Health Organization (WAHO), Bobo-Dioulasso P.O. Box 153, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tene-Alima","family":"Essoh","sequence":"additional","affiliation":[{"name":"Agence de M\u00e9decine Pr\u00e9ventive (AMP), Bureau R\u00e9gional pour l\u2019Afrique, Abidjan P.O. Box 3960, C\u00f4te d\u2019Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Tague","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universit\u00e9 Libre des Pays des Grands Lacs, Kyeshero Lusaka Rue 218, Goma P.O. Box 243, Democratic Republic of the Congo"},{"name":"Medical Research Circle, Goma P.O. Box 73, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6088-2629","authenticated-orcid":false,"given":"Criss Koba","family":"Mjumbe","sequence":"additional","affiliation":[{"name":"Public Health Department, Faculty of Medicine, University of Lubumbashi, Lubumbashi P.O. Box 243, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akpaka","family":"Kalu","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 242, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benido","family":"Impouma","sequence":"additional","affiliation":[{"name":"World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 242, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020). Immunization Agenda 2030: A Global Strategy to Leave No One behind, World Health Organization. Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/strategies\/ia2030."},{"key":"ref_2","unstructured":"WHO, and UNICEF (2026, April 16). Progress and Challenges with Achieving Universal Immunization Coverage 2024 WHO\/UNICEF Estimates of National Immunization Coverage. 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