Immunization
Immunization is one of the most impactful and cost-effective public health interventions available, averting over 4 million deaths every year. In addition to offering protection from preventable diseases, immunization also brings children and families into contact with health systems, providing an avenue for the delivery of other basic health services and laying the foundation for primary health care. As such, ensuring universal access to vaccines is a critical entry point for universal health coverage (UHC).
In addition to its direct impact on the health of populations, immunization brings added value by reducing the burden of disease on individuals, families and communities, including through savings on medical expenses, as well as productivity and educational gains. The return on investment for immunization has been estimated to be US $44 for every dollar invested, including broader social and economic benefits.[1]
In less than a generation, the African Region has made tremendous gains in increasing access to immunization and driving down child deaths. For example, several diseases are on the brink of eradication and elimination (e.g., polio and maternal and neonatal tetanus, respectively), while the introduction of new vaccines is stamping out age-old diseases.[2]
Despite these achievements, national and subnational immunization coverage rates have stagnated in many countries, and the African Region still lags behind other regions of the world in access to vaccines. Approximately 1 in 5 African children do not receive all the necessary and basic vaccines. As a result, more than 30 million children under five still suffer from vaccine-preventable diseases (VPDs) every year in Africa. Of these, over half a million children die from VPDs annually – representing approximately 58% of global VPD-related deaths.[3]
Strategic investments to strengthen health systems are critical to support robust immunization programmes that can deliver vaccines to everyone in Africa, including the most vulnerable. Expanding access to vaccines for is vital to improve child health and survival, as well as to lay the foundation for countries to reach every person with the basic health services they need to survive and thrive.
1. Ozawa S et al; Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011–20, HEALTH AFFAIRS 35, NO. 2 (2016): 199–207
2. Shah MP, Tate JE, Mwenda JM, Steele AD, Parashar UD. Estimated reductions in hospitalizations and deaths from childhood diarrhea following implementation of rotavirus vaccination in Africa. Expert Rev Vaccines 2017; 16:987–95. Troeger S. et al., Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatr. 2018 Oct; 172(10): 958–965.
3. Business case for WHO immunization activities on the African continent, 2018–2030. Brazzaville: World Health Organization; 2018.
On 31 January 2017, at the 28th African Union (AU) Summit, Heads of State from across Africa endorsed the Addis Declaration on Immunization (ADI), a historic and timely pledge to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization. The ADI reaffirmed Africa’s commitment, at the highest level, to achieving ambitious immunization goals. It includes 10 commitments to increase political, financial and technical investments in immunization programmes that can accelerate progress toward universal access to immunization in Africa. The ADI was initially drafted and signed by ministers and other high-level representatives at the Ministerial Conference on Immunization in Africa (MCIA) in February 2016 in Addis Ababa, Ethiopia. Statements of support were issued by civil society organizations, religious leaders from across faiths, and parliamentarians to support countries in the implementation of the ADI.
At the first WHO Africa Health Forum in Kigali, Rwanda, in June 2017, the WHO Offices in the African Region and Eastern Mediterranean Region, the African Union Commission, and immunization partners launched a roadmap to guide the implementation of the ADI. The roadmap provides Member States with three specific strategies that can be incorporated into existing efforts to improve immunization, namely: (i) generate and sustain political commitment and funding for immunization through advocacy and communications; (ii) address gaps in immunization and work with key partners to overcome barriers to access and utilization of immunization services; and (iii) monitor progress to drive impact and ensure accountability.
African Vaccination Week (AVW) is an annual event celebrated during the last week of April, with the aim of strengthening immunization programmes in the African Region by increasing awareness of the importance of every person’s need and right to be protected from vaccine-preventable diseases. The campaign, which is held in synchronization with the annual World Immunization Week, brings together all countries across the region to raise awareness of the benefits of vaccination. AVW’s overarching slogan is “Vaccinated communities, Healthy communities”. Each year, a theme is chosen to reflect regional public health priorities.
Since its launch in April 2011, AVW has sought to keep immunization high on national and regional agendas and to ignite greater collective action on immunization across the continent, underscoring the role that everyone has to play in this effort. Through leveraging advocacy and partnerships, the campaign aims to build momentum for increased access to life-saving vaccines. During AVW, WHO works closely with national governments and other stakeholders in the region to conduct large-scale vaccination campaigns, small-scale vaccination activities, information outreach and health promotion through immunization and other child survival interventions.
In 2006, WHO created the African Vaccine Regulatory Forum (AVAREF) as an informal capacity-building platform aimed at improving the regulatory oversight of interventional clinical trials being conducted in Africa.
Over the years, AVAREF has worked to strengthen regulatory and ethics reviews, promote harmonized standards and approaches, and accelerate the review of vaccines of high public health value among member countries. It has also shed light on the growing complexity of biomedical research, which calls for increased cooperation between partners including donors, researchers, product developers, regulators and the medical ethics community.
AVAREF uses harmonization and reliance as pillars for capacity building, ensuring that there is collaboration between key stakeholders including donors, health professionals and regional economic blocs across the continent by promoting joint reviews, work sharing and use of expertise. As a result, important vaccines against meningitis, malaria, rotavirus, invasive pneumococcal diseases, pneumonia and Ebola have been developed, and important vaccines for other diseases are also under development.
Through joint reviews, AVAREF supports National Regulatory Authorities (NRAs) and Ethics Committees (ECs) to build technical capacity for accelerating review of clinical trial applications (CTAs). Joint reviews are intended to enhance the quality of the reviews of an application submitted to multiple countries by allowing regulators and ECs to exchange and validate their findings with peers. It has also helped vaccines developers to expedite launching clinical studies and eventually introduce vaccines in African Region.
- WHO immunization resources
- Strategic immunization plans
- Key reports
- Technical guidance
- COVID-19 vaccine resources
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- COVAX
- COVID-19 vaccines explained
- COVID-19 vaccines safety
- COVID-19 vaccines Q&A
- COVID-19 advice for the public: Getting vaccinated
- Strategic Advisory Group of Experts on Immunization (SAGE): COVID-19 vaccines technical documents
- COVID-19 vaccines regulation and prequalification
- COVID-19 vaccine introduction toolkit
- Related links
National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary groups of national experts responsible for providing scientific recommendations to their respective ministries of health, to enable them to make independent, evidence-based policy and programme decisions related to immunization. The Global Vaccine Action Plan calls for all countries to establish or have access to a NITAG by 2020. As of 2018, 30 of the 47 countries in the African Region had established a NITAG, whereas 17 had not. Out of the 30 countries with NITAGs, 18 met all the WHO functionality criteria.
WHO places a high priority on the development of national decision-making process and capabilities, including the establishment and strengthening of functional, independent NITAGs. WHO supports countries in the African Region by providing technical guidance for the establishment/strengthening of a NITAG, as well as providing technical guidance, including global and regional policy recommendations, to the NITAG in formulating immunization policies and strategies.
The African Regional Immunization Technical Advisory Group (RITAG) is the principal advisory group to the WHO Regional Office for Africa to provide strategic guidance on vaccines and immunization. RITAG reports directly to the WHO Regional Director for Africa and advises the Regional Director on overall regional policies and strategies, ranging from vaccine and technology research and development, to delivery of immunization services and linkages between immunization and other health interventions. Its remit is not restricted to childhood immunization but extends to all vaccine-preventable diseases as well as all age groups. Members of the RITAG are appointed to serve for an initial term of three years, renewable once.
MEMBERS

Biography
Prof Helen Rees
Chair of RITAG
Executive Director
Wits Reproductive Health and HIV Institute
South Africa

Biography
Dr Deo Nshimirimana
Health Systems Strengthening Specialist
Former WHO Country Representative
Burundi

Biography
Prof Nicaise Ndembi
Senior Advisor
Africa Centres for Disease Control and Prevention
Ethiopia

Biography
Dr Ombeva O. Malande
Vaccinologist & Senior consultant (Paediatric Infectious Diseases)
Makerere University
Uganda

Biography
Prof Ahuka Mundeke Steve
Professor of Microbiology
University of Kinshasa
Democratic Republic of Congo

Biography
Prof Richard A. Adegbola
Research Professor & Consultant Nigeria Institute of Medical Research
Nigeria

Biography
Prof Rudzani Muloiwa
Head of Department of Paediatrics and Child Health
University of Cape Town
South Africa

Biography
Prof Sipho Dlamini
Associate Professor of Medicine
University of Cape Town
South Africa

Biography
Prof Sultan Omar Maneno
Professor of Paediatrics, Infectious Diseases and Public Health
Tanzania

Biography
Prof Dr Marceline Djuidje Ngounoue
Immunologist/Molecular Biologist
University of Yaoundé I
Cameroon

Biography
Dr Edward Nicol
Senior Specialist Scientist
South African Medical Research Council
South Africa

Biography
Dr Ijeoma Edoka
Health Economist
University of the Witwatersrand
South Africa

Biography
Hyacinthe Kankeu Tchewonpi
Health Financing Specialist Global Financing Facility
World Bank,
USA

Biography
Dr Pratima L. Raghunathan
Associate Director
Global Immunisation Division Centers for Disease Control and Prevention,
USA
Additional resources:
- Report of the Regional Immunization Technical Advisory Group meeting, November 2020
- Report of the Regional Immunization Technical Advisory Group meeting, July 2020
- Report of the Regional Immunization Technical Advisory Group meeting, January 2019
- Report of the Regional Immunization Technical Advisory Group meeting, June 2018
- Report of the Regional Immunization Technical Advisory Group meeting, December 2017
- Report of the Regional Immunization Technical Advisory Group meeting, June 2017
Publications
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2023 Annual Report: Universal Health Coverage, Communicable and Noncommunicable Diseases (UCN) Cluster, WHO Regional Office for Africa
This is the second progress report produced by the Universal Health Coverage, Communicable and Noncommunicable Diseases (UCN) Cluster of the World Health Organization (WHO) Regional Office for Africa.