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 2024–2025) 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.
Despite decades of investment in health systems across the WHO African region, population health outcomes remain suboptimal. The region faces evolving challenges, including demographic shifts, emerging health threats, and persistent inequalities. Current health-service delivery models are misaligned with anticipated future health demands, necessitating a reimagined operational framework grounded in a revitalised primary health-care approach. In this Viewpoint, we draw on expert consensus from professionals across 19 countries using the nominal group technique and Delphi-style rounds. Experts were organised into thematic “policy laboratories” focusing on primary care, hospitals, and oversight. Expert insights were collected through structured questionnaires, thematic analysis, and iterative validation, culminating in a 5-day consensus workshop. Three key constructs emerged for future health-service organisation: (1) primary care units as integrated networks delivering first point-of-care interventions; (2) hospitals redefined to include training, research, and clinical governance roles; and (3) oversight structures with decentralised, participatory, and evidence-informed decision-making capacities. The proposed model emphasises person centredness, functional integration, and digital innovation to enhance system responsiveness and resilience. The future of health-service delivery in Africa lies not in replacing existing structures, but in repurposing and realigning them to meet population health needs. Incremental reforms, supported by digital tools, essential health packages, and rationalised service-provision modalities, can enable countries to build resilient, people-centred health-care systems. National and subnational leadership, supported by regional and global partners, is essential for driving this transformation.
Background/Objectives: Transitions to new vaccines or antigen schedules represent complex system changes requiring coordinated governance, reliable data systems, domestic financing, and multisectoral collaboration. In 2025, African countries were moving toward a switch from separate pentavalent and inactivated poliovirus vaccines to the combined hexavalent vaccine. This project report describes the Hexavalent Vaccine Switch Early Adopters Workshop in Dakar, Senegal, which included ten African countries, and its implications for future vaccine introductions. Methods: We conducted a practice analysis drawing on structured documentation of plenary presentations, country case studies, interactive problem-solving sessions, and national roadmap exercises. A thematic framework aligned to ten process points for the hexa switch guided synthesis. Results: Countries reported shared system vulnerabilities, including coexistence risks of legacy and new vaccine stocks, inconsistent data completeness, under-resourced vaccine safety surveillance, and financing uncertainties. Early adopter countries demonstrated operational feasibility, logistical efficiencies, and opportunities for reducing injection burden. Outputs included a Health System Adaptation Checklist, a Switch Risk Mitigation Catalog, and 12-month national roadmaps. Conclusions: Regional peer-learning mechanisms can accelerate decision-making, improve operational quality, and strengthen accountability for vaccine introductions. Structured cross-country collaborations can transform a product switch into a scalable system-strengthening opportunity.
BackgroundChildhood obesity has surged dramatically in the United States over the past three decades, with over 30% of children now classified as overweight or obese. This rising trend presents a major public health and economic challenge, with obesity-related costs rising from just over 1% of United States gross domestic product in 2005 to 3.3% in 2019 and projected to reach 4.6% by 2060 if left unaddressed.AnalysisWhile conventional narratives often attribute obesity to poor individual choices, this policy brief highlights the broader social determinants that shape childhood obesity across different levels of influence. Using a Socio-ecological Model Framework, the brief explores individual, interpersonal, community, and policy-level contributors, including genetic factors, psychosocial stress, family and cultural influences, school and neighborhood food environments, targeted marketing by food corporations, and regulatory gaps.Policy ImplicationsThe brief concludes by recommending four upstream policy interventions. These include banning the sale of unhealthy foods within school premises and promoting healthy school food environments through regulation and education, implementing fiscal measures by taxing unhealthy foods and subsidizing healthier alternatives, integrating physical activity into children’s daily routines through school based and urban planning policies and Strengthening evidence systems and context-specific research. These strategies provide transferrable policy lessons for addressing childhood obesity in other settings including in low-and middle-income countries experiencing similar nutrition transitions. However, their implementation should be adapted to local health system capacities, food environments and policy contexts.
Background:Antimicrobial resistance (AMR) is a major global health threat, and African countries are disproportionately affected due to limited diagnostic capacity, weak surveillance and inadequate monitoring of antimicrobial consumption (AMC). This study analysed regional trends using the Tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS), a standardised tool for monitoring national progress in AMR response. Methods:We conducted an analysis of the TrACSS database covering 47 African countries (2017-2024). Indicators included national AMC monitoring systems, national AMR surveillance systems and laboratory capacity focusing on public and private bacteriology coverage and antimicrobial susceptibility testing (AST) for WHO-priority bacteria and critical fungi. Descriptive and trend analyses were performed, and the association between AMC and AMR system maturity was examined using logistic regression and correlation tests. Results:Between 2017 and 2024, the proportion of countries with advanced AMC monitoring more than doubled (13%-30%), while advanced AMR surveillance quadrupled (13%-57%). From 2022 to 2024, public-sector bacteriology coverage rose from 80%-94% and private sector coverage from 60%-75%. Nearly all countries (95.7% in 2024) reported at least one reference laboratory performing AST for priority bacteria, though pathogen-specific reporting remained limited, with the lowest capacity for Campylobacter spp. (reported by a maximum of 12.2% of countries annually). Dual Candida and Aspergillus testing increased from 23% to 30%, but nearly half (46.8%) of countries still lacked a national mycology reference laboratory. Countries with advanced AMC systems were significantly more likely to also have advanced AMR surveillance (OR 8.1; p<0.001). Conclusion:The WHO African Region has made measurable progress in AMR response over the past 8 years, though gains remain uneven. Strengthening mycology services, expanding bacteriology coverage and integrating AMC and AMR data systems are critical next steps towards achieving resilient, evidence-driven surveillance networks that can better guide stewardship and investment decisions.
