African vaccination week in West Africa: untapped potential

¹World Health Organization, Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso, ²World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo World Health Organization, Regional Office for Africa, Brazzaville, Republic of Con Organization, Regional Office for Africa, Brazzaville, Republic of Congo

^&Corresponding author
Crépin Hilaire Dadjo, World Health Organization, Inter-country Support Team for West Africa, Ouagadougou, Burkina Faso

Essay    

Vaccination is a simple, safe, and effective way to protect humans against dangerous, potentially fatal diseases (meningitis, measles, polio, diphtheria, cervical cancer, etc.). Every year, it saves up to three [1] or even four [2] million lives. Created in 1974 as the Expanded Program on Immunization (EPI), vaccines are estimated to have saved the lives of 154 million people worldwide in 50 years. However, millions of Africans, roughly one-fifth of them [2], continue to miss out on the EPI. The “Big Catch Up” (BCU) initiative, launched by an alliance of vaccination partners in April 2023, with a fund of $290 million approved in December 2023 by Gavi [3], has thus made it possible since then to catch up millions of so-called ‘zero-dose’ children, i.e., children aged 12 to 23 or even 59 months who had not received the first dose of the pentavalent vaccine (vaccine against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b or Hib infections).

To put vaccination and its benefits back on the agenda, a public health event entirely devoted to vaccination was proposed to be commemorated each year in African countries during the last week of April. This is how African Vaccination Week came into being in April 2011 and was observed for the first time on the African continent in April 2011 in 40 of the 46 countries at the time. In fact, AVW was established in Malabo (Equatorial Guinea) during the 60^th session of the Regional Committee for Africa. Resolution AFR/RC60/14, adopted during this session by African ministers of health, called on countries to “institutionalize an annual African Vaccination Week (AVW) for sustaining advocacy, expanding community participation and improving immunization service delivery”. In January 2012, the World Health Organization (WHO) Executive Board adopted resolutions WHA58.15 and WHA61.15 establishing a World Immunization Week (WIW) to be celebrated during the same period as AVW.

The preparation, implementation, and evaluation of AVW activities in the 47 Member states of the WHO African region are coordinated by the Regional Office, with support from the three Inter-country Support Teams (ISTs) for West Africa (17 countries), Central Africa (10 countries) and East and Southern Africa (20 countries). It is accompanied each year by a special message from the WHO Regional Director for Africa on a theme that varies from year to year but remains closely linked to the specific epidemiological context of the continent. In recent years, however, probably under the influence of COVID-19, the themes of AVW and WIW have coincided, at least for the last five years. A regional launch is held to attract the attention of policymakers and other stakeholders, local and international media, and the national community. Member states are given some flexibility to carry out the types of activities they wish, and sometimes even outside the date on which all countries are invited to synchronize.

The first AVW celebrations were a resounding success. According to Okeibunor et al. (2018) [4], the number of countries participating in AVW rose from 40 out of 47 in 2011 to 43 in 2013 and 46 in 2014. During the first three editions, from 2011 to 2013, more than 180 million people received the oral polio vaccine in 19 countries. In 2013 alone, various antigens were administered to 7.5 million people in 17 countries in the African region, while 31.5 million people received vitamin A in 13 countries and deworming drugs were administered to 21.2 million people. Mihigo et al. (2015) specify that AVW served ‘as a vehicle for integrated health service delivery’ [5]). Member states seized the opportunity of this public health event to organize vaccination campaigns, periodic routine immunization intensification sessions, the distribution of vitamin A capsules and deworming tablets, the distribution of impregnated mosquito nets, the organization of child growth monitoring sessions, etc. Information campaigns were organized in both traditional media and social media, capacity-building sessions were held for media and health professionals, and community dialogues were conducted with the involvement of religious and traditional leaders. In fact, all age groups were targeted (infants, children, adolescents, adults, women, and the elderly).

However, this high-potential event, AVW, seems to have lost momentum in recent years, especially in West Africa. Several countries have not observed it for several years; others no longer report on it, making it difficult to compile data and carry out a final assessment of this activity. Based on activity reports shared with IST West Africa (ISTWA), which is responsible for monitoring, supporting countries and conducting the final evaluation of activities, the results for this sub-region are rather mixed. Regularly, barely half of the countries manage to carry out activities within the specified time frame. Even including countries that commemorate this activity beyond April, out of the 17 countries of ISTWA, we were able to identify 8 countries participating in 2025, 6 in 2024, 10 in 2023 and 7 in 2022. The focus is more on political advocacy, awareness-raising activities, especially in the media, social networks and community activities. Of course, activities like those organized at the very beginning of the Week are still ongoing, such as the national measles campaign in Niger, which has vaccinated 5,390,959 children aged 6 to 11 months and 12 to 59 months (during 2025 AVW); the identification and catch-up vaccination of ‘zero-dose’ children in 48 priority "communes" in Benin (during 2025 AVW). Overall, it must be acknowledged that enthusiasm has waned considerably. There are many possible causes. We believe that the main reason lies in the fact that Member states have not taken enough ownership of the activity. AVW, as a predictable event proposed 15 years ago by health ministers themselves, is generally absent from countries' annual vaccination program activity plans. Moreover, very few countries share these plans with ISTWA at the beginning of the year, despite numerous reminders. As a result, many are surprised when asked to share their plans for the AVW activity with ISTWA. The impression given is that the commemoration of this Immunization Week is often perceived in countries as a ‘WHO activity’, somewhat like mass vaccination campaigns. In other words, WHO should support the implementation of activities with secured funding. But what can one speak to the fact that in 2025, a country in this same sub-region, despite having received catalytic funding (between USD 3,000 and 5,000), which was difficult for the Regional Office to mobilize, has still not implemented any activities related to this event, several months after receiving these funds and after the ideal period has passed!

The COVID-19 episode, which led countries to focus on themselves, within their borders, to deal with the pandemic, is also a contributing factor that could explain the loss of motivation in countries. However, there are strong arguments that AVW is a golden opportunity that deserves to be included in the list of activities to be promoted and implemented in our countries for the benefit of the population, particularly the most vulnerable segments of society, namely children and women. AVW makes it possible to revive old initiatives in support of maternal and child health. This is the case with Mother and Child Health Days or Weeks, as celebrated in Sierra Leone and Nigeria, or Child Health Promotion Week, as observed in Ghana. With the same target audience, namely mothers and children, these countries have understood that efforts can be integrated to offer comprehensive health services to those concerned. A variety of interventions are often offered, including vitamin A supplementation, distribution of deworming tablets, nutrition counselling, weighing of children, monitoring of child growth, birth registration, distribution and promotion of the use of insecticide-treated mosquito nets, educational talks, and, of course, vaccination sessions for eligible children.

The AVW is also a good opportunity to catch up on under-vaccinated children and those who have not received any doses. The BCU initiative, launched after the worrying observation of declines in vaccination coverage resulting from the challenges encountered in managing COVID-19, has highlighted this type of intervention. It is a new approach to boosting vaccination coverage worldwide, for which Gavi has supplied millions of vaccine doses and substantial financial resources available to identified priority countries. Benin, a country of the West African sub-region, reports that combining the AVW and BCU in 2025 enabled it to capture 4.74% of its target of zero-dose children, with the pentavalent vaccine 1, and 5.73% of under-vaccinated children, with the pentavalent vaccine 3. Broadening the base of local partnerships around vaccination is also a possible area of action during the AVW. In its activity report, Ghana, another ISTWA country, identified and cited 19 partners who were committed to supporting a variety of actions during the 2025 edition. These partners are recruited from among traditional vaccination partners (WHO, UNICEF, Program for Appropriate Technology in Health (PATH), the government (Ministry of Health, Ministry of Education), the media, and civil society. It should be noted that this country did not receive any specific financial resources from the WHO Regional Office or ISTWA for this edition, which reinforces the idea that finances are not the main obstacle to efficient commemoration of this vaccination week.

Finally, although AVW has always been coordinated by the WHO Regional Office for Africa, a new partner is becoming increasingly interested in this event: A/CDC. In 2023, it joined forces with WHO and UNICEF to jointly celebrate this activity. For the 2025 edition, it organized and supported a regional launch in Sierra Leone, while WHO had designated Guinea to do so. The stakes involved in relaunching African vaccination Week are enormous. As a reminder, the continent faces a triple challenge. First, there is the 50th anniversary of the introduction of the EPI. It is necessary to breathe new life [6] into the programme, given the stagnation or even decline in vaccination performance in countries, and to ensure that the national community benefits from vaccination, a major public health intervention whose effectiveness is not questioned. Secondly, we are in a post-COVID-19 era that has seen an explosion of rumors and misinformation about vaccines. Strategies have been put in place, but with the extraordinary development of information and communication technologies, including artificial intelligence, there is reason to fear a resurgence of the disinformation war targeting vaccines in particular. Finally, the withdrawal of the United States from the WHO and attempts to place leaders sympathetic to the current ideology [7] of the central administration at the head of the organization responsible for vaccine policy in that country can be interpreted as mistrust of vaccines and vaccination worldwide.

With this in mind, AVW deserves to be rehabilitated more than ever. For one week, all countries on the African continent, through AVW, and around the world, through WIW, can highlight the benefits of vaccination, invented in 1796, administer up to 14 antigens to eligible individuals, and mobilize public decision-makers, media, and civil society organizations around this key issue. In this context, it is necessary, above all, for each country to include AVW among its annual activities. Such a commitment would be in line with the fundamental principles of the Immunization Agenda 2030 [8]. Next, it is a matter of mobilizing, at the local level above all, partners who are committed to vaccination, beyond the traditional actors. Furthermore, in compliance with the Addis Declaration on Immunization [2], Member states must commit resources to ensure the successful implementation of this activity. Undoubtedly, A/CDC's marked interest in this continental event should be seized upon so that, alongside traditional actors such as WHO, UNICEF, Gavi and PATH, among others, greater visibility and financial support can be given to this activity in countries. Finally, it is essential that the WHO Regional Office for Africa continues to play its coordinating role in this major public health event. Ultimately, its success will depend on the indispensable collaboration of Member states and partners. The sharing of data by countries will make it possible to measure progress and adjust the way in which this vaccination week is celebrated, if necessary.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Crépin Hilaire Dadjo conceived and wrote the first draft of the manuscript, responded to all the comments of the reviewers, and revised all versions of the manuscript. Hadiatou Diallo reviewed the first draft and validated the data, Sylvain Honoré Woromogo reviewed the first draft. André Arsène Bita Fouda and Ado Mpia Bwaka provided very useful insights into the article. Crépin Hilaire Dadjo, Hadiatou Diallo, Sylvain Honoré Woromogo, André Arsène Bita Fouda and Ado Mpia Bwaka agreed to be accountable for all aspects of the work and approved the final draft of the manuscript for publication. Crépin Hilaire Dadjo is the guarantor of this manuscript and takes full responsibility for the work, including the data and the views expressed.

Acknowledgments     

The authors acknowledge reports of activities shared by WHO Immunization focal points in country offices of West Africa. Authors however, are alone responsible for the views expressed in this article, which do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

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