Vaccine stock management in Africa: challenges, innovations, and future directions

¹Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa, ²School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa, ³World Health Organization Regional Office for Africa, Djoue, PO Box 06, Brazzaville, Congo, ⁴Cochrane South Africa, South African Medical Research Council, Parow Valley 7500, South Africa

^&Corresponding author
Akhona Victress Mazingisa, Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa

Essay    

Introduction

When the World Health Organization (WHO) launched the Expanded Programme on Immunization (EPI) in 1974, vaccine distribution across Africa meant kerosene-powered refrigerators and paper-based inventory systems; logistical challenges that left millions of children unreached. The EPI has significantly improved vaccination coverage across Africa, with vaccination responsible for 52% of the decline in infant mortality in the African region. In Africa alone, over 51 million lives have been saved through vaccines over the past five decades. Additionally, the EPI's evolution from targeting six diseases in 1974 to encompassing protection against 14 vaccine-preventable diseases represents one of public health's greatest achievements [1].

Yet, significant challenges persist in ensuring equitable access to and uptake of vaccines across Africa. Current date reveal that regional coverage with three doses of diphtheria-tetanus-pertussis containing vaccine (DTP3) in the WHO African Region was only 76% and only 17 of 47 (36%) countries in the region achieved the global target of 90% or above coverage for DRP3 in 2024. In addition, there is wide variation in national DTP3 coverage among countries ranging from 42% in the Central African Republic to 98% in Rwanda in 2024. The COVID-19 pandemic exposed vulnerabilities in immunization systems [2]. Central to these gaps is the persistent challenge of vaccine stock management at primary health care (PHC) facilities. Frequent stock-outs, logistical inefficiencies, and limited local manufacturing capacity continue to compromise reliable vaccine delivery and sustained immunization [3,4]. Effective vaccine stock management is crucial for maintaining immunization coverage and avoiding missed vaccination opportunities. This commentary aims to examine the successes, current challenges, innovative solutions and future directions in vaccine stock management in Africa, drawing lessons learned and best practices from different countries.

Importance of effective vaccine stock management in achieving immunization goals

Effective vaccine stock management is essential for enabling the health systems to deliver life-saving vaccines and achieving immunization goals. Studies highlight the importance of proper storage practices, knowledge of vaccine handling, and efficient stock management systems. The fundamental components include estimating requirements, robust inventory control, as well as maintaining appropriate stock levels [5-7]. Frequent stockouts, however, remain a significant barrier to sustaining optimal immunization coverage. For instance, a study in South Africa identified vaccine stock-outs as a leading cause of missed vaccination in children [8]. Other challenges include inadequate knowledge among healthcare workers, particularly about heat-, cold-, vaccine sensitivity, insufficient WHO-recommended refrigerators, and weak distribution and information management systems [5]. Furthermore, inconsistent inventory practices can significantly impact vaccine availability and immunization programme performance. Studies have shown that poor stock management is a major cause of vaccine stock-outs in primary health care facilities [3]. These inaccuracies can lead to unnecessary failure to order when needed, compromising effective inventory management.

Research has highlighted the importance of proper inventory management practices, such as maintaining buffer stocks, optimal inventory levels, and continuous monitoring [9]. Additionally, factors such as unreliable electricity supply, poor record-keeping and lack of standard practices undermine accurate forecasting and planning. African countries such as South Africa, Kenya, and Nigeria have shown a widespread of vaccine stockouts, with up to one-third of WHO Member States experiencing shortages annually [10,11]. These challenges can lead to service interruptions with over 90% likelihood of vaccination disruptions when district-level stockouts occur [11]. The cold chain logistics involves manufacturing, transportation, storage and distribution processes. Maintaining the required temperature for vaccines is critical. Cold chain logistics, which encompass the manufacturing, transportation, storage, and distribution of vaccines, also play a critical role in stock management [12]. Maintaining the required temperatures throughout these processes is essential for preserving vaccine potency. However, persistent challenges in cold chain logistics continue to threaten vaccine quality, leading to wastage and reduced programme effectiveness [3,13]. These challenges became particularly evident during the COVID-19 pandemic, underscoring the urgent need to build stronger and more resilient vaccine supply systems [12,13].

Effective vaccine management assessments

Effective Vaccine Management (EVM) is a global initiative to increase immunization coverage through continuous improvement of vaccine supply chain, ensuring potent, life-saving vaccines are available to vaccinate population through the life course when and where they are needed. The World Health Organization's EVM initiatives provide tools to assess and monitor vaccine supply chains. Leveraging these tools can help identify gaps and areas for improvement [14]. Regular training for healthcare workers on EVM best practices is essential to ensure proper vaccine handling and storage and minimize wastage [15]. Platforms such as TechNet's KnowledgeHub can be used for training and capacity building of primary health care workers, equipping them with skills for effective vaccine handling and stock monitoring [16,17]. Emerging innovations are improving stock visibility and availability in primary health care facilities. Mobile devices and barcode scanning technologies are showing promise in enhancing inventory quality and reducing stock-outs [18]. In Mozambique and other sub-Saharan African countries, there has been a lot of improvement in the vaccine availability and reduced logistics costs [19,20]. However, the current evidence base has limitations, with most studies constrained by small sample size and classified as having high risk of bias [18].

Data reporting and utilization

Accurate and timely data collection is essential for effective vaccine stock management. Robust reporting systems enable countries to monitor vaccine availability, identify bottlenecks, and plan interventions to prevent stock-outs. The Electric Joint Reporting Form (eJRF), used by WHO and UNICEF, collects annual immunization data to track progress and inform global and regional strategies. In many countries, weak data systems and poor record-keeping undermine stock visibility and forecasting accuracy. Facility-level reporting delays often result in reactive, rather than proactive, stock replenishment, contributing to frequent stock-outs. Strengthening electronic data platforms and encouraging their routine use can improve decision-making and supply chain efficiency. When the eJRF is completed by immunization programme staff and validated in collaboration with WHO and UNICEF country offices, these data provide vital insights for targeted support and resource allocation [14].

Innovation and future prospects in vaccine stock management

Africa's vaccine supply chain management is undergoing transformative changes, driven by digital innovations, workforce capacity building, local manufacturing initiatives, and supportive policy frameworks, offering promising solutions to long-standing challenges.

Digital solutions revolutionizing vaccine stock management

Digital tools have emerged as pivotal in enhancing vaccine stock visibility and improving supply chain efficiency across the continent. Electronic Logistics Management Information Systems (eLMIS) have emerged as a cornerstone innovation, improving stock visibility and reducing vaccine stock-outs across several African countries. In Tanzania, the rollout of OenLIMS reduced stock-outs by 70%, with oral polio vaccine (OPV) availability increasing from 87.5% to 97.9% and measles-rubella vaccine stock-outs falling from 9.4% to 1.0% [19]. Similarly, in Gaza Province from 66% to 93% [20]. Stock visibility solutions and mobile-based tools have transformed inventory accuracy. For example, South Africa's Stock Visibility Solutions (SVS), implemented in over 3,200 service points, allows daily monitoring of vaccine stocks via mobile [18]. Innovations such as barcode scanning have improved lot number accuracy to 96.1% and expiration data accuracy to 95.8%, while reducing immunization record errors by one-third compared to manual systems.

In Zambia, eLMIS enabled seamless vaccine transactions, including the tOPV-to-bOPV switch, which reached over six million children with real-time stock tracking [21]. These digital tools have replaced paper-based systems, reduced reporting delays from days to minutes, and enabled proactive stock replenishment. Beyond these successes, artificial intelligence (AI) is emerging as a transformative tool for optimizing logistics and inventory management. Musa et al, (2025), highlight the potential of AI in streamlining supply chains, reducing human error, and improving vaccine availability across Africa. Successful pilot projects in Nigeria, Malawi, Rwanda, and Ghana demonstrate AI's promise in forecasting demand and enabling real-time decision-making. However, challenges such as data privacy concerns, limited technological infrastructure, and uneven stakeholder readiness remain barriers to scaling these solutions [22].

Scaling workforce capacity for sustainable impact

Human resource capacity is critical for effective vaccine stock management. Many health facilities across Africa still rely on undertrained staff to manage complex supply chains, contributing to stock mismanagement and frequent vaccine shortages [3]. To address this gap, initiatives like the Strategic Training Executive Programme (STEP) has trained over 600 supply chain leaders across Africa and Asia, while the STEP 2.0 model introduced in 2021 emphasizes collaborative problem-solving with private sector mentors [23]. “People that Deliver” (PtD) has professionalized over 600 supply chain workers in East Africa, where countries have committed to 12-month roadmaps for strengthening immunization logistics. The University of Rwanda's Centre of Excellence has launched Africa's first Master's in Regulatory Affairs and other programs tailored to vaccines and supply chain management [24]. UNICEF's AGORA platform further complements these efforts with interactive modules on cold chain logistics and strategic vaccine procurement [25].

Expanding local vaccine manufacturing to reduce dependency

Africa's heavy reliance on imports accounting for over 99% of its vaccines has left the region vulnerable to global supply chain disruptions. The COVID-19 pandemic starkly exposed this vulnerability, underscoring the urgency of building local manufacturing capacity. Recent investments are reshaping the vaccine manufacturing landscape. South Africa's Aspen Pharmacare, through partnerships with Johnson & Johnson and Serum Institute of India, has expanded its annual production capacity to 500 million doses. The WHO mRNA Technology Transfer Hub at Afrigen Biologics in Cape Town successfully transferred technology to Biovac Institute, marking a milestone in developing regional mRNA vaccine production capabilities. Senegal's Institute Pasteur de Dakar (IPD) secured $222 million for the MADIBA project, increasing its production capacity from eight million yellow fever doses annually to 300 million doses across multiple vaccine types. Rwanda's modular manufacturing facilities, developed in partnership with BioNTech, offer scalable solutions for rapid deployment of mRNA vaccine production across the continent.

Future prospects

Africa's vaccine stock management systems are at a turning point. Building on digital innovations, local manufacturing, and workforce capacity-building, future progress must focus on scaling these solutions equitably across countries. Strategic investments in sustainable cold chain infrastructure, strengthened data systems, and regional collaboration will be critical to closing gaps and preventing service disruptions. With robust policy support, these efforts can ensure every health facility has the resources to maintain uninterrupted vaccine availability and safeguard immunization coverage for all.

Conclusion

As Africa looks ahead beyond the 50 years of EPI, including producing 60% of its vaccine needs locally by 2040, addressing stock management challenges at the frontline remains critical. Frequent stock-outs and weak cold chain systems at primary health care facilities directly affect vaccination uptake and public trust in immunization programmes. Sustained investments in digital tools, resilient infrastructure, and workforce training, combined with coordinated regional efforts, will be key to ensuring reliable vaccine supply chains. Strengthening these systems at the point of care is not just a technical imperative but a moral one, vital to protecting populations from vaccine-preventable diseases and advancing health equity across the continent.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

The study was conceptualised by Akhona Victress Mazingisa and Chinwe Juliana Iwu-Jaja. Akhona Victress Mazingisa, Chidozie Declan Iwu, Charles Shey Wiysonge and Chinwe Juliana Iwu-Jaja contributed to different sections of the paper. All authors read and approved the final version of the paper. This paper reflects the perspectives of the authors and does not necessarily represent the views of their affiliated institutions.

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