Launch of the Consensus Study Report on: The Root Causes of Low Vaccination Coverage and Under-Immunisation in Sub-Saharan Africa

Academy of Science of South Africa (ASSAf) ; Uganda National Academy of Sciences (UNAS) (2021)

MP4 Video; Size: 424MB; Duration: 1:30

Please cite as: Academy of Science of South Africa (ASSAf), (2021). Launch of the Consensus Study Report on: The Root Causes of Low Vaccination Coverage and Under-Immunisation in Sub-Saharan Africa. [Online] Available at:

Despite the global availability of proven efficacious and cost-effective vaccines for the past several decades, vaccine-preventable diseases kill more than half a million children under five years of age every year In Africa –representing approximately 56% of global deaths (WHO, 2017). Sub–Saharan Africa (SSA) alone accounts for 40% of all global deaths, a phenomenon attributed to lack of access to available lifesaving vaccines (Wiysonge, Uthman, Ndumbe, & Hussey, 2012). WHO estimates that in 2019 the African region accounted for approximately 43% of unimmunised and incomplete immunised infants in the world (i.e.: 8.5 million of the global 19.4 million). Relatedly, the region scores the lowest immunisation coverage, at 76% versus the global coverage of 86% (WHO, 2020a). This is despite several documented efforts by different stakeholders to improve coverage in the region (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017). Many studies have been conducted on coverage and drivers for and bottlenecks against immunisation in SSA. (Wiysonge, Uthman, Ndumbe, & Hussey, 2012), (Wiysonge, Young, Kredo, McCaul, & Volmik, 2015), (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017), (Madhi & Rees, 2018) (Bangura, et al., 2020), all of which have observed that there is varied performance among the constituent countries, and also within countries over time, denoting some implicitly common underlying correlates threading through areas of higher performance; and the same is seen with the poorer performing areas. This consensus study therefore seeks to categorise and make explicit these “root causes” and based on documented successes, to make recommendations to address the bottlenecks and harness the opportunities for reaching every child with all the recommended vaccines. The theory of change presentation style used in this report, categorising the root causes under four broad interlinked themes, can provide a common basis to rally like-minded partners around a thematic cause and thus develop multicomponent, comprehensive strategies to bring about impactful change. This is in line with the call made by the World Health Organisation Strategic Advisory Group of Experts on Immunisation, which recommended that countries, regions and global immunisation partners commit to a comprehensive review of progress, impact, and implementation of the WHO Global Vaccine Action Plan to inform a post2020 strategy taking into account lessons learned. This strategy will assist with attaining the relevant United Nations Sustainable Development Goals by 2030.

Author and contributor ORCIDs: Madhi, Shabir ORCID; Soodyall, Himla ORCID; Mayanja-Kizza, Harriet ORCID; Wiysonge, Charles ORCID; Mugisha, Emmanuel ORCID
Publisher: Academy of Science of South Africa (ASSAf)
Sponsorship: Department of Science and Innovation (DSI)(South Africa); South African Medical Research Council (SAMRC)(South Africa)
Peer review status: Non-Peer Reviewed