Progress with Immunization Coverage and the Control, Elimination, and Eradication of Vaccine-Preventable Diseases in the WHO African Region Since the End of the COVID-19 Public Health Emergency of International Concern

The end of the COVID-19 pandemic in May 2023 marked a pivotal transition from emergency response to recovery and rebuilding of health systems across the world. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. This review critically synthesizes post-pandemic immunization and vaccine-preventable disease (VPD) trends using publicly available data. Regional coverage for most vaccine doses returned to 2019 pre-pandemic levels by 2024. However, 6.7 million zero-dose children remain concentrated in a small number of countries. Accelerated recovery efforts – including the Big Catch-Up initiative, policy normalization of catch-up vaccination, and strengthened social and behaviour change strategies – have mitigated further backsliding. Concurrently, accelerated disease control initiatives - targeting measles, yellow fever, tetanus, meningitis, and poliomyelitis - have highlighted both renewed momentum toward elimination and eradication, and persistent vulnerabilities driven by immunity gaps, climate shocks, urbanization, and conflict. The strongest marker of regained momentum has been accelerated introductions of vaccines against malaria (in 20 new countries), human papillomavirus (in 10 new countries), and other VPDs across the region. However, sustained progress will require institutionalizing catch-up vaccination, systematically using implementation research to strengthen subnational tailoring, enhancing integrated surveillance systems, and securing predictable domestic financing within the framework of the Immunization Agenda 2030.