A comprehensive analysis published in PLOS Medicine report assessed childhood immunization trends in 38 African countries using nearly one million records from Demographic and Health Surveys conducted between 2000 and 2019.
Despite overall improvements in vaccine coverage, the study warns that 12 countries remain at serious risk of failing to meet 2030 immunization goals if current trajectories continue.
These goals include achieving 80% full immunization under the Universal Health Coverage (UHC) framework and 90% under the Immunization Agenda 2030 (IA2030). Among the 38 countries studied, only 26 are expected to reach the UHC target and just 19 are projected to meet the IA2030 standard.
Several of the countries unlikely to meet full immunization targets include South Africa, Egypt, and Congo (Brazzaville)—nations with relatively higher socioeconomic development, indicating that resources alone don’t guarantee success.
Other nations expected to fall short across all sub-national regions are Comoros, Angola, and Guinea, suggesting deep and widespread gaps rather than uneven performance masked by national averages.
Conversely, countrywide consistency in coverage is projected for several nations. Kenya, Rwanda, Malawi, Eswatini, Morocco, Burkina Faso, and Niger are on track to meet UHC targets in every part of the country. Moreover, Malawi and Burkina Faso are expected to hit the IA2030 targets across all regions.
The study spotlights stark equity gaps—children from wealthier families are up to 58% more likely to be fully immunized than those from poorer households ([The EastAfrican][2]). Although most countries are expected to see narrowing disparities by 2030, exceptions include Nigeria and Angola, where inequalities may persist or even worsen.
Regionally, Central and Western Africa continue to lag significantly behind, with lower overall immunization rates and pronounced internal disparities.
Even with global and regional gains, several challenges remain stubbornly persistent. Weak primary healthcare systems, limited accessibility, frequent vaccine stockouts, logistical hurdles such as cold chain capacity, funding shortfalls, and logistical waste management issues undermine efforts to expand immunization coverage .
Moreover, many African countries are gradually being phased out of Gavi (the Vaccine Alliance) funding as they move into middle-income status—compounding concerns that domestic investment may fall short exactly where continued support is most needed.
To avoid leaving millions of children unprotected, the study urges governments and health partners to adopt more equitable and targeted strategies. These include strengthening health systems, improving surveillance and accountability, overcoming socioeconomic disparities, and ensuring vaccines reach underserved rural and impoverished communities—especially in the 12 countries lagging behind.
