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Just this morning I had reason to think about the whole issue of peer review in our local academic journals. South Africa is in the enviable position on the continent of having a large body of highly regarded and internationally recognised academic institutions. As editor of the South African Medical Journal (SAMJ) I have a long tradition of excellence to uphold – sometimes a daunting task. Over the years the SAMJ has evolved and is now a wellrespected repository of research and policy papers that are read and cited around the world. During the COVID-19 outbreak in the country, the SAMJ has attracted a large number of submissions from our body of clinicians and researchers, all of whom are happy to submit to a local journal, where I have expedited review and online publication in the interests of keeping people abreast of all the various issues around the current pandemic.

Historically overshadowed by communicable diseases, the burden of non-communicable diseases (NCDs) has surged over the past two decades, posing a significant threat to public health, and necessitating urgent attention. This study examines the mortality burden from four major groups/categories of NCDs including cancers, cardiovascular diseases (CVD), chronic respiratory diseases (CRD) and diabetes, prevalence of four NCD associated risk factors including tobacco use, alcohol consumption, physical inactivity and overweight, availability of NCD essential medicines and progress indicators of the NCD response in the WHO African region. The data used in this study were obtained from the WHO NCD data portal, Global Health Observatory, and Global Health Estimates, covering the most recent available data for each indicator, ranging from 2000 to 2019 to assess how trends in NCD mortality burden have evolved, as well as the current status of the four main risk factors, availability of essential medicines, and key NCD response indicators. The analysis focused on descriptive statistics for globally used, disease-specific key indicators to examine trends and variations across countries: (i) age-standardized mortality rates (ASMR) for major NCDs (cancers, CRD, CVD and diabetes), (ii) prevalence of NCD risk factors (tobacco use, alcohol consumption, physical inactivity, and overweight), (iii) availability of essential medicines for NCDs in public health facilities, and (iv) national NCD response indicators, such as the presence of NCD targets, mortality data, risk factor reduction measures, and surveillance. Mortality was reported as ASMR or percentages; risk factors as prevalence, except alcohol (litres per capita). Changes in mortality were calculated as absolute and relative differences, with tables and figures generated in Microsoft Excel. Between 2000–2019, NCD-related deaths and the percentage of deaths due to NCDs increased from 24.2 to 37.1% resulting in 12.9 and 53.3% absolute and relative increases. The ASMR decreased by 130.6 per 100,000 population resulting in an 18.2% relative decrease, during the same period; however, it remains consistently higher than the global average. In 2019, 64% of NCD deaths were among people 70 years or younger and the percentage of premature deaths from NCDs ranged from 36.5 to 72.1%. Despite the burden of NCDs, the availability of essential medicines and health services was sub-optimal in public health facilities. The prevalence of key risk factors such as tobacco use, physical inactivity, overweight, and alcohol consumption per capita varied by sex and across the region, with the prevalence of tobacco use and consumption of alcohol higher among men, while the prevalence of insufficient physical activity and overweight higher among women. Public health responses to NCDs remained sub-optimal due to limited national NCD targets, inadequate surveillance, risk factor reduction measures, and access to essential medicines. Though the NCD ASMR has decreased, there has been an increase in NCD-related deaths and the percentage of deaths due to NCDs over the last two decades in the WHO African Region. The mortality burden of NCDs and the prevalence of risk factors remains relatively high, while mounting a public health response for preventing and controlling these NCDs remains challenging. Accelerated action is essential to meet global and regional NCD reduction targets. Strengthening national NCD targets, improving surveillance, ensuring access to essential medicines, and scaling up risk factor reduction strategies are critical to reversing current trends and achieving the 2030 SDG NCD targets.

Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017-2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria–tetanus–pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.

This study summarizes progress made in rolling out COVID-19 vaccinations in the African region in 2022, and analyzes factors associated with vaccination coverage. Data on vaccine uptake reported to the World Health Organization (WHO) Regional Office for Africa by Member States between January 2021 and December 2022, as well as publicly available health and socio-economic data, were used. A negative binomial regression was performed to analyze factors associated with vaccination coverage in 2022. As of the end of 2022, 308.1 million people had completed the primary vaccination series, representing 26.4% of the region’s population, compared to 6.3% at the end of 2021. The percentage of health workers with complete primary series was 40.9%. Having carried out at least one high volume mass vaccination campaign in 2022 was associated with high vaccination coverage (β = 0.91, p < 0.0001), while higher WHO funding spent per person vaccinated in 2022 was correlated with lower vaccination coverage (β = −0.26, p < 0.03). All countries should expand efforts to integrate COVID-19 vaccinations into routine immunization and primary health care, and increase investment in vaccine demand generation during the transition period that follows the acute phase of the pandemic.

Background/Objectives: The Addis Declaration on Immunization (ADI) is a historic pledge aiming at increasing political will to achieve universal access to immunization services and includes ten commitments to shape the future of immunization in Africa. Methods: To analyze African countries’ performance in achieving the fourth ADI commitment, a cross-sectional retrospective study was conducted including the 54 African Member States of the World Health Organization (WHO) out of 55 African Union (AU) Member States. The fourth ADI commitment aims at increasing the effectiveness and efficiency of immunization delivery systems and has four performance indicators. Results: The median percentage of districts with less than 10% of dropout rate between the first dose of diphtheria–tetanus–pertussis-containing vaccine (DTP1) and the third dose (DTP3) was 86.5%, ranging from 22% to 100%. Thirty-four countries (63%) recorded 80% or above of districts with less than 10% dropout rate between DTP1 and DTP3. Eleven countries (20.3%) and ten countries (18.5%) sustained 90% or above coverage for DTP3 and first dose of measles-containing vaccine (MCV1), respectively, in the past three years (2021–2023). Four countries (7.4%) had 44.5 skilled health workers per 10,000 people. Out of the 54 WHO Member States, 7 achieved at least three of the four indicators of the fourth ADI commitment (13%). Conclusions: It is critical, as a follow up to this study, to document best practices from the seven countries that achieved the fourth ADI commitment. Additionally, a deeper analysis of factors associated with achieving the ADI commitments is required.

Cameroon introduced the malaria vaccine in its routine immunization program on 22 January 2024 in the 42 districts out of 200 that are among the most at risk of malaria. A cross-sectional analysis of the data on key vaccine events in the introduction roadmap and the vaccine uptake during the first 30 days was conducted. In addition to available gray literature related to the introduction of the malaria vaccine, data on the malaria vaccine uptake by vaccination session, collected through a digital platform, were analyzed. A total of 1893 reports were received from 22 January 2024 to 21 February 2024 from 766 health facilities (84% of overall completeness). Two regions out of ten recorded less than 80% completeness. As of 21 February 2024, 13,811 children had received the first dose of the malaria vaccine, including 7124 girls (51.6%) and 6687 boys (48.4%). In total, 36% of the children were vaccinated through outreach sessions, while 61.5% were vaccinated through sessions in fixed posts. The overall monthly immunization coverage with the first dose was 37%. Early results have shown positive attitudes towards and acceptance of malaria vaccines. Suboptimal completeness of data reporting and a low coverage highlight persistent gaps and challenges in the vaccine rollout.

Three months after the first shipment of RTS,S1/AS01 vaccines, Cameroon started, on 22 January 2024, to roll out malaria vaccines in 42 districts among the most at risk for malaria. Cameroon adopted and implemented the World Health Organization (WHO) malaria vaccine readiness assessment tool to monitor the implementation of preintroduction activities at the district and national levels. One week before the start of the vaccine rollout, overall readiness was estimated at 89% at a national level with two out of the five components of readiness assessment surpassing 95% of performance (vaccine, cold chain and logistics and training) and three components between 80% and 95% (planning, monitoring and supervision, and advocacy, social mobilisation and communication). ‘Vaccine, cold chain and logistics’ was the component with the highest number of districts recording below 80% readiness. The South-West and North-West, two regions with a high level of insecurity, were the regions with the highest number of districts that recorded a readiness performance below 80% in the five components. To monitor progress in vaccine rollout daily, Cameroon piloted a system for capturing immunisation data by vaccination session coupled with an interactive dashboard using the R Shiny platform. In addition to displaying data on vaccine uptake, this dashboard allows the generation of the monthly immunisation report for all antigens, ensuring linkage to the regular immunisation data system based on the end-of-month reporting through District Health Information Software 2. Such a hybrid system complies with the malaria vaccine rollout principle of full integration into routine immunisation coupled with strengthened management of operations.

Background: Since 1974, Essential Programme on Immunisation managers from ten Central African countries meet yearly with partners to review progress made and share experiences and lessons learned from the implementation of immunization programmes. The 2024 meeting occurred in Kinshasa, Democratic Republic of Congo, in September 2024. This conference report summarizes the key takeaways from discussions on using immunization data for decision-making, the implementation of the Big Catch-Up (BCU) initiative to reduce the burden of zero-dose children, and progress and challenges in introducing selected new vaccines. Conference Takeaways: Inaccurate administrative data on routine immunization observed in most countries, compared to WHO/UNICEF Estimates of National Immunization Coverage and national survey estimates, affect timely decisions to improve the Expanded Programme on Immunization (EPI) performance. Five countries in Central Africa are among the priority countries of the BCU initiative but, as of the end of August 2024, are yet to formally start its implementation. Cameroon and Central African Republic introduced the malaria vaccine in January 2024 and August 2024, respectively, while the Democratic Republic of Congo, Chad, and Burundi have planned to do so by 2025. Conclusions and Recommendations: Meeting participants put forward several recommendations for countries and immunization partners, including but not limited to (i) investing more in routine immunization data quality assurance to better use data to inform decisions, (ii) accelerating the implementation of the BCU initiative to close the immunity gap resulting from routine immunization disruptions due to the COVID-19 pandemic, (iii) updating malaria vaccine introduction plans to invest more in demand generation and community engagement, and (iv) learning from Cameroon’s experience in tackling hesitancy to human papilloma virus vaccine. It is critical to set up an appropriate mechanism for monitoring the implementation of these recommendations.

This manuscript describes the process and impact of strengthening the WHO Regional Office for Africa (WHO AFRO)’s COVID-19 vaccination information system. This system plays a critical role in tracking vaccination coverage, guiding resource allocation and supporting vaccination campaign roll-out for countries in the African region. Recognising existing data management issues, including complex reporting prone to human error, compromised data quality and underutilisation of collected data, WHO AFRO introduced significant system improvements during the COVID-19 pandemic. These improvements include shifting from an Excel-based to an online Azure-based data collection system, automating data processing and validation, and expansion of collected data. These changes have led to improvements in data quality and quantity including a decrease in data non-validity, missingness, and record duplication, and expansion of data collection forms to include a greater number of data fields, offering a more comprehensive understanding of vaccination efforts. Finally, the creation of accessible information products—including an interactive public dashboard, a weekly data pack and a public monthly bulletin—has improved data use and reach to relevant partners. These resources provide crucial insights into the region’s vaccination progress at national and subnational levels, thereby enabling data-driven decision-making to improve programme performance. Overall, the strengthening of the WHO AFRO COVID-19 vaccination information system can serve as a model for similar efforts in other WHO regions and contexts. The impact of system strengthening on data quality demonstrated here underscores the vital role of robust data collection, capacity building and management systems in achieving high-quality data on vaccine distribution and coverage. Continued investment in information systems is essential for effective and equitable public health efforts.