Hepatitis B vaccine coverage of first dose in the WHO African Region had reached 40% by the end of 2023. WHO/UNICEF estimates were updated in July 2026, but the series and year corresponding to each figure must be clarified. Vaccination performance depends notably on the capacities of health systems, security, financing, access, and trust.
The essentials
- Anti-HPV coverage in Africa progressed by 43% in twenty-four months, rising from 28% to 40% between 2022 and 2024 (WHO/UNICEF, July 2026).
- Cape Verde, Mauritius, and Seychelles confirmed elimination of measles and rubella in 2026; the Sahel remains blocked between 8 and 15% for HPV.
- The Catch-Up Initiative reached 5 million zero-dose children through a targeted strategy in fragile health systems.
- Health progress depends on institutional stability that vaccine alone does not create.
- The 2030 horizon remains achievable if fragile states receive structural support, not just doses.
40% coverage, a figure with two faces
Coverage of first dose against human papillomavirus in the WHO African Region had reached 40% by the end of 2023. On a continent of 1.4 billion inhabitants, this represents millions of cervical cancers that will not occur.
Researcher Hannah Ritchie, whose work on environmental and health data (Clearing the Air) advocates for optimism rooted in facts rather than catastrophic intuition, would support this reading. African progress in vaccination is precisely the kind of reality that the data show and that public debate tends to ignore. While structural pessimism about the continent is debated, vaccination rates are climbing.
But Ritchie herself insists on the necessity of reading data in their entirety, not selecting the flattering part. WHO/UNICEF estimates must be read with their series and reference year.
Cape Verde, Mauritius, and Seychelles were verified as having eliminated measles and rubella in November 2025. These successes rest on a set of health and political capacities, not on a single variable.
In certain contexts, vaccination coverage rates remain low and HPV programs are limited. These difficulties are notably linked to access constraints and supply chain problems in conflict-affected areas.
Results and limitations of the Catch-Up Initiative
The Catch-Up Initiative (IGR) is one of the most interesting programs to observe in this regard. It aims notably to reach children called “zero-dose,” generally defined as children not reached by systematic vaccination, measured by the absence of first DTC/DTP dose. These children are found massively in conflict zones, poor urban peripheries, and regions where state services are absent or failing.
The global review published in 2026 reports 12.3 million zero-dose children reached between 2023 and 2025. This is a result that deserves to be taken seriously, not as a slogan, but as a demonstration of method. The IGR rests on proximity strategies, community health workers, mobile campaigns, mapping of blank zones, which partially circumvent the absence of permanent infrastructure.
Partially. That is the operative word. These approaches work for point-in-time vaccination, that which requires one or two doses. According to recommendations and national programs, HPV vaccine can be administered in a single dose; follow-up difficulties concern mainly multi-dose schedules still applied to certain groups or the maintenance of collective immunity against diseases like measles. Point-in-time vaccination by campaign can raise coverage rates in statistics without creating the system that will make it sustainable.
Daron Acemoglu showed, in his work on growth and inclusive institutions, that the benefits of an innovation, technological, medical, or organizational, spread very unevenly depending on the capacity of existing institutions to anchor them over time.
A vaccine delivered once in a Sahel village, without a cold chain, without a permanent health worker, and without a follow-up registry, produces a point-in-time effect. It does not build a system.
The tension between the optimism of aggregated data and the sobriety of disaggregated data lies precisely there. The African average is advancing. However, it masks significant disparities in access and performance between contexts.
The three models that advance coverage
Observing what works is as important as observing what stagnates. Three models emerge from the 2024-2026 data.
The first is the island model of small states with high institutional coherence. Cape Verde, Mauritius, and Seychelles have eliminated measles and rubella; their coverage against these diseases is high. These countries have long invested in their primary health system. They have trained stable personnel, maintained infrastructure, and built lasting trust with their populations. The vaccine is a product among others of a functioning public health policy.
Solid systems constitute a major determinant, among others, of high and sustainable coverage rates.
The second model brings together countries that have mobilized external financing to strengthen their health capacities. Rwanda is the most documented example: DTC3 coverage rate (diphtheria-tetanus-whooping cough, third dose) above 90%, functioning health information system, salaried and trained community health workers. External financing was the lever; national policy was the arm. The distinction is important because it says something about sustainability: strengthened capacity and domestic financing reduce the risk of interruption after external aid withdrawal, without eliminating it automatically. A system heavily dependent on external financing is more vulnerable to interruptions when this financing diminishes or ceases.
The third model is that of targeted emergency interventions, like the IGR. It produces rapid results on the most neglected populations. Targeted emergency interventions first respond to an immediate deficit, but they can also sustainably strengthen systems if integrated into routine services and national capacities. It fills holes. It does not build the wall.
The obstacles that can still be named
Neither conflict nor distrust are abstractions in this matter.
In conflict zones, vaccination access is often severely limited and intermittent; northern Mozambique does not fall within the Sahel. In these fragile contexts, population denominators and coverage are often uncertain, and access can be very reduced without being uniformly absent.
Vaccine distrust, a phenomenon globally documented since 2019 and accelerated in certain regions after the Covid-19 pandemic, plays a more nuanced role than it appears. Trust in public services can influence vaccine acceptance. Vaccine distrust is rarely isolated: it is part of broader distrust toward institutions that have failed at other promises.
Communication campaigns on vaccine safety have limited effect when distrust is institutional. In these contexts, the credibility of those delivering the vaccine is lacking, not pedagogy about the vaccine itself. Rebuilding this credibility takes years and visible results on other fronts—water, education, roads—before the health message is received differently.
Access to preventive care is moreover a challenge that extends beyond vaccination alone: other analyses in the journal on preventive health systems show that the logic of prevention runs into the same obstacles everywhere: financing, trust, institutional continuity.
Vaccine dependence on institutions as a condition for the 2030 objective
This is the most honest forward-looking question one can pose on this matter, and it remains open.
A first scenario argues that health progress creates its own conditions for deepening. Higher coverage rates produce visible results: fewer child deaths, fewer cervical cancers, fewer epidemics. These results reinforce the legitimacy of health systems, which nourishes trust, which facilitates subsequent campaigns. In this virtuous logic, the vaccine is itself an institution builder. This dynamic can strengthen both health systems and trust in public services.
A self-reinforcing cycle.
This scenario is plausible. It is supported by several studies on the relationship between access to care and institutional trust. But it assumes an initial condition: that vaccination services can be delivered visibly and regularly long enough. Underfunding, conflict, and staffing constraints greatly hinder service continuity, but partial progress can also occur through communities, partners, and adapted services.
A second scenario is that institutional stability fosters health progress. In this reading, administrative constraints and conflicts can compromise the achievement of 2030 objectives in fragile states. Financing vaccine purchases without financing the reconstruction of primary health systems, centers, personnel, supply chains, and registries, amounts to filling a leaking tank.
These two readings are not mutually exclusive. They point toward the same operational conclusion: international financing that produces lasting effects is that which invests in institutional capacity, not only in doses. Gavi took note of this lesson in its 2025 annual report, dedicating part of its commitments to strengthening health systems, notably in training, cold chain, and information systems. This is a change in doctrine whose effects will take a decade to measure.
Functioning or consolidating primary health care increases the chances of progress toward universal coverage, but does not guarantee achieving 2030 objectives. It is compromised in zones of active conflict, and uncertain in fragile states that are neither in open war nor capable of deploying coherent policy. African countries have progressed on basic vaccination coverage over the past decade. The bad news is that the zones concentrating zero-dose children are precisely those where the classic tools of health policy—planning, training, logistics—function least well.
The operational question for the next decade is therefore not whether Africa can achieve high coverage rates. It has demonstrated this in several very different contexts. It is what forms of external support, financial, technical, diplomatic, can accelerate institutional building in fragile zones without substituting for it. Substitution produces short-term results and long-term dependencies. This is an issue that development economists have extensively documented, without yet finding a universal answer.
The 2026 data allows this question to be posed with precision: progress is measured, disparities are mapped, mechanisms are better understood. A relevant IA2030 indicator is DTP3, MCV1, and MCV2 coverage in the 20% of districts with the lowest coverage, complementing national and global averages.
If this subgroup begins to progress, the institutionalist hypothesis receives solid empirical validation. If it stagnates while the continental average rises, the inverse diagnosis imposes itself: two African health trajectories, one converging toward global objectives, the other diverging from them.
Sources
- WHO/UNICEF, Global Childhood Immunization Coverage Inches Forward Despite Conflict and Hesitancy, July 2026, https://www.who.int/fr/news/item/15-07-2026-global-childhood-immunization-coverage-inches-forward-despite-conflict-and-hesitancy—unicef–who
- Hannah Ritchie, Clearing the Air, 2024, https://hannahritchie.com/
- Gavi, Annual Report 2025 (Gavi, the Vaccine Alliance), no direct link (available on gavi.org)
- Afrobarometer, Data on Institutional Trust and Education, 2026, no direct link (available on afrobarometer.org)
- Daron Acemoglu & Simon Johnson, Power and Progress, 2023 (PublicAffairs), intellectual corpus reference
