A decade of rotavirus vaccination in the World Health Organization, African region: An in-depth analysis of vaccine coverage from 2012 to 2023

Significant progress has been achieved in the introduction of rotavirus vaccines in the World Health Organization, African Region (WHO/AFR), with only 19 % (9/47) of the countries yet to introduce the vaccines. Despite this achievement, a considerable number of eligible children in Africa still lack access to these lifesaving rotavirus vaccines. We performed in-depth data exploration and analysis on the WHO/UNICEF rotavirus vaccine uptake estimates of vaccine coverage to document progress and estimated the number of children missing vaccination through under- or un-vaccination between 2012 and 2023. Thirty-eight countries have introduced the vaccine in the national immunization programs and the vaccine coverage rates have increased from 5 % to 61 % between 2012 and 2023 in the WHO/AFR, compared to 11 % to 55 % at the global level. Coverage by sub-regions ranged from 48 % in Central African countries to 73 % in the Southeast sub-region in 2023. Vaccine coverage has been increasing every year, yet some countries reported a significant drop during the COVID-19 pandemic (2020−2022) compared to the pre-pandemic (2019_or earlier) period. For instance, in Senegal, coverage declined from 94 % to 70 %; Namibia, 90 % to 55 %; Republic of Congo, 71 % to 23 %; for 2019 and 2022, respectively. Four countries experienced a significant decline between 2021 and 2022: Botswana (85 % to 65 %), Kenya (95 % to 23 %), Zambia (87 % to 32 %), and Zimbabwe (86 % to 55 %); but coverage increased in 2023 (post-pandemic) in Kenya (71 %), Senegal (83 %), and Zambia (40 %). The estimates of vaccinated children increased steadily over the years, reaching 23.5 million in 2023. However, 257.8 million children missed vaccination between 2012 and 2023, of which 18.5 million in 2022. Although countries in the WHO/AFR have made significant progress in introducing rotavirus vaccines, reaching every eligible child remains a challenge; and more than half of children are missing the full benefit of protection against rotavirus diarrhoea. There is a need for accelerated actions and concerted efforts to reach missed children and support for the nine remaining countries to introduce the vaccine.