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Creating sustainable value through people-centred vaccination systemsCreating sustainable value through people-centred vaccination systems
Spotlight on rebuilding trust through policy, partnerships and people in West African public health
4 Min Read
Canva
It is often said that futures are not stumbled upon, they are created as a result of our actions or inactions. Taking conscious effort to shape the immunisation system in Africa will involve a blend of public trust, policy design and accountability. Immunisation has proven to be one of the most effective public health interventions globally, protecting populations from vaccine preventable diseases (VPD), reducing health security risk.
Getting the system to work in West Africa goes beyond cold chains and storage facilities, vaccines will not yield their desired public health impact if they remain in ice-lined refrigerators in central stores or health facilities.
There is no shortage of national recommended vaccines in the health systems, billions have been invested in both the vaccines and the logistics, but we can still observe an unequal distribution of vaccine coverage. In 2022, the coverage of the three doses of vaccine containing diphtheria, tetanus and pertussis (DTP3) was 72 per cent in the WHO Africa region, as compared to the 84 per cent global rate. It is interesting to note that coverage differs between countries, and also between regions of countries. There is an urgent need to move past surface level fixes, and address the deeper issues that makes our health system fragile.
Policies define the vision of a future, making it easier to identify targets and reference points for evaluation. They help to map out targets and show the expected roles of various groups, they also help build consensus and inform people. Health policies refer to decisions, plans and actions that are undertaken to achieve specific health care goals within a society. They are not just technical frameworks; they are the foundation on which trust in public health are either built or broken. They reflect political will and often determine whether health services reach the people who need them the most, or if they even trust the system enough to use them.
Despite the significant investment in vaccines, there are still gaps in access.
This is often due to weak policy design or poor implementation. In 2013, the WHO regional office carried out a survey among its member states and found that only 19 out of 46 had a written policy or technical guidance for their immunisation programmes. Of those, most failed to address all critical areas of immunisation, and very few were backed by legal frameworks.
In many instances, immunisation policies are developed at national level with very little input from subnational actors or frontline health workers. This top-down approach creates a disconnect between policy intent and operational reality. Communities in remote or underserved regions get lost in the process and are left with situations that do not resonate with their realities. This further reduces trust in public health infrastructure.
The World Health Assembly (WHA) produced the framework, Immunization Agenda 2030 (IA2030), with several targets for immunisation systems in the world to achieve by 2030. IA2030 calls for immunisation to be owned by countries, have people-centred designs, and integrated into the broader primary healthcare systems. It points the importance of strong governance, inclusive policy processes, and accountability.
To build trust, we need to align national policies with IA2030. It will require cocreating policies with the people it is meant to serve, strengthen mechanisms for implementation oversight, and ensure that coverage targets translate into community-level impact. In fragile systems, trust is not a given — it must be designed, resourced, and protected through policies that are both responsive and resilient.
Partnership is an important aspect of building resilient public health systems.
No single actor, whether government, donor, private sector, or civil society, can address the complexity of immunisation challenges alone. However, in many settings partnerships are fragmented or superficial. Programmes are shaped by donor priorities with limited engagement from local institutions, communities, or service providers.
Coordination platforms may exist, but they lack the authority or cohesion needed to harmonise resources and drive joint accountability. This disjointed approach weakens the programme outcomes and public confidence. Political and technical responses cannot operate in isolation, a sustainable, system-wide response demands comprehensive and planned inclusion through stakeholder dialogues, where political leaders, technical experts, providers, and community representatives develop a shared understanding of issues, evidence, and actions. These dialogues require intentional groundwork, strong leadership, and a spirit of openness. It should be documented and evaluated to ensure follow-through.
Strengthening immunisation systems in West Africa must reflect this spirit of structured and inclusive partnership.
It is not enough to collaborate during implementation, participation must begin at the policy and planning stages. When people see themselves represented in the processes, through dialogue, co-creation, and mutual accountability, they are more likely to trust, support, and sustain those systems.
The future of immunisation in West Africa will depend on how well we build systems that people can trust and actually use. It’s not just about cold chains or vaccines, it’s about getting the basics right: strong policies, meaningful partnerships, and putting people at the centre of it all.
References available on request.
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